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A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial
Journal article   Open access   Peer reviewed

A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial

Laura N Gitlin, Laraine Winter, Marie P Dennis, Nancy Hodgson and Walter W Hauck
JAMA : the journal of the American Medical Association, v 304(9), pp 983-991
01 Sep 2010
DOI: https://doi.org/10.1001/jama.2010.1253
PMID: 20810376
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc4091681View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Activities of Daily Living Aged Aged, 80 and over Behavior Therapy Caregivers Dementia - complications Dementia - nursing Dementia - physiopathology Dementia - therapy Female Health Status Home Care Services Humans Interpersonal Relations Male Middle Aged Prospective Studies Quality of Life Treatment Outcome
Optimal treatment to postpone functional decline in patients with dementia is not established. To test a nonpharmacologic intervention realigning environmental demands with patient capabilities. Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania. Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits; obtained blood and urine samples; and trained families in home safety, simplifying tasks, and stress reduction. Control group caregivers received 3 telephone calls and educational materials. Functional dependence, quality of life, frequency of agitated behaviors, and engagement for patients and well-being, confidence using activities, and perceived benefits for caregivers at 4 months. Of 284 dyads screened, 270 (95%) were eligible and 237 (88%) randomized. Data were collected from 209 dyads (88%) at 4 months and 173 (73%) at 9 months. At 4 months, compared with controls, COPE patients had less functional dependence (adjusted mean difference, 0.24; 95% CI, 0.03-0.44; P = .02; Cohen d = 0.21) and less dependence in instrumental activities of daily living (adjusted mean difference, 0.32; 95% CI, 0.09-0.55; P = .007; Cohen d = 0.43), measured by a 15-item scale modeled after the Functional Independence Measure; COPE patients also had improved engagement (adjusted mean difference, 0.12; 95% CI, 0.07-0.22; P = .03; Cohen d = 0.26), measured by a 5-item scale. COPE caregivers improved in their well-being (adjusted mean difference in Perceived Change Index, 0.22; 95% CI, 0.08-0.36; P = .002; Cohen d = 0.30) and confidence using activities (adjusted mean difference, 0.81; 95% CI, 0.30-1.32; P = .002; Cohen d = 0.54), measured by a 5-item scale. By 4 months, 64 COPE dyads (62.7%) vs 48 control group dyads (44.9%) eliminated 1 or more caregiver-identified problems (chi(2/1) = 6.72, P = . 01). Among community-living dyads, a nonpharmacologic biobehavioral environmental intervention compared with control resulted in better outcomes for COPE dyads at 4 months. Although no group differences were observed at 9 months for patients, COPE caregivers perceived greater benefits. clinicaltrials.gov Identifier: NCT00259454.

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Web of Science research areas
Gerontology
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