Howard S. Kirshner, MD
Does a biobehavioral, multicomponent intervention improve functioning and well-being in patients with dementia and well-being in their caregivers?
Randomized controlled trial (Care of Persons with Dementia in their Environments, COPE). ClinicalTrials.gov NCT00259454.
Unclear allocation concealment.*
4 and 9 months.
Community setting in Pennsylvania, USA.
237 patient–caregiver dyads. Patients were ≥ 21 years of age (mean age 82 y, 68% women for 209 analyzed), had a physician diagnosis of probable dementia or a Mini-Mental State Examination (MMSE) score < 24 and behavioral symptoms or need for help with daily activities, and lived with, or ≤ 5 miles from, their family caregiver. Caregivers (mean age 62 y, 89% women) reported difficulty in managing patients, provided ≥ 8 hours/week of care or oversight, and were not planning a nursing home placement for the patient. Exclusion criteria included life expectancy < 9 months, current cancer treatment, > 3 acute hospitalizations in the past year, and for patients, schizophrenia or bipolar disorder, dementia secondary to head trauma, or being bed-bound with an MMSE score of 0.
COPE intervention, which included patient assessment and caregiver education and training tailored to caregiver concerns and patient capabilities, given in ≤ 12 home or telephone sessions over 4 months by occupational therapists and advanced practice nurses (n = 117), or three 20-minute telephone calls and educational materials from trained research staff (control group, n = 120).
Included functional dependence (15-item scale), quality of life (Quality Of Life—Alzheimer Disease scale), activity engagement (5-item scale), agitation (Agitated Behavior In Dementia [ABID] scale), and caregiver well-being (Perceived Change Index). Higher scores = better outcomes for all measures except the ABID scale.
88% at 4 months (intention-to-treat analysis).
The main results are in the Table. Results at 9 months are not reported here because follow-up was < 80%
A biobehavioral intervention improved some measures of functioning in patients with dementia and improved well-being in their caregivers.
COPE program vs control intervention in patients with dementia and their caregivers†
†COPE = Care of Persons with Dementia in their Environments; other abbreviations defined in Glossary.
‡Higher scores = better outcomes for all scales, except the Agitated Behavior In Dementia scale.
§Adjusted for dyad living arrangement (alone or together) and baseline value of outcome.
Kirshner HS. A biobehavioral intervention improved caregiver well-being and some measures of functioning in patients with dementia. Ann Intern Med. ;153:JC6–4. doi: 10.7326/0003-4819-153-12-201012210-02004
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Published: Ann Intern Med. 2010;153(12):JC6-4.
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