Clinical Trial of a Home Safety Toolkit for Alzheimer’s Disease

Abstract

This randomized clinical trial tested a new self-directed educational intervention to improve caregiver competence to create a safer home environment for persons with dementia living in the community. The sample included 108 patient/caregiver dyads: the intervention group (n = 60) received the Home Safety Toolkit (HST), including a new booklet based on health literacy principles, and sample safety items to enhance self-efficacy to make home safety modifications. The control group (n = 48) received customary care. Participants completed measures at baseline and at twelve-week follow-up. Multivariate Analysis of Covariance (MANCOVA) was used to test for significant group differences. All caregiver outcome variables improved in the intervention group more than in the control. Home safety was significant at P ≤ 0.001, caregiver strain at P ≤ 0.001, and caregiver self-efficacy at P = 0.002. Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group (P ≤ 0.001). The self-directed use of this Home Safety Toolkit activated the primary family caregiver to make the home safer for the person with dementia of Alzheimer's type (DAT) or related disorder. Improving the competence of informal caregivers is especially important for patients with DAT in light of all stakeholders reliance on their unpaid care.

Effectiveness of interventions for co‐residing family caregivers of people with dementia: Systematic review and meta‐analysis

“…The most common categories that components fell under include: education and skills training (Au et al ., ; Beauchamp et al ., ; Belle et al ., ; Czaja et al ., ; Elliott et al ., ; Gitlin et al ., , ; Gonyea, O'Connor & Boyle, ; Hepburn et al ., ; Kurz, Wagenpfeil, Hallauer, Schneider‐Schelte & Jansen, ; Marriott, Donaldson, Tarrier & Burns, ; Steffen, ; Waldorff et al ., ), counselling (Connell & Janevic, ; Drentea et al ., ; Mittelman et al ., , , , ; Roth et al ., ; Waldorff et al ., ) and support groups (Belle et al .; Czaja et al .; Drentea et al ., ; Elliott et al .; Mittelman et al .; Roth et al ., ). Other less common components fell under the following categories: stress management (Belle et al .; Elliott et al .; Marriott et al .; Steffen), exercise and health promotion (Belle et al .; Connell & Janevic; Elliott et al .), computerised telephone support system linking caregivers to therapy sessions and community resources (Belle et al .; Eisdorfer et al ., ; Elliott et al .), role play (Belle et al .; Elliott et al .), and environmental modification (Gitlin et al .; Horvath et al ., ).…”

“…Four studies had significant positive effects on family caregiver health (Elliott et al ., ; Gitlin et al ., ; Horvath et al ., ; Mittelman et al ., ) and one study had non‐significant results (Waldorff et al ., ). The final study had significant effects at 4 months but not at nine months post‐intervention (Gitlin et al ., ).…”

“…There were variations in the control interventions provided in the 22 studies (Appendix 3). They included usual care (Beauchamp et al ., ; Drentea et al ., ; Gitlin et al ., ; Mittelman et al ., , , , ; Roth et al ., ), psychoeducation (Au et al ., ; Gonyea et al ., ), counselling (Kurz et al ., ), support services (Belle et al ., ; Elliott et al ., ; Gitlin et al ., ; Waldorff et al ., ), home safety (Horvath et al ., ), wait‐list controls (Hepburn et al ., ; Steffen, ) and no intervention (Connell & Janevic, ). Two studies incorporated two control groups.…”

Aging in Place vs. Relocation for Older Adults with Neurocognitive Disorder: Applications of Wiseman’s Behavioral Model

“…Though receiving less attention than the role of caregivers, a burgeoning literature also recognizes the influence of the physical environment on safety and health outcomes for those with a neurocognitive disorder, including the impact of wandering behaviors, cooking hazards, medication mismanagement, access to firearms, and improper space design (Horvath et al, 2013; Horvath, Harvey, & Trudeau, 2007; Lach, Reed, Smith, & Carr, 1995; Van Hoof, Blom, Post, & Bastein, 2013). Numerous complications threaten the safety and appropriateness of remaining in the home as symptoms worsen and stresses mount.…”

“…For example, both social scientists (e.g., Lawton, 2001) and architecture and planning experts (e.g., Calkins, 1988) have written about designing residential environments for persons with dementia, frequently focusing on an institutional setting. Home environments have also received attention; for example, the typical home is rife with environmental hazards, such as loose stair rails and bathrooms lacking grab bars, which should be proactively addressed to avoid accident and injury (Rowe, & Fehrenbach, 2004; Horvath et al, 2013). Many people with a neurocognitive disorder and their family caregivers, however, lack awareness of these risks, the strategies to mitigate the risks, and the resources available to learn about these issues.…”