Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2013 Sep 23:13:96.
doi: 10.1186/1471-2318-13-96.

A non-pharmacologic approach to address challenging behaviors of Veterans with dementia: description of the tailored activity program-VA randomized trial

Laura N Gitlin  1 , William C Mann, W Bruce Vogel, Paul B Arthur
Affiliations
Clinical Trial

A non-pharmacologic approach to address challenging behaviors of Veterans with dementia: description of the tailored activity program-VA randomized trial

Laura N Gitlin et al. BMC Geriatr. .

Abstract

Background: Behavioral symptoms accompanying dementia are associated with increased health care costs, reduced quality of life and daily functioning, heightened family caregiver burden, and nursing home placement. Standard care typically involves pharmacologic agents, but these are, at best, modestly effective, carry serious risks, including mortality, and do not address behavioral symptoms families consider most distressful and which may prompt nursing home placement. Given dementia's devastating effects and the absence of an imminent cure, the Veterans Administration has supported the development and testing of new approaches to manage challenging behaviors at home.

Methods/design: The Tailored Activity Program - Veterans Administration is a Phase III efficacy trial designed to reduce behavioral symptoms in Veterans with dementia living with their caregivers in the community. The study uses a randomized two-group parallel design with 160 diverse Veterans and caregivers. The experimental group receives a transformative patient-centric intervention designed to reduce the burden of behavioral symptoms in Veterans with dementia. An occupational therapist conducts an assessment to identify a Veteran's preserved capabilities, deficit areas, previous roles, habits, and interests to develop activities tailored to the Veteran. Family caregivers are then trained to incorporate activities into daily care. The attention-control group receives bi-monthly telephone contact where education on topics relevant to dementia is provided to caregivers. Key outcomes include reduced frequency and severity of behavioral symptoms using the 12-item Neuropsychiatric Inventory (primary endpoint), reduced caregiver burden, enhanced skill acquisition, efficacy using activities, and time spent providing care at 4 months; and long-term effects (8 months) on the Veteran's quality of life and frequency and severity of behavioral symptoms, and caregiver use of activities. The programs' impact of Veterans Administration cost is also examined. Study precision will be increased through face-to-face research team trainings with procedural manuals and review of audio-taped interviews and intervention sessions.

Discussion: The Tailored Activity Program - Veterans Administration is designed to improve the quality of life of Veterans with dementia and lessen the burden of care on caregivers. Activities are tailored to reflect the Veteran's preserved capabilities and interests to enhance active engagement, while not taxing areas of cognition that are most impaired.

Trial registration: ClinicalTrials.gov NCT01357564.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of study design.
See this image and copyright information in PMC

References

    1. Alzheimers Association. 2013 Alzheimer’s disease facts and figures. Retrieved May 28, 2013, from http://www.alz.org/documents_custom/2013_facts_figures_fact_sheet.pdf.
    1. Krishnan LL, Petersen NJ, Snow AL. et al. Prevalence of dementia among veterans affairs medical care system users. Dement Geriatr Cogn Disord. 2005;20(4):245–253. doi: 10.1159/000087345. - DOI - PubMed
    1. Gitlin L, Kales H, Lyketsos C. Nonpharmacologic management of behavioral symptoms in dementia. JAMA. 2012;308(19):2020–2029. doi: 10.1001/jama.2012.36918. - DOI - PMC - PubMed
    1. Savva GM, Zaccai J, Matthews FE. et al. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. Br J Psychiatry. 2009;194(3):212–219. doi: 10.1192/bjp.bp.108.049619. - DOI - PubMed
    1. Beeri MS. et al. The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer’s disease patients. Int J Geriatr Psychiatry. 2002;17:403–408. doi: 10.1002/gps.490. - DOI - PubMed

Publication types

Associated data