Evaluation of a telephone-based support group intervention for female caregivers of community-dwelling individuals with dementia

Family caregivers, the second victims or hidden patients in dementia care, are at risk for social isolation, stress, depression, and mortality. Telephone-based support (telesupport groups) represents a practical, low-burden, low-cost source of emotional support. The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients. Recruited through various community sources, 103 female caregivers were randomized to the telesupport group treatment or a control condition. Effects on caregiver burden, depression, and personal gains were evaluated at 6 months, the main end point. Older caregivers (≥65) in telesupport reported lower depression than control group caregivers did

A model to promote activity competence in elders.

This paper describes an occupational therapy home-based intervention in which purposeful activities were used to promote adaptation and competence in older adults with chronic disabilities. Seven home care therapists visited 17 randomly selected, community-living elders who were chronically disabled and who volunteered to participate in the program. The number of visits ranged from 3 to 10 and occurred over a 3-month period according to clients\u27 needs and wishes. Therapists enhanced their ability to enter the client\u27s social and cultural system by using participant-observation techniques and collaboratively identified activities. Therapists documented each home visit with a structured fieldnote form. An analysis of 112 field-notes indicated that therapists were able to understand a client\u27s needs; this understanding resulted in small qualitative gains in areas identified as important by the client. Reilly\u27s concept of an activity continuum was a useful framework from which to work with this population. The implications for program development, treatment outcomes, and accountability with this approach promote improved future treatment planning with the elderly with chronic disability

Harvest Health: Chronic Disease Self-Management Program for Older African-Americans

No abstract available

REACH Reaches Philadelphia Through Jefferson\u27s College of Health Professions

No abstract available

Dementia management: an occupational therapy home-based intervention for caregivers.

This paper describes an occupational therapy intervention designed for family caregivers of persons with dementia. The intervention, based on the framework of a competence-environmental press model and the principle of collaboration, was implemented during 5 home visits. Each visit was designed to build caregiving skills through collaboration in identifying problem areas, developing and implementing environmental strategies, and modifying management approaches. A case vignette illustrates the therapeutic process and outcomes. The theoretical rationale and structure of the intervention and innovative documentation for evaluation of the theoretic process are also presented

How do we change practice when we have the evidence?

Translating research findings into practice includes myriad pragmatic realities, including understanding the suitability of the data to a particular patient group, writing new guidelines for occupational therapy practitioners, facilitating adoption of the guidelines, and instituting new patterns of care for patients. The process is more than a matter of disseminating the information to practitioners and expecting immediate change in patient treatment. Indeed, the field of implementation science is devoted to the identification of the numerous barriers and supports that constrain or expedite practice change in response to research. Moving forward and adopting evidence-based findings will require a focused understanding of the particular setting where change is warranted. Among the issues to address are the health system levels involved in change (professional, legislative, administrative, practitioner, and patient and family members), the values and beliefs of the participants, and knowledge of the communication channels that exist in the setting and how information and new ideas make their way through the setting

How occupational therapists teach older patients to use bathing and dressing devices in rehabilitation.

OBJECTIVE: This article describes the methods occupational therapists use to teach bathing and dressing device use to older patients in rehabilitation programs. The relationship of three patient characteristics to five aspects of assistive device instruction was examined. METHOD: The study sample included 86 patients and 19 occupational therapists who provided the assistive device training. Patients were 55 years of age or older and in rehabilitation for an orthopedic deficit, cerebrovascular accident, or lower limb amputation. Therapists recorded information on teaching methods, perceptions of patient knowledge, and expectations for future device use after each treatment session. RESULTS: Patients received an average of three dressing and two bathing devices for home use. Therapists devoted an average of two and a half sessions (10 min average duration) to teach dressing device use and an average of one session (9 min average duration) to teach bathing device use. Teaching occurred mostly in the clinic setting through oral instruction and demonstration. At discharge, patients who evaluated devices positively and were evaluated as having a positive affect were perceived by the therapists as having greater knowledge of device use. More time was spent teaching those patients with lower Functional Independence Measure scores, less positive evaluations of devices, and lower affect scores. Family caregivers were involved in one or more dressing sessions for 26% of patients and one or more bathing sessions for 36% of patients. CONCLUSION: Assistive device training in rehabilitation centers consists largely of simulated sessions in the occupational therapy clinic, and patients in the study described the instruction they received as satisfactory. More research is needed to study the long-term effectiveness of assistive device training after patients return home

Message from Dr. Laura Gitlin, Director of CARAH

Welcome to the first issue of CenterPieces, the newsletter of the Center for Applied Research on Aging and Health. Aging is a highly personal phenomenon. It obviously affects each of us on an individual, familia, and socio-political-economic level. Only a short 50 years ago, aging was viewed as a disease rather than a natural and important stage of human development. Although older people are at increased risk for heart disease, cancer, stroke, falls and cognitive impairments, more so than any other age group, new scientific breakthroughs show that frailty and physical and cognitive decline is a complex phenomenon and not an inevitable part of aging. In fact, the vast majority of people over the age of 65 experience excellent health into their 80’s and beyond. Scientific understandings combined with population changes continue to challenge our basic notions about growing old. With the human life span now projected at 120 years, the fastest population growth occurring among persons 85+ years old, and the number of people aged 100 having more than doubled since 1990 (Japan has over 1 million persons 90+ years!), the mechanisms of aging and the physiological, behavioral and psychological adaptations are now center stage questions. The changing age structure of the United States (12% \u3e 65 years in USA; 16% \u3e 65 years in PA) is unprecedented. It is a phenomenon shared worldwide with sweeping, dramatic implications for health policy, health service delivery and health professional training. Despite major advancements in understanding the aging process and treating age related diseases, we still have a long scientific journey to realize and enable healthy aging, particularly for minority older adults for whom health disparities continue to persist. For example, a 2003 study estimates that one in three persons 65 years or older – representing more than 11 million people – are at risk of going untreated or receiving inappropriate treatments for diseases associated with aging including dementia, mobility disorders and other conditions that place older adults at increased risk of losing their independence. Thus, many critical questions of public health import are in need of answers. Given city, state, national and world-wide population trends, a focus on the health and wellbeing of older people must take precedence in our research, education and social initiatives. This is a critical time for multiple disciplines to join forces to study and serve older adults whose health can be characterized by complexity, comorbidities and chronicity. This newsletter is one way CARAH plans to advance an aging perspective at Thomas Jefferson University. We invite you to work with us as we move forward with research, education and clinical service innovations