Gitlin, Laura N.

Greening, Shirley E.

Name not available

REACH Reaches Philadelphia Through Jefferson\u27s College of Health Professions

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Health Policy Newsletter ____________________________________________________________ Volume 10, Number 3    September, 1997               Article 4 ____________________________________________________________  REACH Reaches Philadelphia Through Jefferson's College of Health Professions  Laura N. Gitlin, PhD Shirley E. Greening, MS, JD*  * Thomas Jefferson University  Copyright ©1997 by the authors.  The Health Policy Newsletter is a publication of Thomas Jefferson University, Jefferson Medical College and the Department of Health Policy, 1015 Walnut Street, Suite 621, Philadelphia, PA 19107. (215) 955-6969.  Suggested Citation:Gitlin LN, Greening SE.  REACH reaches Philadelphia through Jefferson’s College of Health Professions.  Health Policy Newsletter 1997; 10(3): Article 4.  Retrieved [date] from http://jdc.jefferson.edu/hpn/vol10/iss3/4. Laura N. Gitlin and Shirley E. Greening:  REACH Reaches Philadelphia Through JCHP Health Policy Newsletter Vol. 10, Number 3 (September 1997), Article 4 REACH Reaches Philadelphia Through Jefferson's College of Health Professions Memory loss, cognitive impairment and psychiatric behavioral problems characterize the progressive deterioration associated with Alzheimer's disease and related forms of dementia. However, the relationship between the stage of dementia and the prevalence and order of appearance of behavioral disturbances, and how to measure this relationship, remains a less well understood and understudied aspect of the disease process. Most dementia patients are cared for at home by family members. Family caregivers must contend with behavioral problems on a daily basis and this can pose a serious threat to their own health and well-being.   Resources for Enhancing Alzheimer's Caregiver Health (REACH) is an initiative that was established in 1995 by the National Institutes of Health (NIH) to carry out social and behavioral research on interventions designed to enhance family caregiving for Alzheimer's disease and related disorders. Since 1995, six research projects have been funded through cooperative agreements with the National Institutes on Aging (NIA) and the National Institute of Nursing Research. These projects focus on characterizing and testing the most promising home and community based interventions for enhancing family caregiving, particularly with minority families.   The Community and Homecare Research Division (CHORD) and the Department of Occupational Therapy in the College of Health Professions is one of the six research sites* for the NIH's REACH initiative. The Philadelphia REACH Project, under the direction of Principal Investigator Laura N. Gitlin, PhD, is conducting a five-year study entitled "Home Environmental Skill-building Program for Caregivers." The intervention being tested extends a previously funded NIA study that examined treatment efficacy of in-home occupational therapy services. The intervention builds on a conceptual model of the home environment and its impact on dementia. The model integrates the following aspects of the home care environment in order to derive specific strategies to modify their adverse effect for dementia patients: objects (e.g., physical tools or items in the home), tasks (daily life routines such as dressing or bathing), social groups (household composition and other social resources) and culture (values and beliefs). The current REACH project evaluates the benefits of a home-based environmental skill-building program that involves, first, instructing caregivers about the impact of the environment on dementia, and second, helping caregivers use their environment effectively to minimize functional decline and behavioral difficulties experienced by dementia.   As part of the skill-building program, occupational therapists visit the homes of caregivers multiple times over a 12-month period. Occupational therapists work with the caregivers to identify problem areas, introduce environmental strategies such as home alterations or simplifications of tasks, and provide training. The Philadelphia Corporation for Aging, a partner in this initiative, is providing home modifications and assistive devices through its department of housing. This process should result in better home safety, improved well-being for the caregiver, and decreased functional dependence and problem behaviors in the individual with dementia.   A total of 250 family caregivers from diverse cultural and economic backgrounds will be enrolled in the study. Caregivers will be randomly assigned to an experimental group or a control group. Caregivers in both groups will be followed for 18 months. Laura N. Gitlin and Shirley E. Greening:  REACH Reaches Philadelphia Through JCHP Health Policy Newsletter Vol. 10, Number 3 (September 1997), Article 4 Each of the participants in the study receive educational materials and payment for testing sessions. The experimental group will receive the skill-building intervention, while the control group will receive care as usual.   The multi-site REACH effort is expected to provide definitive answers about the relative benefits of different caregiver interventions. Anticipated outcomes include: (l) development and utilization of an assessment protocol to systematically evaluate dementia households for safety and use of home modifications in research and service programs; (2) a comprehensive manual of effective environmental strategies; and (3) a standardized and reproducible service for families caring for dementia patients.   A Coordinating Center for the REACH initiative has been established at the University of Pittsburgh. The Coordinating Center will develop and maintain a common database of measures used across the six sites. The major outcome of this initiative will be the availability of a pooled database, forming the basis for future analysis of the feasibility and outcomes of different intervention approaches for caregivers of diverse cultural and minority backgrounds.   To keep the public informed, the National Institutes on Aging's Public Information Office will communicate news about the projects and about research on aging in general.   For more information about Philadelphia REACH, contact Laura Gitlin, Community and Homecare Research Division, at 215-503-2896.   *REACH Initiative Sites  • Center for Aging, University of Alabama at Birmingham  • Veterans Affairs Medical Center, Memphis, Tennessee  • Center for Adult Development and Aging, University of Miami, Florida  • Veterans Affairs Palo Alto Health Care System, California  • Community and Homecare Research Division, College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania  • Medical Information Systems Unit, Boston Medical Center Hospital, Massachusetts  • University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania   About the Authors  Laura N. Gitlin, PhD, heads the Community and Homecare Research Division; Shirley E. Greening, MS, JD, is Chairman and Professor, Department of Laboratory Sciences, both in the Jefferson College of Health Professions, Thomas Jefferson University. 

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REACH Reaches Philadelphia Through Jefferson\u27s College of Health Professions

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