Effectiveness of the Care of Persons With Dementia in Their Environments Intervention When Embedded in a Publicly Funded Home- and Community-Based Service Program.
Family caregivers
Medicaid waiver programs
Pragmatic trial elements
Journal
Innovation in aging
ISSN: 2399-5300
Titre abrégé: Innov Aging
Pays: England
ID NLM: 101703706
Informations de publication
Date de publication:
2020
2020
Historique:
received:
24
06
2020
entrez:
28
12
2020
pubmed:
29
12
2020
medline:
29
12
2020
Statut:
epublish
Résumé
In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer's disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program. Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS (COPE; After 4 months, caregivers receiving COPE reported greater perceived well-being (least squares mean = 3.2; 95% CI: 3.1-3.3) than caregivers receiving UC (3.0; 2.9-3.0; Embedding COPE in a publicly funded HCBS program yielded positive immediate effects on caregivers' well-being, marginal positive immediate effects on behavioral and psychological symptoms, and long-term effects on meaningful activity engagement among persons living with ADRD. Findings suggest that COPE can be effectively integrated into this service system, an important step towards widespread adoption. NCT02365051.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer's disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program.
RESEARCH DESIGN AND METHODS
METHODS
Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS (COPE;
RESULTS
RESULTS
After 4 months, caregivers receiving COPE reported greater perceived well-being (least squares mean = 3.2; 95% CI: 3.1-3.3) than caregivers receiving UC (3.0; 2.9-3.0;
DISCUSSION AND IMPLICATIONS
CONCLUSIONS
Embedding COPE in a publicly funded HCBS program yielded positive immediate effects on caregivers' well-being, marginal positive immediate effects on behavioral and psychological symptoms, and long-term effects on meaningful activity engagement among persons living with ADRD. Findings suggest that COPE can be effectively integrated into this service system, an important step towards widespread adoption.
CLINICAL TRIALS REGISTRATION NUMBER
BACKGROUND
NCT02365051.
Identifiants
pubmed: 33367114
doi: 10.1093/geroni/igaa053
pii: igaa053
pmc: PMC7745768
doi:
Banques de données
ClinicalTrials.gov
['NCT02365051']
Types de publication
Journal Article
Langues
eng
Pagination
igaa053Subventions
Organisme : NIA NIH HHS
ID : R01 AG044504
Pays : United States
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.
Références
Alzheimers Dement. 2020 Mar 10;:
pubmed: 32157811
Psychosom Med. 2002 May-Jun;64(3):510-9
pubmed: 12021425
J Am Geriatr Soc. 2020 Jul;68 Suppl 2:S28-S36
pubmed: 32589277
Contemp Clin Trials. 2016 Jul;49:155-65
pubmed: 27394383
Innov Aging. 2019 Oct 16;3(3):igz031
pubmed: 31660442
JAMA. 2010 Sep 1;304(9):983-91
pubmed: 20810376
Am J Geriatr Psychiatry. 2006 Nov;14(11):900-10
pubmed: 17068312
J Neuropsychiatry Clin Neurosci. 2000 Spring;12(2):233-9
pubmed: 11001602
BMJ. 2015 May 08;350:h2147
pubmed: 25956159
Med Care. 2009 Feb;47(2):191-8
pubmed: 19169120
Health Aff (Millwood). 2012 Jun;31(6):1195-203
pubmed: 22665831
Am J Alzheimers Dis Other Demen. 2006 Oct-Nov;21(5):304-11
pubmed: 17062548
BMC Geriatr. 2020 Apr 15;20(1):137
pubmed: 32293325
Gerontologist. 2015 Apr;55(2):210-26
pubmed: 26035597
Am J Geriatr Psychiatry. 2008 Mar;16(3):229-39
pubmed: 18310553
Am J Psychiatry. 1960 Oct;117:326-8
pubmed: 13750753
Med Care. 2012 Mar;50(3):217-26
pubmed: 22310560
Ann Intern Med. 2006 Nov 21;145(10):727-38
pubmed: 17116917
Innov Aging. 2019 Aug 23;3(3):igz022
pubmed: 31528712
J Clin Epidemiol. 2010 Aug;63(8):e1-37
pubmed: 20346624
Int Psychogeriatr. 2010 Sep;22(6):984-94
pubmed: 20594384