2011 National Meeting

1005 — Clinical Trial of a Home Safety Intervention for Alzheimer's Disease

Horvath KJ (New England GRECC) , Trudeau SA (New England GRECC), Rudolph JL (New England GRECC), Trudeau PA (CHQOER), Duffy MA (Boston College)

Objectives:
This research tests the effectiveness of a new multimodal educational intervention to improve caregiver competence to create a safer home environment for veterans with dementia living in the community. Objective 1: To test the effectiveness of a Home Safety Toolkit intervention on caregiver self-efficacy, caregiver adherence to home safety recommendations, and caregiver strain. Objective 2: To test the effectiveness of a Home Safety Toolkit intervention on the frequency of risky behaviors and accidents among care recipients with dementia of the Alzheimer’s type living in the community.

Methods:
This randomized clinical trial tested the Home Safety Toolkit intervention developed in preliminary studies. Participants (108 patient/caregiver dyads) came from the Bedford VAMC Dementia Outpatient Clinic, the VA Boston HCS, or the Boston University Alzheimer’s Disease Center. The intervention group (n = 60) received the Home Safety Toolkit, including a new booklet “Keep the Home Safe for a Person with Memory Loss,” and low-cost items to make home safety modifications. The control group (n = 48) received customary care, including a standard list of recommendations for home safety. Participants completed measures at baseline and twelve-week follow-up. Biweekly telephone contacts in both groups by the research team tracked risky behaviors and accidents, while providing coaching and support. Multivariate Analysis of Covariance (MANCOVA) was used to test for significant group differences with the following outcome variables: home safety (adherence), post-intervention caregiver self-efficacy and post-intervention caregiver strain, care-recipient risky behaviors, and accidents.

Results:
Controlling for covariates, all caregiver outcome variables improved in the intervention group more than the control. Home safety (adherence) was significant at p = < .001; caregiver strain at p = < .001; and caregiver self-efficacy at p = .006. Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group (p = < .001).

Implications:
Multi-modal interventions can be effective in supporting caregiver competence to provide a safe environment for community-dwelling veterans with dementia. Expanded implementation research is indicated to develop procedures for clinical dissemination across VA sites.

Impacts:
This proven intervention to decrease the potential for serious injury promotes both patient safety and optimal utilization of clinical resources.