Home Safety Intervention Improves Caregiver Competence for Individuals with Alzheimer's Disease
A person with dementia of the Alzheimer's type (DAT) will live an average of 4-8 years and as long as 20 years after the onset of symptoms, during which 80% of their care is provided by family and friends. Older adults are at increased risk of accidents and injuries in the home compared to the general population, and persons with dementia are at even greater risk than their peers because of cognitive and functional impairments associated with the illness. This randomized controlled trial sought to give informal caregivers the knowledge and resources to prevent risky behaviors and accidents in the homes of persons with DAT or a related dementia. Investigators designed a Home Safety Toolkit that includes a booklet on high-frequency/high-severity risks for accidents and injuries in the home, and sample items (i.e., smoke alarm, night lights, slide bolt lock, medicine case) that allow caregivers to make easy home safety modifications. The study cohort included 108 patient/caregiver dyads, including VA patients. The intervention group (n=60) received the Home Safety Toolkit, while the control group (=n=48) received customary care. Groups were equivalent on demographic and disease severity measures such as age of the caregiver and cognitive impairments of the care recipient. Outcomes - measured at baseline and at 12-week follow-up - were caregiver self-efficacy, caregiver strain, home safety, and care recipient risky behaviors and accidents.
- All outcome variables improved more for caregivers in the Home Safety Toolkit intervention group than for caregivers in the control group. For example, caregivers in the intervention group had significantly improved home environmental safety compared to those in the control group, and patients in the intervention group had fewer risky behaviors and accidents compared to patients in the control group.
- The intervention group had 80% overall confidence in their ability to make a home safer compared to 75% for caregivers in the control group. Caregivers in the intervention group also had lower perceived strain in caregiving compared to caregivers in the control group.
- This study sample had few female care recipients and few male caregivers. A recent publication showed that male caregivers of persons with dementia reported less caregiver burden than female caregivers; thus, future studies might focus on the potential effects of gender on interventions.
Considering the nature of home safety as a problem area for persons with DAT living at home, making even modest improvements in caregiver self-efficacy and caregiver strain will make an impact on the challenging circumstances of home caregiving for a person with DAT.
This study was partly funded by HSR&D (NRH 05-056). Drs. Horvath, Trudeau, and Berlowitz and Ms. Trudeau are part of HSR&D's Center for Healthcare Organization and Implementation Research (CHOIR) in Bedford, MA.
Horvath K, Trudeau S, Rudolph J, Trudeau P, Duffy M, and Berlowitz D. Clinical Trial of a Home Safety Toolkit for Alzheimer’s Disease. International Journal of Alzheimer’s Disease. 2013.