BACKGROUND/RATIONALE:
Prior work (NRI 97-030) supported the development of an empirically derived multimodal home safety intervention to make the home safer for a person with memory loss. This proposed study continues a program of research guided by the Home Safety/Injury Model (Hurley, Gauthier, Horvath, et al. 2004) to maintain the person with dementia of the Alzheimer's type (DAT) in the home environment for as long as possible without increased morbidity to either the veteran or the informal caregiver.
OBJECTIVE(S):
The purpose of this research proposal is to test the effectiveness of a new multimodal educational intervention to improve caregiver competence to create a safer home environment, and decrease risk and accidents to veterans with dementia living in the community.
Objective 1: To determine the effect of the Home Safety Toolkit intervention on caregiver self-efficacy, caregiver adherence to home safety recommendations, and caregiver strain.
Objective 2: To determine the effect of the 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 study is a randomized clinical trial to test a Home Safety Toolkit intervention that was developed in preliminary studies. The sample will consist of primary family caregivers of a person with DAT receiving care at the Bedford VAMC Dementia Outpatient Clinic, the VA Boston HCS, or the Boston University Alzheimer's Disease Center. The intervention group receives the Home Safety Toolkit, which consists of a new booklet "Keep the Home Safe for a Person with Memory Loss", based on health literacy principles and includes low-cost items to make home safety modifications that promote caregiver self-efficacy. The control group receives customary care which consists of a standard list of recommendations for home safety called "Worksheet to Make the Home Safer". Multivariate Analysis of Covariance (MANCOVA) will be used to test hypotheses for significant group differences with the following outcome variables: adherence to recommendations; post-intervention caregiver self-efficacy and post-intervention caregiver strain; care-recipient risky behaviors and accidents. Covariates will include: baseline measures of caregiver self-efficacy and caregiver strain, caregiver years of formal education and use of social support resources.
FINDINGS/RESULTS:
While aggregate findings of data are yet to be analyzed, anecdotal response to the Home Safety Intervention have been overwhelmingly positive to date.
IMPACT:
The potential for serious injury to veterans with dementia and others in their environment is increasing as the number of veterans with Alzheimer's disease increases The prevalence of dementia in VHA enrollees is estimated to increase from 201,538 to 281,689 in the next 10 years. The Alzheimer's Association estimates that more than 70% of people with Alzheimer's disease live at home, thus in 2015 the number of veterans living at home with Alzheimer's disease is estimated to be more than 195,000. Proven interventions to decrease the potential for serious injury will promote both patient safety and optimal utilization of clinical resources. Identifying correlates of caregiver competence to prevent home injury will enable both clinicians and researchers to focus efforts on the most vulnerable veteran/caregiver dyads. Evaluating the effectiveness of a home safety intervention will have applications to other areas of patient/family education.
Anecdotally, one caregiver recently commented, "I can't believe what a difference some of these changes have made. They seem so simple but I finally have peace of mind knowing I am doing what I can to keep [my husband] safe."
PUBLICATIONS:
Journal Articles
- Allen SM, Resnik L, Roy J. Promoting independence for wheelchair users who live alone: The role of home accommodations. The Gerontologist. 2006.
