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Skills2Care (f/k/a Environmental Skill-Building Program PRINCIPAL INVESTIGATOR: Laura N. Gitlin, Ph.D., Director 130 S. 9th Street, Suite 513 Philadelphia, PA 19107 Office: (215) 503-2896 Fax: (215) 923-2475 Email: Laura.Gitlin@jefferson.edu Intervention Title: OVERALL SNAPSHOT OF CAREGIVER INTERVENTION/PROGRAM: This is a home-based environmental intervention designed to help family caregivers of persons with dementia learn specific strategies through education, skill-building, and environmental strategies. These strategies are designed to help caregivers so that they can modify their living space so that they develop a more supportive environment such that the person with dementia will exhibit fewer disruptive behaviors and experience a slower rate of decline and dependence in instrumental and basic activities of daily living (IADLs and ADLs). Trainingpeaks Wko Crackers. This intervention is based upon a competence-environmental press framework and personal control theory. In general, the intervention involves 5, 90-minute home visits by an occupational therapist who evaluates the home environment, observes performance of the person with dementia and the caregiving and communication style of the caregiver. Based on this assessment of an in-depth interview with the caregiver regarding their specific daily issues, concerns and challenges, the interventionist provides basic education about dementia and the stressors of caregiving, and trains caregivers in specific strategies to help caregivers cope with daily care challenges.

Strategies provided reflect simple modifications to the physical environment (e. Compressor Aerodynamics Cumpsty Pdf Printer. g., removal of hazardous objects, use of a memory board or daily calendar) and social environment (e.g., communication techniques, cueing and approaches to simplifying everyday tasks) to more resource dependent recommendations (e.g., installing grab bars or handrails), as well as basic problem solving and stress management techniques. Evidence supporting the impact of the program has been well-documented. The environmental program appears to have a modest effect on dementia patients’ IADL dependence and also among certain subgroups of caregivers, the program improves self-efficacy and reduces upset in specific areas of caregiving.

There is also evidence showing that caregivers are receptive to and utilized environmental strategies offered by occupational therapists. Both six and 12-months after the start of the study, care-recipients in the intervention group were better able to perform everyday tasks and take care of themselves. They were also more likely to use problem-solving strategies to make tasks easier and also less frightened of falling than the adults in the non-intervention group (e.g., control group). Furthermore, compared to controls, caregivers in the intervention group reported less upset with memory-related behaviors, less need for assistance from others, and better affect. Intervention spouses reported less upset with disruptive behaviors; men reported spending less time in daily oversight; and women reported less need for help from others, better affect, and enhanced management ability, overall well-being, and mastery relative to control group counterparts. BRIEF BACKGROUND RELATED TO THE DEVELOPMENT OF THE INTERVENTION: Older adults with heart disease, arthritis or other chronic health conditions often have difficulties with everyday activities such as bathing or walking. Among other things, these difficulties can contribute to reduced quality of life and to fear of falling, which may cause anxiety, depression, isolation, and even falls.

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As a result of difficulties with daily activities, older adults may need help in their homes, or need to move to a family member's home or a nursing home or other facility. This innovative caregiver intervention was designed to be a home environmental approach.

The rationale for using the home environment as a therapeutic modality is based in a competence-environmental press framework and recent advances in control theory. A competence-environmental press framework suggests that as competency declines in persons with dementia, an unchanging physical and social environment presents substantial demands or press on an individual that may result in negative behavioral and functional outcomes. In other words, with the progression of dementia, the person becomes unable to navigate the home environment and may ignore or misinterpret cues and environmental information that would otherwise support adaptive behavior. Therefore, modifying and simplifying aspects of the environment to match reduced competency may minimize excess disability in persons with dementia. In a model offered by Barris and colleagues (1985) and extended by Cororan and Gitlin (1991), the environment is conceptualized as consisting of four hierarchically arranged and interacting layers: objects (physical tools or items in the home), tasks that compose daily life routines (dress, bathing, toileting), social groups and their organizations (household composition and other social resources) and culture (values and beliefs that shape the provision of care in the home). It is thought that each layer may be modified to balance the demands of the environment with the individual’s level of competency or abilities. Thus, during the intervention, strategies are introduced that target three layers of the environment: objects, tasks, and social groups.