Care of Persons with Dementia in their Environments (COPE)

Care of Persons with Dementia in their Environments (COPE)

Primary Practice

In-person caregiver education program delivered by professionals (OTs)

Description

Care of Persons with Dementia in their Environments (COPE) is a training program designed to support the physical function and quality of life for patients with dementia and the well-being of their caregivers. It addresses core elements of dementia care including optimizing physical health and function, engaging in daily activities, maintaining quality of life, and supporting caregivers. The program is composed of three sections: assessment, education, and training.

The program begins with an assessment that is administered by an occupational therapist (OT). The therapist conducts an interview with the caregiver to identify the person with dementia routines, previous and current roles, habits and interests, and caregiver concerns. Moreover, the therapist perform a cognitive and functional test to identify the person with dementia strengths and deficits in attention, initiation and perseveration, construction, conceptualization, and memory. Results from the assessment are then used to provide a personalized education and training program. Caregiver education include understanding the capabilities of the person with dementia, potential effects of medications, and general health concerns such as pain, dehydration, constipation…etc. Lastly, occupational therapists train caregivers to modify home environments, daily activities, and communications to support patient capabilities, use problem- solving to identify solutions for caregiver-identified concerns, and reduce stress. For each targeted concern, a written action plan is provided describing treatment goals, patient strengths, and specific strategies. Caregivers receive up to 10 sessions over 4 months with occupational therapists and 1 face-to-face session and 1 telephone session with an advance practice nurse.

Goals/Objectives

To support individual with dementia capabilities by reducing environmental stressors and enhance caregiver skills, problem-solving, and reduce stress.

Target Population

Caregivers of adults with dementia

Implementation

The program is being implemented in some Medicaid Home and Community-Based Services (HCBS) programs.

Evidence of Outcomes

Evidence-Based Practice
A randomized experimental design was used to determine the efficacy of the program. Data were collected at 4 months and 9 months from 12 participants. Results indicated that caregivers who received the training showed an improvement in well-being, and in confidence using activities. Moreover, by 4 months, 63% of caregivers who received the training vs 45% of those in the control group eliminated 1 or more caregiver-identified problems. Results persisted at 9 months only for caregivers and not for the person with dementia.

References

Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010). A bio-behavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial. Journal of the American Medical Association, 304(9), 983-991.