AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
Memory Care Home Solutions, St. Louis, Missouri, USA.
Gerontologist. 2024 Aug 1;64(8). doi: 10.1093/geront/gnae045.
Few proven dementia-care programs are integrated into community-based agencies. We report on the acceptability and effectiveness of an evidence-based program, Care of People in their Environment (COPE), delivered by community-based agency staff.
Pretest/post-test design with 3 data points (baseline, 3-month program completion, 6-month follow-up). COPE was delivered by 6 occupational therapists and 4 social workers at 2 agency sites with people living with dementia and caregivers. Staff assessed the interests and abilities of people living with dementia, home safety, caregiver challenges, and readiness to learn strategies. Staff provided dementia education, stress reduction, and nonpharmacological techniques tailored to caregiver-identified challenges. Acceptability (3- and 6-months), included completed sessions, upset with and confidence managing care challenges, strategies used, and program satisfaction. Effectiveness (3- and 6-months) included people living with dementia's health events (falls, emergency room visits, hospitalizations, and 911 calls), rehospitalization risk and functional dependence; and caregiver well-being and readiness. Benefits by in-person (n = 188) versus virtual/hybrid (n = 46) delivery due to Coronavirus Disease-2019 were evaluated.
Of 843 dyads screened, 271 (32.1%) enrolled, 246 (90.8%) completed COPE, and 234 (95.1%) completed ≥1 follow-up. Regarding acceptability, caregivers completed about 8 sessions, reported improved confidence and upset (p < .001), most implemented strategies 3-months (72.8%) and 6-months (83.5%), and expressed high program satisfaction. For effectiveness, compared to baseline, odds of people living with dementia's health events were lower including rehospitalization risk, although functional dependence increased; caregiver well-being (3-, 6-months, p < .001) and readiness (3-months, p < .01) improved. Outcomes did not differ by delivery mode.
Acceptability and effectiveness were strong. COPE resulted in tangible improvements for families regardless of delivery mode.
很少有经过验证的痴呆症护理方案整合到社区机构中。我们报告了一种基于证据的方案，即环境中的人的护理（COPE），由社区机构工作人员实施的可接受性和有效性。
采用预测试/后测试设计，有 3 个数据点（基线、3 个月的项目完成情况、6 个月的随访）。COPE 由 2 个机构中的 6 名职业治疗师和 4 名社会工作人员为患有痴呆症的人和照顾者提供服务。工作人员评估了患有痴呆症的人的兴趣和能力、家庭安全、照顾者的挑战以及学习策略的准备情况。工作人员根据照顾者确定的挑战，提供痴呆症教育、减轻压力和非药物技术。可接受性（3 个月和 6 个月）包括完成的课程、对护理挑战的不满和管理信心、使用的策略以及对项目的满意度。有效性（3 个月和 6 个月）包括患有痴呆症的人的健康事件（跌倒、急诊就诊、住院和 911 呼叫）、再次住院风险和功能依赖；以及照顾者的健康和准备情况。由于 2019 年冠状病毒病（COVID-19），评估了面对面（n=188）与虚拟/混合（n=46）交付方式的收益。
在筛选的 843 对中，有 271 对（32.1%）入组，246 对（90.8%）完成了 COPE，234 对（95.1%）完成了至少 1 次随访。关于可接受性，照顾者完成了大约 8 次课程，报告说信心和不满（p<0.001）有所改善，大多数策略在 3 个月（72.8%）和 6 个月（83.5%）时得到实施，对项目的满意度很高。对于有效性，与基线相比，患有痴呆症的人的健康事件的可能性较低，包括再次住院的风险，尽管功能依赖增加；照顾者的健康（3 个月、6 个月，p<0.001）和准备情况（3 个月，p<0.01）得到改善。结果不因交付模式而异。
可接受性和有效性都很强。无论交付模式如何，COPE 都为家庭带来了切实的改善。
