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 study continued 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 was 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 was a randomized clinical trial to test a Home Safety Toolkit intervention that was developed in preliminary studies. The sample consisted 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 received 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 received customary care which consists of a standard list of recommendations for home safety called "Worksheet to Make the Home Safer". Participants completed measures at baseline and twelve week follow up. Biweekly telephone contacts in both groups by the research team tracked risky behavior and accidents, while providing coaching and support. Multivariate Analysis of Covariance (MANCOVA) was 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 were estimated based on preliminary studies and included: baseline measures of caregiver self-efficacy and caregiver strain, caregiver years of formal education and use of social support resources.

FINDINGS/RESULTS:
The final sample of participants consisted of 108 patient/caregiver dyads - randomly assigned to the intervention group (n=60) and control group (n=48). Controlling for covariates, all caregiver outcome variables improved in the intervention group more than the control. Home safety (adherence) was significant at p .001; caregiver strain at p .001; and caregiver self-efficacy at p = .006. Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group (p .001).

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. Multi-modal interventions can be effective in supporting caregiver competence to provide a safe environment for community dwelling veterans with dementia. This proven intervention to decrease the potential for serious injury promotes both patient safety and optimal utilization of clinical resources.
Expanded implementation research is indicated to develop procedures for wide-spread implementation across VA sites.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Horvath KJ, Trudeau SA, Rudolph JL, Trudeau PA, Duffy ME, Berlowitz D. Clinical trial of a home safety toolkit for Alzheimer's disease. International journal of Alzheimer's disease. 2013 Sep 29; 2013(Article ID 913606):913606. [view]
2. Lambe S, Cantwell N, Islam F, Horvath K, Jefferson AL. Perceptions, knowledge, incentives, and barriers of brain donation among African American elders enrolled in an Alzheimer's research program. The Gerontologist. 2011 Feb 1; 51(1):28-38. [view]

Book Chapters

1. Horvath KJ, Harvey RM, Trudeau SA. A home safety program for community-based wanderers: Outcomes from the Veterans Home Safety Project. In: Safe and Ethical Approaches for Wandering Behaviors: A Practice Guide. New York, NY: Springer; 2007. Chapter 14. 259-276 p. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems Science, Neurodegenerative Diseases
DRE: Prevention
Keywords: Caregivers – not professionals, Cost, Research method
MeSH Terms: none