Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain

Adriana Ávila; Iván De-Rosende-Celeiro; Gabriel Torres; Mirian Vizcaíno; Manuel Peralbo; Montserrat Durán

doi:10.1111/hsc.12594

Promoting functional independence in people with Alzheimer's disease: Outcomes of a home-based occupational therapy intervention in Spain

Health Soc Care Community. 2018 Jul 11. doi: 10.1111/hsc.12594. Online ahead of print.

Authors

Adriana Ávila¹, Iván De-Rosende-Celeiro¹, Gabriel Torres², Mirian Vizcaíno¹, Manuel Peralbo³, Montserrat Durán³

Affiliations

¹ Departamento de Ciencias da Saúde, Unidade de Investigación de Terapia Ocupacional en intervencións non farmacolóxicas, Universidade da Coruña, A Coruña, Spain.
² Departamento de Educación Física e Deportiva, Universidade da Coruña, A Coruña, Spain.
³ Departamento de Psicoloxía, Universidade da Coruña, A Coruña, Spain.

PMID: 29998539
DOI: 10.1111/hsc.12594

Abstract

Nonpharmacologic therapies such as occupational therapy (OT) are promising for people with Alzheimer's disease (AD). However, more research is needed to better understand the effectiveness of home-based OT programs. This pilot study aimed to assess the effects of a home-based, high-intensity and multicomponent OT intervention on the activities of daily living of people with AD in Spain. The secondary objective was to examine its impact on the cognitive functions. A multiple-baseline intrasubject design was used. Twenty-one community-dwelling older adults with mild AD (mean age 78.6 years) and their primary caregivers participated in a 12-week home-based OT program. This intervention was replicated for 8 weeks after a 1.5-month intervention withdrawal period. The intervention followed a holistic, biopsychosocial and client-centred approach and consisted of the following components: meaningful activities/tasks, cognitive stimulation, activation of psychomotor and sensory skills, home modification, caregiver counselling and training in daily living skills. Functional independence was the primary outcome (Barthel Index). The cognitive functions were assessed by the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric (LOTCA-G). Data were analysed using nonparametric tests. Main results showed that after completing the OT program, 6.5 months after the moment of inclusion, the level of functional independence improved significantly and the effect size was large. Moreover, there was a significant moderate-to-substantial improvement in several cognitive functions after each of the two intervention periods: place orientation, time orientation and attention/concentration. In summary, the findings give a great deal of information as a basis for further research. This study provides evidence that an intensive home-based OT intervention has a positive influence on daily activities and some cognitive functions, suggesting that this program may be beneficial as a nonpharmacological supplementary tool in health and social care for people with AD living in the community.

Keywords: Alzheimer's disease; activities of daily living; cognition; occupational therapy; treatment outcome.