A Pragmatic Pilot Phase Preliminary Results of Daily Engagement in Meaningful Activity Professional Program for home care patients with subjective cognitive decline

Abstract

AbstractBackgroundA substantial number of home health older patients with subjective cognitive decline (SCD) require more time, structure, and guidance to complete tasks and adjust to new skills and environments, thereby presenting complex demands on home health services and caregivers. Without support, patients with SCD often lose their sense of control, have fewer personal choices, disengage from meaningful activities, and have less confidence in their ability to manage daily challenges and other chronic illness issues. Our multi‐component intervention titled, Daily Engagement in Meaningful Activities Professional (DEMA‐Pro) intervention was developed based on five preliminary studies shown to improve health outcomes and promote confidence in managing daily challenges in patients with SCD. The objectives of pragmatic pilot phase study were to 1) evaluate the feasibility and benefits of a DEMA‐Pro for patients with SCD; 2) explore nurses’ experience of DEMA‐Pro implementation.MethodWe used a one‐group, pre‐ and post‐intervention design and recruited 49 patients with SCD, aged 50+, from the four home healthcare sites to receive six weekly DEMA‐Pro telephone sessions. The Outcome and Assessment Information Set D (OASIS‐D) were collected at starting date (pre‐intervention) and discharge date (post‐intervention). Quantitative surveys and qualitative focus group methods were used to explore the DEMA‐Pro nurses (n = 3) experiences of implementation.ResultThe consent rate was 67.1%, the completed intervention rate 36.7%, and the partial completed intervention rate 25.5%. For 36 subjects with discharge data available, both IADLs and self‐care scores improved (d = 3.11 and d = 2.66, respectively). Specifically, those that completed all 6 DEMA‐Pro sessions (n = 14), partial completers (n = 12), and non‐completers (n = 10), had improved scores on IADLs (d = 4.0, 4.2, and 2.5, respectively) and Self‐Care (d = 3.7, 3.1 and 2.0, respectively). Completers had greater improvement than non‐Completers for both outcomes and greater improvement on IADLs than partial completers (all p‐values < 0.03). Nurses reported high satisfaction with their training, and high confidence that the implementation of the intervention met patient and caregiver needs.ConclusionThe DEMA‐Pro has shown benefits and feasibility that will need further testing in a large pragmatic trial in homecare settings.