Effectiveness of Reducing Disability in Alzheimer’s Disease among dementia patients and their family caregiver

Abstract

AbstractBackgroundDementia impacts the mental health of individual‐caregiver dyads. Interventions such as Reducing Disability in Alzheimer’s Disease (RDAD) improve dyad mental health, but to implement it locally community agencies in Kansas City suggested three changes: 1) reduced reliance on licensed social workers, 2) centralized exercise interventionists and 3) more flexible delivery. We aimed to assess the effectiveness of the Kansas City RDAD implementation (RDAD‐KC), which addressed these three gaps. We hypothesized that dyads’ mental health would improve from baseline to the end of the intervention.MethodThis is a secondary‐analysis of an in‐home dementia support services quality improvement project amongst a collaborative of nine community agencies in the Kansas City region. Agencies administered RDAD‐KC to a non‐probabilistic sample of dyads they recruited in their service areas. Eligibility criteria included living in the community, having moderate dementia, with enough home space to exercise, ability to walk across the room with or without assistive devices and no physical activity restrictions. The original RDAD is a 12‐module dyad home‐based multicomponent intervention that focuses on exercise for people with dementia and coping with behavioral symptoms for caregivers. RDAD‐KC 1) allowed non‐licensed interventionists, 2) included exercise videos and contact of a centralized exercise team and 3) allowed fitting the intervention delivery to the dyads’ situation, needs, and time available. Data analyses included paired samples t‐tests. Final data analysis included those who had a family caregiver, no intellectual disability and completed nine of the 12 modules.ResultAmong the 157 screened dyads, 66 completed ≥9 modules. People with dementia were 77.4 years in average, 72.9% identified as White, 19.7% as Black, 17.0% rural and 71.2% had their partners as caregivers. All outcomes improved statistically (p<0.01) from pre to post‐intervention: Behavioral symptom severity (range 0‐36) decreased from 11.3 to 8.6, caregiver unmet needs (range 0‐34) decreased from 10.6 to 5.6, caregiver behavioral symptom distress (0‐60) decreased from 15.5 to 10.4 and caregiver strain (0‐26) decreased from 11.1 to 9.7.ConclusionA more flexible implementation of RDAD leads to clinically meaningful improvement of mental health outcomes among dyads. RDAD‐KC might inform the scaling‐up of RDAD in the region.