Alzheimer's disease results in progressive functional decline,
leading to loss of independence. Researchers from the Indiana Center for Aging Research and the Regenstrief Institute
have found that occupational therapy tailored to the individual
patient's needs did not delay the loss of everyday functions such as
walking, eating, bathing and toileting.
This is the first study to investigate whether two years of in-home
occupational therapy might help those with Alzheimer's disease delay the
loss of their physical function.The researchers note that the results
of this trial underscore the burden undertaken by caregivers as they
provide care for family members with Alzheimer's disease and the need to
explore ways to help caregivers manage this burden.
‘In-home occupational therapy for Alzheimer's disease did not delay the loss of everyday functions.’
Both groups in the randomized controlled study of a total of 180
Alzheimer's patients seen at the Healthy Aging Brain Center and primary
care practices at Eskenazi Health received best-practice dementia care,
which the IU and Regenstrief researchers have previously demonstrated
improved behavioral outcomes and reduced caregiver stress but did not
halt functional decline. In this new study one of the two groups also
received occupational therapy.
"Persons with dementia face a steady decline in function that we
found is not slowed by home-based occupational therapy," said study
corresponding author Christopher M. Callahan, founding director of
the IU Center for Aging Research and a Regenstrief Institute
"The participants in the study declined both mentally and
functionally as the neurodegeneration of the brain continued. This is a
disappointing outcome because previously published but shorter-term
studies had suggested these interventions might be able to slow the
physical decline that leads to nursing home placement."
If there is no pill and no therapy to slow the pace of disease
progression, what can be done? "There is a limited amount of money that
we - families and society - have available for these patients and
their caregivers and we should spend that money on things that patients
and families find the most helpful," Dr. Callahan said. We simply need
more options to better support family caregivers as they provide care to
persons with dementia.
He notes that modifications to homes such as removing risks for
falls, making bathrooms more accessible, and making kitchens safer may
enable Alzheimer's patients to remain in a home environment and out of
an institution longer. "Home modifications are relatively expensive but
less expensive than a year of care in a skilled nursing home," he said.
Over the two years of the study an occupational therapist traveled
to the home of the patient and family caregiver, thus avoiding the
burden of having to travel to treatment sessions. The occupational
therapy was individualized to each patient and focused on areas of
issues identified by the caregiver.
For example, sessions might focus on
safely bathing the patient or transfers into and out of cars.
Caregivers were instructed in ways to assist their family member in
activities that she or he had enjoyed prior to the disease such as
gardening. Exercise was primarily chair-based with participants seated
"Targeting Functional Decline in Alzheimer Disease: A Randomized Trial" is published online ahead of print in the Annals of Internal Medicine
"Given the burden of caring for persons with dementia, which largely
is shouldered by family members, research must focus on identifying
strategies to support caregivers in the home to provide care to persons
with dementia," the authors conclude. "If the gradual functional decline
attributable to Alzheimer's disease is irreversible, a new generation
of assisstive devices, home modifications, community services, and
technologies is needed to make longer-term support in the home a
practical reality for patients and families."