Piersol, C. V., Connor, S., Giller, I., Kanton, K., & Lipman, S. & Seager, S. (2017). A Systematic review of interventions for caregivers of people with Alzheimer's disease and related Major Neurocognitive Disorders. American Journal of Occupational Therapy, 71, 7105180020p1-7105180020p10. https://doi.org/10.5014/ajot.2017.027581
More than 15 million Americans provide unpaid care and services to people with Alzheimer’s disease (AD) and other major neurocognitive diseases (NCD) that cause dementia. For these individuals, there is typically no advanced preparation and training. Occupational therapy practitioners are skilled in the delivery of interventions which meet the varying and often multifaceted needs of caregivers, resulting in improved caregiver self-efficacy. To understand the current evidence describing caregiver interventions, the purpose of this systematic review was to examine the evidence for the effectiveness of educational and supportive strategies for caregivers of PWD on the ability to maintain participation in the role.
Deemer, A.D., Massof, R.W., Rovner, B.W., Casten, R.J., Piersol, C.V. (2017). Functional outcomes of the low vision depression prevention trial in age-related macular degeneration. Investigative Ophthalmology & Visual Science, 58, 1514–1520. http://doi.org/10.1167/iovs.16-20001
Age-related macular degeneration (AMD) is a degenerative eye disease that leads to progressive central vision loss, which can severely affect an individual's function and place them at risk for depression. A recently completed clinical trial, the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration (VITAL), demonstrated that behavioral activation (BA) plus low vision rehabilitation delivered by an occupational therapist (OT-LVR) in the patients' home reduced the incidence of severe depression in high-risk AMD patients with low vision. The purpose of this study was to evaluate whether the in-home BA + OT-LVR was more effective in improving the patients' functional ability than conventional optometric low vision services. Results suggest that BA + OT-LVR services, provided by an OT in the patient's home following conventional low vision optometry services, are more effective than conventional optometric low vision services alone for those with mild visual impairment.
Piersol, C. V., Herge, E. A., Copolillo, A. E., Leiby, B. E., & Gitlin, L. N. (2016). Psychometric Properties of the Functional Capacity Card Sort for Caregivers of People With Dementia. OTJR: Occupation, Participation and Health, 36(3), 126-133. https://doi.org/10.1177/1539449216666063
Caregiver appraisal plays a significant role in patient care decisions and can place patients with dementia at risk. This study examines the psychometric properties and utility of The Functional Capacity Card Sort (FCCS), an assessment designed to determine caregiver appraisal. Evidence is provided that shows FCCS is a valid and reliable tool used in conjunction with formal assessment to identify caregiver over- or underestimation, which has implications for patient safety and caregiver education.
Fortinsky, R. H., Gitlin, L. N., Pizzi, L. T., Piersol, C. V., Grady, J., Robison, J. T., & Molony, S. (2016). Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design. Contemporary Clinical Trials, 49, 155-165. https://doi.org/10.1016/j.cct.2016.07.006
Dementia is the leading cause for the loss of independence in older adults worldwide. This paper presents the rationale and design for a translational study in which Care of Persons with Dementia in their Environments (COPE), an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission.
Gitlin, L. N., Piersol, C. V., Hodgson, N., Marx, K., Roth, D. L., Johnston, D…Lyketsos, C.G. (2016). Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial. Contemporary Clinical Trials, 49, 92-102. Epub 2016 Jun 21. http://dx.doi:10.1016/j.cct.2016.06.006
Neuropsychiatric symptoms (NPS) are harmful and potentially life-threatening symptoms that affect almost all Americans with dementia. With limited pharmacological solutions for NPS, identification of non-pharmacalogic strategies is critical. The Dementia Behavior Study is a randomized clinical trial to test the efficacy of an activity program to reduce NPS and resulting caregiver burden. The primary outcome is change in agitation/aggression at 3 and 6 months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS.
Moriarty, H., Winter, L., Robinson, K., Piersol, C.V., Earland, T. V., Iacovone, D. B….Gitlin, L. N. (2016). A randomized controlled trial to evaluate the Veteran’s In-Home Program for Military Veterans with traumatic brain injury and their families: Report on Impact for Family Member. Physical Medicine & Rehabilitation, 8, 495-509. https://doi.org/10.1016/j.pmrj.2015.10.008
The Veterans’ In-Home Program (VIP) is a home-based occupational therapy intervention designed to promote participation and wellbeing in both veterans with traumatic brain injury and their family members. This randomized controlled trial compared the VIP to standard outpatient clinic care in affecting family members’ mental health, burden, and satisfaction. Results showed that family members in the VIP had significantly lower depressive symptom and burden scores compared to controls at follow-up. VIP is the first-evidence based intervention that considers both the veteran with TBI and the family.
Martini de Oliveira, A., Radanovic, M., Homen de Mello, P.C., Buchain, P.C., Vizzotto, A.D., Celestino, D.L., Stella, F., Piersol, C.V. & Forlenze, O.V. (2015). Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: A systematic review. BioMed Research International, 1-9. http://dx.doi.org/10.1155/2015/218980
Behavioral and psychological symptoms of dementia (BPSD) are defined as a group of symptoms of disturbed perceptive thought content, mood, or behavior that include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering. Care of patients with BPSD involves pharmacological and nonpharmacological interventions. The aim of this systematic review was to identify and summarize the main nonpharmacological interventions for BPSD in the treatment of patients with dementia. Nonpharmacological interventions were found to provide positive results in reducing symptoms of BPSD. Most studies have shown that these interventions have important and significant efficacy.
- Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial
- Effectiveness of Interventions for Caregivers of People With Alzheimer's Disease and Related Major Neurocognitive Disorders: A Systematic Review
- Functional outcomes of the low vision depression prevention trial in age-related macular degeneration
- Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design
- Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial
- A Randomized Controlled Trial to Evaluate the Veterans' In-home Program for Military Veterans With Traumatic Brain Injury and Their Families: Report on Impact for Family Members
- Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial
- Psychometric properties of the Functional Capacity Card Sort for caregivers of people with dementia
- Scholarship of Practice in the Care of People with Dementia: Creating the Future Through Collaborative Efforts
- Home: An evolving context for health care
- Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: A systematic review
- Exploration of Individual and Family Factors Related to Community Reintegration in Veterans With Traumatic Brain Injury
- Effectiveness and acceptability within a skilled nursing facility setting
- The Let's Go Program for Community Participation: A Feasibility Study
- Correlates of quality of life for individuals with dementia living at home: The role of home environment, caregiver, and patient-related characteristics
- Meeting the needs of caregivers of persons with dementia: An important role for occupational therapy
- Enhancing quality of life in functionally vulnerable older adults: From randomized trial to standard care
- The tailored activity program to reduce behavioral symptoms in individuals with Dementia: Feasibility, acceptability, and replication potential
- Level I fieldwork today: A study of contexts and perceptions
- Adaptive equipment: A study of utilization after hospital discharge