title: Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders.
abstract: BACKGROUND
  Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia. This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Resources for Enhancing Alzheimer's Caregiver Health (REACH) initiative.
  
  
  METHODS
  A randomized two-group design was implemented with three assessment points: baseline, 6 months, and 12 months. Caregivers were randomly assigned to a usual care control group or intervention that consisted of six occupational therapy sessions to help families modify the environment to support daily function of the person with dementia and reduce caregiver burden. Following 6-month active treatment, a maintenance phase consisted of one home and three brief telephone sessions to reinforce strategy use and obtain closure. Non-inferiority statistical analysis was used to evaluate whether intervention caregivers maintained treatment benefits from 6 to 12 months in comparison to controls.
  
  
  RESULTS
  For the sample of 127 at 6 months, caregivers in intervention reported improved skills (p = .028), less need for help providing assistance (p = .043), and fewer behavioral occurrences (p = .019) compared to caregivers in control. At 12 months, caregiver affect improved (p = .033), and there was a trend for maintenance of skills and reduced behavioral occurrences, but not for other outcome measures.
  
  
  CONCLUSIONS
  An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year. More frequent professional contact and ongoing skills training may be necessary to maintain other clinically important outcomes such as reduced upset with behaviors.
authors.affiliation: Center for Applied Research on Aging and Health, Philadelphia, Pennsylvania 19107, USA. laura.gitlin@jefferson.edu
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
authors.forename: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000544:Alzheimer Disease / Q000175:diagnosis / Q000451:nursing*; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods; D006701:Home Nursing / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000193:education*; D011336:Probability; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric