title: Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design.
abstract: Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission.
  
  
  
  The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only.
  
  
  
  The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide.
authors.affiliation: Center on Aging, School of Medicine, University of Connecticut, United States. Electronic address: Fortinsky@uchc.edu.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Fortinsky
authors.affiliation: School of Nursing, Johns Hopkins University, United States.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.affiliation: College of Pharmacy, Thomas Jefferson University, United States.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
authors.affiliation: College of Health Professions, Thomas Jefferson University, United States.
authors.forename: Catherine Verrier
authors.initials: CV
authors.lastname: Piersol
authors.affiliation: Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, United States.
authors.forename: James
authors.initials: J
authors.lastname: Grady
authors.affiliation: Center on Aging, School of Medicine, University of Connecticut, United States.
authors.forename: Julie T
authors.initials: JT
authors.lastname: Robison
authors.affiliation: School of Nursing, Quinnipiac University, United States.
authors.forename: Sheila
authors.initials: S
authors.lastname: Molony
mesh_terms: D000203:Activities of Daily Living; D057179:Advanced Practice Nursing; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000534:rehabilitation*; D017144:Focus Groups; D006699:Home Care Services; D006792:House Calls; D006801:Humans; D009788:Occupational Therapy; D011788:Quality of Life; D013689:Telephone; D057170:Translational Research, Biomedical; D014481:United States
keywords: Dementia; Family caregiving; Home care; Older adults