Abstract:

This article describes the specific environmental strategies that were accepted and used by 100 family caregivers who participated in a home-based occupational therapy intervention. The intervention was designed to enhance the skills of caregivers in using the physical and social environment to address troublesome behaviors and dependency associated with the progression of dementia. The intervention involved five 90-minute home visits by occupational therapists who worked with families to identify caregiving issues and generate environmental-based solutions. Solutions ranged from no cost recommendations (e.g., removing clutter, simplifying the environment), to resource dependent recommendations (e.g., installing grab bars or handrails). METHOD OF STUDY: Study participants were interviewed at home prior to intervention to gather basic demographic information and level of functioning of the person with dementia. During intervention, the occupational therapist recorded the number and types of caregiver issues that were the focus of intervention, the number and types of strategies introduced for each care issue and whether each strategy was accepted and subsequently utilized by caregivers. Barris, Kielhofner, Levine and Neville's (1985) model of the environment (objects, tasks, social groups, culture) was used to organize treatment focus and categorize environmental strategies. RESULTS: Of the nine problem areas that formed the focus of intervention, the issues most frequently identified by caregivers as problematic included caregiver-centered concerns, catastrophic reactions, wandering, and incontinence. Caregivers were willing to try a total of 1,068 strategies offered as part of intervention. Of the strategies, 869 (81%) were subsequently used independently by caregivers. Caregivers used a greater number of strategies that modified the task and social environments (with respectively 84% and 83% of tried strategies actually used by caregivers) than the objects layer of the environment (74% of tried strategies). CONCLUSIONS: Caregivers are receptive to and utilize environmental strategies offered by occupational therapists. Understanding which strategies were accepted and used by caregivers in this study provides important knowledge from which to enhance occupational therapy practice with this under-served population.