Bath time is often extremely distressing to persons with Alzheimer's disease (AD), leading to the behavioral symptom of resistiveness to care. Encountering these behaviors is distressing for caregivers as well. Most studies of interventions for behavioral symptoms of AD have been done in nursing homes, but most care takes place in the home. The overall goal of this research is to improve the at-home bathing experience of both patients with AD and their spouse caregivers. This study builds on preliminary studies that: 1) developed observational measures of patient behaviors and 2) developed and pilot tested the reminiscence during bathing intervention.
The specific aim of this randomized clinical trial is to evaluate the effectiveness of a 3-week reminiscence intervention, applied during bathing persons with (AD), in decreasing resistiveness to care (RTC), relieving patient discomfort, and improving spouse caregiver appraisals of burden, self-efficacy with bathing, and satisfaction. Reminiscence provides a personalized intervention that draws on preserved individuality and retained long-term memories, is simple to implement by solitary lay caregiver, and is adaptable to home environment. Best-loved memories, identified through interview with spouse caregivers, are used to engage the patient immediately prior to and during the bath. Home visits and telephone calls provide coaching and practice for caregivers in implementation. The sample includes 100 patient/spouse caregiver couples, randomized into one of the two groups: reminiscence with coaching (R-C) or home-based bathing support (B-S) control. Using a repeated measures design, observations will be made at baseline, post-intervention (5 weeks), and follow-up (8 weeks). All outcome measures will be standardized, psychometrically sound and appropriate for sequential administration. Patient outcomes are resistiveness to care and discomfort, measured by observation; caregiver outcomes burden, self-efficacy, and satisfaction, measured with interviewer-administered questionnaires. We hypothesize that for the R-C intervention group, patients will experience less RTC and less discomfort, and caregivers will experience fewer burdens, more self-efficacy, and more satisfaction than control group counterparts.
| Mahoney, Ellen K; Trudeau, Scott A; Penyack, Sarah E et al. (2006) Challenges to intervention implementation: lessons learned in the Bathing Persons with Alzheimer's Disease at Home study. Nurs Res 55:S10-6 |
