This application seeks support to test the feasibility and effectiveness of an intervention for caregivers of persons with Alzheimer's Disease and Related Disorders (ADRD). The intervention is a 16-week, home-based service entitled """"""""Environmental Skill-building Program (ESP)."""""""" The purpose of the program is to provide caregivers with the necessary skills and technical support to manipulate the home environment to change and control the severity of behavioral problems affecting the performance of activities of daily living (ADL) in individuals with ADRD. The Environmental Skill-building Program is a standardized, reproducible program. It uses a combination of protocols that are selected based on decision rules which prioritize specific problem areas of ADL management that may result in caregiver physical and emotional strain. The program is based on the theoretical framework of competence-environmental press and a model from occupational therapy of the environment conceptualized as four hierarchical layers: objects (physical items), tasks (daily routines), social groups (household composition and social resources) and culture (shared values and beliefs). A two-group randomized design will be used to: 1) test the short- and long-term effect of the home Environmental Skill-building Program (ESP) on caregiver use of environmental strategies; 2) test the short- and long-term effect of ESP on frequency of problem behaviors and ADL functioning in individuals with mild and moderate ADRD; 3) test the short- and long-term effect of ESP on physical and emotional burden in caregivers; and 4) describe similarities and difference of types of environmental strategies used by caregivers for individuals with mild versus moderate dementia. A sample of 250 caregivers from diverse cultural and economic backgrounds who reside with and care for an individual with mild or moderate dementia will be recruited from the Philadelphia Corporation for Aging's Long Term Care Access Unit. Eligible participants will be interviewed in their home (Time 1) and then randomly assigned to either an experimental or control group condition which will not receive grant supported services. Randomization will be stratified by caregiver gender (male vs. female) and familial relationship (spouse vs. non-spouse). All subjects will receive a home interview at Time 2 (five months from baseline) and a telephone interview at Time 3 (12 months from baseline). This research represents the collaborative efforts among an interdisciplinary team of researchers and occupational therapists in the College of Allied Health Sciences, Thomas Jefferson University and health and human service professionals and housing modification experts at the Philadelphia Corporation for Aging (PCA), an Area Agency on Aging.
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