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KEY WORDS
activities of daily living
Alzheimer disease
health promotion
interpersonal relations
leisure activities
quality of life
An evidence-based review was undertaken to answer the question, What is the evidence for the effect of
interventions designed to establish, modify, and maintain activities of daily living (ADLs), instrumental
activities of daily living (IADLs), leisure, and social participation on quality of life (QOL), health and wellness, and client and caregiver satisfaction for people with Alzheimers disease and related dementias?
A systematic search of electronic databases and application of inclusion and exclusion criteria guided the
selection of 26 articles. Limited high-level evidence on ADL interventions was identified. IADL interventions
for people living in the community showed promise. Tailored and activity-based leisure interventions were
common and seemed to have positive impacts on caregiver satisfaction, and some interventions had
positive results for client well-being and QOL. Social participation interventions focused on people with
dementia still able to engage in verbal social interactions; these interventions had at least short-term positive effects.
Letts, L., Edwards, M., Berenyi, J., Moros, K., ONeill, C., OToole, C., et al. (2011). Using occupations to improve quality of
life, health and wellness, and client and caregiver satisfaction for people with Alzheimers disease and related
dementias. American Journal of Occupational Therapy, 65, 497504. doi: 10.5014/ajot.2011.002584
497
Results
The 2005 literature search and application of the inclusion
and exclusion criteria resulted in 24 articles selected for the
review. During the review process, we identified 2 other
studies from the occupational therapy literature (1 in 2007
and 1 in 2008) that had direct relevance to the topic, and
we decided to include them in the review, resulting in
a total of 26 articles included in the review.
Articles reviewed included 7 Level I (systematic
reviews, meta-analyses, and randomized controlled trials
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reported for caregiver QOL and health status. The intervention included identifying occupational performance
issues, goal setting, and helping participants implement
compensatory and environmental strategies. These results
built on those of a previous single-group pilot study (Graff,
Vernooij-Dassen, Hoefnagels, Dekker, & de Witte, 2003;
Level III, N 5 12) that implemented a 7-wk intervention
(maximum of 10 home visits) and demonstrated positive
outcomes in satisfaction with performance for clients and
caregivers (p 5 .002).
Dooley and Hinojosa (2004; Level I, N 5 40) suggested that an occupational therapy home assessment
followed by written recommendations and one follow-up
visit to discuss the implementation of the recommendations
may improve QOL and decrease caregiver burden more
than only an initial home assessment and receipt of recommendations by mail. In comparing outcomes between
the two groups, they found significant group effects for
positive affect, activity frequency, self-care status, and
caregiver burden (p < .001).
In a study conducted in a dementia care unit,
Fitzsimmons and Buettner (2003; Level I, N 5 12) found
that a regular (daily) therapeutic cooking group for residents had a significant positive impact on behavioral
outcomes (reduced agitation and passivity). In addition, blood pressure (as a proxy for health) increased as
engagement increased and decreased as agitation decreased (p < .067), suggesting health benefits from the
intervention.
Avila et al. (2004; Level III, N 5 5) pilot tested a
neuropsychological rehabilitation intervention (including
errorless learning, memory training, and IADL training).
They noted modest improvements on most scales after
treatment. QOL improved for patients and caregivers,
but the changes were not statistically significant (for patients,
p 5 .60; for caregivers, p 5 .83). Similarly, they found a trend
toward improved cognition and ADL function. However,
participants also received pharmacological interventions, and
attributing the findings to the neuropsychological rehabilitation interventions alone is difficult.
In six descriptive case studies, Topo, Jylha, and Laine
(2002; Level IV, N 5 6) showed that an easy-to-use
telephone (with identifying photos and preprogrammed
numbers) resulted in clients slightly improved ability
to use the phone. Family caregivers reported increased
satisfaction with clients telephone use. However, the
findings are based on a family questionnaire developed by
Topo et al.
In the area of IADLs, the evidence related to homebased occupational therapy interventions for people with
AD or related dementias and their caregivers has shown
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References
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