Tailored Activity Program-Veterans Affairs
Tailored Activity Program-Veterans Affairs
The Tailored Activity Program - Veterans Administration is a Phase III efficacy trial
 designed to reduce behavioral symptoms in Veterans with dementia living with their caregivers
 in the community. The study uses a randomized two group parallel design with 160 diverse
 Veterans and caregivers. The experimental group receives a transformative patient-centric
 intervention designed to reduce the burden of behavioral symptoms in Veterans with dementia.
 An occupational therapist conducts an assessment to identify a Veteran's preserved
 capabilities, deficit areas, previous roles, habits, and interests to develop activities
 tailored to the Veteran. Family caregivers are then trained to incorporate activities into
 daily care. The attention-control group receives bi-monthly telephone contact where education
 on topics relevant to dementia is provided to caregivers. Key outcomes include reduced
 frequency and severity of behavioral symptoms using the 12-item Neuropsychiatric Inventory
 (primary endpoint), reduced caregiver burden, enhanced skill acquisition, efficacy using
 activities, and time spent providing care at 4 months; and long-term effects (8 months) on
 the Veteran's quality of life and frequency and severity of behavioral symptoms, and
 caregiver use of activities. The programs' impact of Veterans Administration cost is also
 examined. Study precision will be increased through face-to-face research team trainings with
 procedural manuals and review of audio-taped interviews and intervention sessions.
This study tests the efficacy of a transformative patient-centric intervention designed to
 reduce the burden of NPS in Veterans with dementia who live at home with family caregivers.
 The innovative intervention, the Tailored Activity Program (TAP-VA), involves 8 sessions over
 4 months in Veterans' homes. An occupational therapist conducts a systematic assessment to
 identify a Veteran's preserved capabilities and deficit areas, and previous roles, habits and
 interests from which to develop and introduce activities tailored to the Veteran's profile.
 Family caregivers are then trained to incorporate tailored activities into daily care
 routines. The intervention was pilot tested in an NIMH funded study with 60 community-living
 individuals with dementia. Findings from this pilot showed statistically significant and
 clinically meaningful reductions in NPS, specifically agitation and less time being on "duty"
 by family caregivers. Results of this pilot phase support moving forward with a full-scale
 Phase III efficacy trial. The investigators tested TAP-VA in a randomized two-group parallel
 design in which 160 racially and ethnically diverse Veterans with dementia and their family
 caregivers (dyads) were randomly assigned to receive TAP-VA or an attention control group.
 All dyads were evaluated at baseline and 4-months (main trial endpoint), and then reassessed
 at 8-months to evaluate long-term treatment effects (baseline to 8 months), including
 continued activity use, caregiver well-being, and costs.
Inclusion Criteria:

 Inclusion Criteria for Veterans with dementia include:

 -  English speaking

 -  diagnosed with dementia as above

 -  able to participate in at least two activities of daily living

 -  ADLs - bathing

 -  dressing

 -  grooming

 -  toileting

 -  transferring from bed to chair

 -  not currently participating in any other dementia-related intervention.

 -  If the Veteran with dementia is on any of four classes of psychotropic medications:

 -  antidepressant

 -  benzodiazepines

 -  antipsychotic

 -  anti-convulsant

 -  an anti-dementia medication (memantine or a cholinesterase inhibitor)

 -  We will require that he/she have been on a stable dose for 60 days prior to enrollment
 to minimize possible confounding effects of concomitant medications (the typical time
 frame used in clinical trials).

 -  Caregivers of Veterans must be:

 -  English speaking

 -  self-identify as the primary member of the family caring (hands-on or
 supervision) for the Veteran and 21 years of age or older (male or female)

 -  living with the Veteran

 -  accessible by telephone to schedule interview, intervention sessions and
 follow-up interviews

 -  planning to live in area for 8 months (to reduce loss to follow-up)

 -  indicate willingness to learn activity use

 -  report one or more NPS in the Veteran in the past month

 -  not currently participating in any other caregiver-related intervention.

 -  Finally, we will require that caregivers taking a psychotropic medication
 (antidepressant, benzodiazepines, antipsychotic, or anti-convulsant) at time of
 telephone screen be on a stable dose of the medication for 60 days prior to
 enrollment.

 Exclusion Criteria:

 -  Non English speaking

 -  Non-Veteran

 -  No caregiver

 -  No diagnosis of dementia