Date Presented 3/30/2017
This session describes preliminary effects of a strategy training intervention on performance of daily activities among persons at risk for disability associated with dementia. Findings suggest that strategy training may be an intervention platform to delay decline to disability.
Primary Author and Speaker: Juleen Rodakowski
Additional Authors and Speakers: Elizabeth R. Skidmore
PURPOSE: Older adults with mild cognitive impairment (MCI; the state between normal cognition and dementia) and depressive symptoms are at risk for disability associated with dementia. Unfortunately, few pharmacological or nonpharmacological interventions slow decline to disability for these at-risk older adults. Strategy training is a nonpharmacological intervention that is designed to enhance participation in daily activities, and it may slow decline to disability for these at-risk older adults (Rodakowski et al., 2016). We examined preliminary effects of strategy training on performance of daily activities among individuals with MCI and depressive symptoms.
DESIGN: Multiple community-based recruitment methods (e.g., libraries, senior centers, and independent living facilities) were used to recruit older adults experiencing MCI and depressive symptoms. We randomized older adults (age >60 yr) adjudicated with MCI and depressive symptoms to strategy training or usual care. For strategy training, 10 sessions were delivered over 5 wk by an occupational therapist in the participants’ homes.
METHOD: The Performance Assessment of Self-Care Skills (PASS) assessed performance in daily activities through standardized, criterion-referenced observations of eight tasks (shopping, bill paying, checkbook balancing, bill mailing, telephone use, medication management, critical information retrieval, and small device repair; Rogers & Holm, 1984). A composite score of the cues required to complete the daily activities was calculated. Within-group t tests and Cohen’s d effect sizes assessed preliminary effects of the intervention.
RESULTS: Twenty individuals with MCI and depressive symptoms were randomized to strategy training (ST; M age = 76.2, SD = 2.2) or usual care (UC; M age = 76.4, SD = 2.6). There was a significant within-group effect from baseline to 3 mo in the number of cues required by individuals in ST, t(7) = 2.67, p = .02. Mean scores on the PASS differed between groups at 3 mo (ST, M = 6.8, SD = 2.5; UC, M = 12.1, SD = 7.5), and although this difference was not statistically significant after controlling for baseline scores, it was associated with a large effect size (Cohen’s d = .96).
CONCLUSION: Strategy training is associated with promising preliminary effects on performance of daily activities among individuals with MCI and depressive symptoms. These findings suggest that strategy training may be one effective platform to enhance performance of daily activities among individuals who are at risk for declines to disability. An effective intervention, such as strategy training, that is designed to slow decline to disability for at-risk individuals is critical for older adults to maintain independent living status. Strategy training is delivered by an occupational therapist; thus, this type of effective intervention could demonstrate the benefits of occupational therapy intervention delivered early in the trajectory of decline to disability.
References
Rodakowski, J., Reynolds C. F., Lopez, O. L., Butters, M. A., Dew, M. A., & Skidmore E. R. (2016). Developing a non-pharmacological intervention for individuals with mild cognitive impairment. Journal of Applied Gerontology. Advance online publication. https://doi.org/10.1177/0733464816645808
Rogers, J. C., & Holm, M. B. (1984). Performance Assessment of Self-Care Skills (3.1). Pittsburgh: Authors.
