Feasibility & Acceptability of a Behavioral Activation Intervention for Depression in Caregivers of People With Dementia

Data suggests that caregivers of people with dementia who have more activity upon awakening report lower levels of depression than sedentary counterparts (Smagula et al., 2019). Interventions designed to address morning activity falls within occupational therapy. This study explores occupational therapist feasibility and participant satisfaction of a structured morning activity intervention for caregivers of people with dementia.

DESIGN: We conducted a single group pre-post study.

METHODS: A trained occupational therapist delivered an adapted behavioral activation intervention (Alexopoulos et al., 2017) remotely, weekly, over nine-weeks to 19 dementia caregivers (mean age=69; SD=7; female= 18). Protocol adherence and procedures data were collected via a fidelity checklist; they included goal setting, action plan development, activity monitoring, and skill development using prompts and intervention materials. Caregiver satisfaction was collected with the Client Satisfaction Questionnaire (CSQ) (score range 7 – 28; higher scores indicate more satisfaction; Larsen et al., 1979). All data were analyzed with descriptive statistics using frequencies for adherence and procedures and means and standard deviations for participant satisfaction.

RESULTS: An average of nine sessions were delivered to each participant. Adherence to intervention protocol was achieved for 99.8% of sessions, and adherence to procedures was 99.7%. Participant satisfaction was high, ranging from 24 – 28 (mean = 27; SD 1.32).

CONCLUSION: High protocol and intervention procedure adherence demonstrate intervention feasibility for occupational therapists. Satisfaction scores indicate participant success in increasing morning activity with the structured intervention. This study exemplifies how occupational therapists can successfully implement an intervention to enhance morning activity in dementia caregivers. Outcomes may reduce depressive symptoms in these vulnerable caregivers.

References

Smagula, S., Hasler, B., Schulz, R., Graves, J., Reynolds, C., Aizenstein, H., … Hall, M. (2019). Activity patterns related to depression symptoms in stressed dementia caregivers. International Psychogeriatrics, 1–8. https://doi.org/10.1017/S1041610219001601

Alexopoulos, G. S., O'Neil, R., Banerjee, S., Raue, P. J., Victoria, L. W., Bress, J. N., … Arean, P. A. (2017). 'Engage' therapy: Prediction of change of late-life major depression. Journal of Affective Disorders, 221, 192–197. https://doi.org/10.1016/j.jad.2017.06.037

Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197–207. https://doi.org/10.1016/0149-7189(79)90094-6

Smagula, S. F., Isenberg, A. S., Stahl, S. T., Alexopoulos, G. S., Reynolds, C. F., 3rd, & Rodakowski, J. (2022). Adaptation and pilot study of a behavioral intervention targeting morning activation deficits in dementia caregivers: Scheduling activity and monitoring mornings (SAMM). The American Journal of Geriatric Psychiatry, 30(4), 494–503. https://doi.org/10.1016/j.jagp.2021.09.017