Feasibility of the Tailored Activity Program for Hospitalized (TAP-H) Patients With Behavioral Symptoms

Laura N Gitlin, Katherine A Marx, Dana Alonzi, Tristen Kvedar, Jennifer Moody, Maranda Trahan, Kimberly Van Haitsma, Laura N Gitlin, Katherine A Marx, Dana Alonzi, Tristen Kvedar, Jennifer Moody, Maranda Trahan, Kimberly Van Haitsma

Abstract

Purpose of the study: To evaluate feasibility of implementing the Tailored Activity Program for Hospitals (TAP-H) to improve engagement in patients with dementia admitted for behavioral disturbances.

Design and methods: TAP-H involves up to 11 in-hospital sessions to develop activities tailored to patient interests and capabilities and train staff/families in their use. Interventionists (occupational therapists) recorded session lengths, patient engagement (N = 20), and staff (N = 4) readiness to use activities. Family interviews (N = 20) identified patient behaviors at admission and satisfaction with TAP-H 1 month postdischarge. A time series design with multiple behavioral observations (63 videotaped sessions) compared affective, verbal, and nonverbal behavioral responses in a standardized activity (baseline) to treatment sessions.

Results: Average number of treatment sessions per patient was 8.00 (SD = 2.71, range 3-13). Average time spent per session was 38.18min (SD = 10.01, range 19.09-57.50). Interventionists observed high patient engagement across treatment sessions. Observational data revealed increases in pleasure and positive gestures and decreases in anxiety/anger, negative verbalizations, and negative nonverbal behaviors from baseline to intervention sessions. Staff improved in readiness and families expressed high program satisfaction with 59.4% of activities used at home.

Implications: TAP-H represents a unique collaborative care model that integrates facility-based staff in the behavioral treatment of patients with dementia and results in improved affect and reduced negative behaviors. TAP-H can be incorporated into routine hospital care and payment mechanisms. Future efforts should evaluate its effectiveness in reducing inappropriate pharmacologic use and strategies to enhance continued activity use by staff during hospitalization and families following discharge.

Keywords: Behavioral symptoms; Caregiving; Dementia; Nonpharmacological management.

© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.
Figure 1.
(a–c) Affect, verbal, and nonverbal behaviors at baseline and across intervention sessions.
Figure 1.
Figure 1.
(a–c) Affect, verbal, and nonverbal behaviors at baseline and across intervention sessions.
Figure 1.
Figure 1.
(a–c) Affect, verbal, and nonverbal behaviors at baseline and across intervention sessions.

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