Evidence-Based Interventions
to Improve Quality of Life in
Dementia
Rebecca G. Logsdon, PhD
Research Funding
National Institute on Aging AG13757,
AG10845, AG05136, and AG14777
Alzheimer’s Association FSA-95-009, IIRG-0306319
Administration on Aging Alzheimer’s Disease Grants to
States
Northwest Research Group on Aging
Linda Teri, Rebecca Logsdon, Sue McCurry,
Kenneth Pike, David LaFazia,
Amy Moore, June van Leynseele
Cathy Blackburn, Cat Olcott
Quality of Life
Quality of life for older adults with chronic illness:
a sense of well-being, satisfaction with life, and selfesteem, accomplished through the care received, the
accomplishment of desired goals, and the ability to
exercise a satisfactory degree of control over one’s
life.
Quality of Life for Individuals
with Dementia



Sense of well-being

Absence of clinical depression and excessive anxiety

Freedom from physical pain

Safety and security
Satisfaction with life

Preferred living arrangements

Engagement in meaningful and pleasant activities

Participation in family and social activities
Self-esteem

Recognition of contributions

Respect from others
Quality of Life for Individuals
with Dementia



Sense of well-being

Absence of clinical depression and excessive anxiety

Freedom from physical pain

Safety and security
Satisfaction with life

Preferred living arrangements

Engagement in meaningful and pleasant activities

Participation in family and social activities
Self-esteem

Recognition of contributions

Respect from others
Quality of Life for Individuals
with Dementia



Sense of well-being

Absence of clinical depression and excessive anxiety

Freedom from physical pain

Safety and security
Satisfaction with life

Preferred living arrangements

Engagement in meaningful and pleasant activities

Participation in family and social activities
Self-esteem

Recognition of contributions

Respect from others
Quality of Life



Care received

Appropriate level of assistance

Provided in ways acceptable to the care recipient
Achievement of desired goals

Recognition of personal preferences

Individualized care to accomplish individualized needs
Control over one’s life

Participation in decision-making

Freedom to choose from acceptable alternatives
Quality of Life



Care received

Appropriate level of assistance

Provided in ways acceptable to the care recipient
Achievement of desired goals

Recognition of personal preferences

Individualized care to accomplish individualized needs
Control over one’s life

Participation in decision-making

Freedom to choose from acceptable alternatives
Quality of Life



Care received

Appropriate level of assistance

Provided in ways acceptable to the care recipient
Achievement of desired goals

Recognition of personal preferences

Individualized care to accomplish individualized needs
Control over one’s life

Participation in decision-making

Freedom to choose from acceptable alternatives
QOL & Psychosocial Intervention:
RCT Evidence Base

Maximize social and ADL function
Dooley, 2004; Gitlin, 2001, 03, 05; Graff, 2006; Lowenstein, 2004
Spector, 2003; Tarraga, 2006

Treat depressive symptoms and encourage pleasant activities
Teri, 1997, 2005; Gerdner, 1996, 2002; Huang, 2003
Lichtenberg, 2006; Logsdon, 2006

Improve or maintain physical mobility
Lazowski, 1999; Littbrand, 2006; Rolland, 2007 (NH)
Teri, 2003; Logsdon, 2005

Reduce caregiver burden and depression
Gallagher-Thompson, 1994, 2000, 07; Schulz, 2003, 05
Mittelman, 1995, 2004; Teri, 2005
RDAD: Reducing Disability in
Alzheimer’s Disease
Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner D, Barlow W, Kukull W,
LaCroix A, McCormick W, Larson E. (2003) Exercise plus behavior management in
patients with Alzheimer’s disease: A controlled clinical trial. JAMA, 290(15); 20152022.
Active treatment:
● Home-based exercise – strength, balance, endurance
● Behavior therapy – communication, problem-solving
 Control:
● Routine Medical Care
 Therapists: Master’s level home health providers (SW & PT)
 12-week treatment duration, monthly follow-up 4 months
 MMSE 0 to 29; Mean = 17
 Assessments at baseline, 3, 6, 12, and 24 months

Funded by the National Institute on Aging AG10845 and AG14777
Benefits of Physical Activity
for Individuals with Dementia
Improves Strength
and Mobility
Lazowski, et al, 1999
Arkin, et al, 2003
Hageman, et al, 2002
Rolland, et al, 2000
Reduces Depression
Teri, et al, 2004
Decreases Behavioral
Disturbances
Rolland, et al, 2000
Teri, et al, 2004
May Mitigate Cognitive
Decline
Rolland, et al, 2000
Emery, et al, 1998, 2003
Challenges of Exercise for
Individuals with Dementia
•
•
•
•
Reluctance to try new
activities
Difficulty learning &
remembering to do exercises
Inability to exercise
independently due to safety
concerns
Family caregivers lack
knowledge about exercise,
already burdened by daily
tasks, may be physically frail
RDAD Treatment Protocol
• 12-week program
• Delivered by community home health
providers (physical therapist or social worker)
• Exercise
•




Aerobic/endurance activities (walking)
Strength
Balance
Flexibility
Problem-solving



Education about AD
Intervening with behavioral problems
Enhance caregiver resources and skills
Change in Percent of Subjects
Exercising 60+ Minutes a Week
Community-residing AD patients
Mean Age = 78
Mean MMSE = 17
56% exercising 60+ minutes at baseline
30
26
25
20
RDAD
RMC
15
10
8
6
ITT: Pre-Post <.01
5
3
0
3-Month
12-Month
RDAD Outcomes
SF-36 Role Functioning
HDRS, Pts >6 on Cornell at baseline
ITT: Pre-Post p < .01
ITT: Pre-Post p < .05
Longitudinal p = .05
15
1
10
10
8
RDAD
RMC
5
0.6
RDAD
0.5
RMC
0
0
-0.5
-5
-1
-6
-10
-1.5
-1.6
-2
-2
-15
-2.5
-20
-17
-3
3-month
12-month
-3.5
3-Month
-3.2
24-Month
Change in Behavior
Reasons for residential
placement over 24-month
follow-up
60%
RDAD
50%
50%
RMC
40%
30%
20%
24%
27%
19% 18%
19%
10%
0%
-10%
Illness or Cognitive
Decline
Increased ADL
Impairment
Behavioral Problems
STAR-C: Caregiver Support
Teri L, McCurry SM, Logsdon RG, & Gibbons LE. (2005). Training community
consultants to help family members improve dementia care: A randomized controlled
trial. The Gerontologist, 45(6), 802-811.
Active treatment:
● Seattle Protocols – communication, problem solving, pleasant events
 Control:
● Routine medical care
 Caregiving consultants: Master’s-level mental health counselors
 8 weekly sessions, monthly phone calls 4 months
 MMSE 0-28; Mean = 14
 Assessments at baseline, 3, 6, and 12 months

Funding: Alzheimer’s Association Pioneer Grant P10-1800
STAR Caregivers
• 8 weekly in-home caregiver counseling sessions
• Communication, problem-solving, pleasant events
• Target behaviors
• agitation, anxiety, depression
• Provided by master’s level caregiving consultants
• Companion for person with dementia if needed
• Training, ongoing supervision, and weekly monitoring of
adherence to protocol by geropsychologists
ABCs and Problem-Solving

Problem behaviors can interfere with your ability to
care for a person with dementia and their ability to
enjoy life

Understanding dementia-related behaviors requires
observation of the ABCs: Activators, Behaviors,
and Consequences

You can change a problem behavior by preventing
it, or stopping it once it occurs
The ABC Problem Solving Plan
Where can you
break the chain of
events???
gram.
Promoting Pleasant Events

Individuals with dementia retain many skills
despite cognitive impairments.

Interpersonal relationships are very
important, and are fostered by shared
pleasant activities.

Caregiver depression and burden may be
lessened by focusing on positive, rather than
negative interactions.
Identify and Re-introduce
Pleasant Activities
 What did the person
enjoy in the past?
 What does he/she
enjoy now?
 How can tasks be
modified to
accommodate current
abilities?
 Who is available to
help with these
activities?
Baseline
Post-Treatment
Follow up
STAR-C Outcomes
17
16
15
30
Pre-Post p<.05
Longitudinal p<.02
CESD
15.8
14
28.1
13.2
13.6
26
12.4 12.5
25
24
23.3
12
22.3
22
11
10
STAR
27
Pre-Post p<.03
Longitudinal p<.04
28
14.8
13
RMBPC-Reaction
Burden
20
RMC
Pre-Post p<.01
Longitudinal p<.03
25
STAR
30
29.4
26
RMC
QOL-AD
Pre-Post p<.05
Longitudinal p<.03
29
25
28.4
23
23
23
28
28.3 28.4 28.2
27.8
21
21
20
27
19
26
17
25
15
STAR
RMC
STAR
RMC
Early Stage Support Groups
Logsdon RG, McCurry SM, & Teri L (2005). Time limited support groups for individuals
with early stage dementia and their care partners. Clinical Gerontologist, 30(2), 5-19.
Active treatment:
● Early Stage Memory Loss seminar program
 Control:
● Delayed treatment
 Support Group Facilitators: Master’s level social workers
 9 weekly sessions, participant and care partner attend together
 MMSE 18-30; Mean = 24
 Assessments at baseline and post treatment (2 months)

Funding: Alzheimer’s Association; R Logsdon, PI
Early Stage Memory Loss
Seminars

Groups planned and run by the Alzheimer’s
Association Chapter

Individuals with early stage dementia and care
partners attend together

Didactic Content: Everyone together, speaker or
facilitator-led information

Discussion, Questions, Support: Participants and
Care partners split up into two groups
Early Stage Memory Loss
Outcomes
For the Person with Memory Loss




Improved Social Functioning (p < .05)
Decreased Family Conflict (p < .05)
Decreased Depression (p < .01)
Improved Quality of Life (p < .01)
For the Care Partner

Decreased Distress about Problem Behaviors (p<.05)
Benefits of Early Stage Groups
0%
5%
10%
15%
20%
25%
30%
35%
Social Support
Information About AD
Decreased Isolation
Emotional Support
Participant
Care Partner
Legal Information
Community Resources
Caregiving Advice
Logsdon, et al, 2005 (Clinical Gerontologist)
Take Home Messages from
Research

Quality of life as perceived by the person with dementia does
not necessarily decline due to memory loss or cognitive
decline.

Quality of life is strongly influenced by mood.

Mood is influenced by pleasant activities, exercise, and social
support.

Family members, friends, and other caregivers can
significantly impact QOL for individuals with dementia.

What’s good for the person with dementia is good for the
caregiver.
AoA Sponsored Evidence-Based
Translation of These Interventions
RDAD


Ohio: Community-based
investigation
Washington State:
Memory Care & Wellness
Program in Adult Day
Centers
STAR-C


New Mexico
Oregon
Technical Support: Manuals, Materials, Measures
Training: For Planners, Evaluators, & Direct Care Providers
Fidelity Monitoring: Ongoing Supervision, Consultation