Abstract

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer’s disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

Clinical Case

Mrs. Clark, at age 75 yr, lived with her husband of 52 yr in a two-story home. Among her daily routines, Mrs. Clark managed the family checkbook, sang in the community choir, and enjoyed caring for her five grandchildren. Over the next 3 yr, paying bills and keeping track of daily activities became progressively more difficult to the point where errors occurred, and Mr. Clark and their daughter had to help. In addition, friends of Mrs. Clark noticed that she gradually stopped returning calls and was late or forgot choir practice. At age 78 yr, Mrs. Clark was diagnosed with Alzheimer’s disease (AD) by a neurologist to whom she was referred by her primary care physician. She continued to perform daily self-care activities by herself; however, her husband began to notice a decline in her ability. Her symptoms reflected a progression to the middle stage of the disease. After an appointment with her primary care physician, Mrs. Clark was referred for home-based occupational therapy to promote safety and functional performance at home and to provide caregiver education.

Occupational Therapy Assessment and Findings

During the first home visit, the occupational therapist, Tamara, interviewed Mrs. Clark and her husband to complete an occupational profile using the American Occupational Therapy Association’s template (retrieved from https://www.aota.org/∼/media/Corporate/Files/Practice/Manage/Documentation/AOTA-Occupational-Profile-Template.pdf). The occupational profile revealed that Mrs. Clark has two children and five grandchildren. Mr. Clark shared Mrs. Clark’s interests, which include singing, listening to music, gardening, and baking; however, she stopped singing in the community choir and left the stove on several times. Mr. Clark was concerned because his wife started to need more help in the morning to get ready; however, when he offered help, she often refused and sometimes became agitated. In addition, he reported that his wife has not been sleeping well at night—she will get up and wander around the house. Mrs. Clark told Tamara that she gets ready by herself every morning. When questioned about his priority for therapy goals, Mr. Clark stated he would like his wife to do as much for herself as possible, accept his help when needed, avoid periods of agitation, and sleep more soundly at night. Throughout the evaluation visit, Mr. Clark appeared stressed and overwhelmed.

Guided by the occupational profile, Mrs. Clark’s ability to perform self-care activities was assessed with the Performance Assessment of Self-Care Skills (Holm & Rogers, 2008). Mrs. Clark’s functional cognition was assessed with the Large Allen Cognitive Level Screen–5 (LACLS–5; Allen et al., 2007) and the Allen Diagnostic Module–Second Edition (ADM–2; Earhart, 2006) to identify her Allen Cognitive Level (ACL). The ACL describes the functional capacity to perform daily activities safely within the home environment, which is used to guide intervention and caregiver training. In addition, the Disability Assessment for Dementia (Gélinas, Gauthier, McIntyre, & Gauthier, 1999)—a proxy-respondent scale that assesses executive functioning skills in relation to performance of basic and instrumental activities of daily living—was administered to Mr. Clark. To assess Mrs. Clark’s agitation, Tamara used the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, 1986). She asked Mr. Clark to rate the frequency of agitated behaviors (physically aggressive, physically nonaggressive, verbally aggressive, and verbally nonaggressive).

To evaluate Mr. Clark’s health and well-being over the course of the intervention, Tamara administered the Geriatric Depression Scale—Short Form (Sheikh & Yesavage, 1986; Yesavage et al., 1982) and the Perceived Quality of Life Scale (Patrick, Danis, Southerland, & Hong, 1988). To evaluate home safety, Tamara administered the Safety Assessment of Function and the Environment for Rehabilitation—Health Outcome Measurement and Evaluation (Version 3; Chiu & Oliver, 2006; Chiu et al., 2006). See Table 1 for assessment results.

Assessment results revealed Mrs. Clark was independent in functional mobility; however, she was at a fall risk when transferring to and from the toilet and tub. In self-care performance, Mrs. Clark required verbal cues for accuracy and demonstrated poor safety awareness. Consistent with these findings, Mrs. Clark’s functional cognition reflected a reliance on well-established procedural memories to complete basic daily routines. The ACL indicated that Mrs. Clark could not live alone and needed 24-hr supervision to organize daily activities and to remove dangerous objects. Less than once a week, Mrs. Clark became agitated during self-care activities in the morning, and the most prevalent type of agitation was physical nonaggressive behaviors such as pacing and rummaging.

As the primary caregiver, Mr. Clark indicated that he was mildly depressed with a poor self-rated quality of life. Overall, the home environment had minor to major problems, primarily in the kitchen and with household activities. Of concern was numerous scatter rugs throughout the home and the storage of dangerous items (e.g., knives, cleaning solutions) in full view. Intervention goals focused on optimizing performance of activities of daily living (ADLs), targeting the morning and evening self-care routines; decreasing agitation; increasing activity engagement, including physical activity, to promote sleep; and improving caregiver communication and cuing skills.

Tamara reviewed the evidence from the September/October 2017 issue of the American Journal of Occupational Therapy (Jensen & Padilla, 2017; Piersol et al., 2017; Smallfield & Syrovatla-Keckenlaible, 2017) and also read the intervention recommendations with strong evidence from the Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease and Related Major Neurocognitive Disorders (Piersol & Jensen, 2017). She was encouraged to find strong evidence that rooms designed consistent with the intended purpose, as is found in home environments, improved behaviors of people with AD because she had often anecdotally noted this as a benefit for her clients receiving therapy in the home. Additionally, she found the following strong evidence that she used to plan the intervention for Mrs. Clark:

Occupational Therapy Intervention

Mrs. Clark received 12 home visits over 8 wk. Tamara asked that Mr. Clark be present during every visit. Mrs. Clark’s daughter attended 4 of the home visits.

Sample Intervention 1—Morning Home Visit Focused on Optimizing ADL Performance and Reducing Agitative Behaviors

Tamara scheduled several visits for early morning to address Mrs. Clark’s morning routine. A raised toilet set and tub bench were obtained from a local equipment loan closet, and, with Mr. Clark present, Tamara provided training in safe transfers with these devices using an errorless learning approach. During each session, Mrs. Clark performed several repetitions of both transfers, with Tamara preventing mistakes and ensuring a consistent sequence by using simple instructional cues, communication strategies, and occasional guiding for proper hand placement. At the end of the first training session, she left a written sequence of the steps with Mr. Clark and educated him on appropriate cueing and communication strategies to solidify a consistent routine and to promote reliance on procedural memories.

Errorless learning was also initiated for dressing and grooming, with Tamara consulting with Mr. Clark on Mrs. Clark’s past habits to ensure the best morning routine. Mrs. Clark appeared distracted and confused by extra items on the sink and in her closet, and this triggered agitation and refusal to accept assistance. Tamara assisted Mr. Clark in reducing clutter and setting out only needed hygiene and clothing items to reduce activity demands and agitation. To improve safety during dressing, Mrs. Clark sat in her favorite chair in the bedroom while Mr. Clark cued and assisted her through getting dressed. Multisensory stimulation, including softer lighting and quiet ambient music played during Mrs. Clark’s morning routine, seemed to decrease her tendency to become agitated.

Sample Intervention 2—Afternoon Home Visit Focused on Enhancing Sleep and Preventing Nighttime Falls

Given the strong evidence that exercise improves or maintains ADL performance, including sleep, Tamara used Mrs. Clark’s interest in gardening to introduce increased physical activity into her daily routine. Mr. and Mrs. Clark’s neighborhood sponsored a community garden, which was only two blocks from their home. During an afternoon home visit, Tamara, Mrs. Clark, and Mr. Clark walked to the garden, and Mrs. Clark participated in gardening activities at several raised flower beds in the garden. Resources for group exercise programs at the local community center were provided as additional exercise options.

To address Mrs. Clark’s night wandering and risk for falls, Tamara provided Mr. Clark with resources for renting a bed-exit alarm. She also recommended automatic nightlights in the bedroom and bathroom and arranging the bedroom to allow Mrs. Clark a clear path to the bathroom from her bed.

Conclusion

After 12 home visits over 8 wk, Mrs. Clark had met her goals designed to optimize independence and safety despite the cognitive decline inherent in AD. Through activity and environmental modifications, ADL training with an emphasis on errorless learning techniques, and deliberate caregiver education on appropriate cueing and assistance, Mrs. Clark was able to maintain or improve in several areas of the Performance Assessment of Self-Care Skills and decrease agitated behaviors (see Table 1). Mr. Clark demonstrated improved scores on the Geriatric Depression Scale—Short Form and the Perceived Quality of Life Scale, largely because of improved communication and ADL skills with his wife. Tamara provided Mr. Clark with recommendations for local professionally led support groups for caregivers of people with AD because Tamara found strong evidence for these groups to enhance caregiver well-being and quality of life.

References

Allen
,
C. K.
,
Austin
,
S. L.
,
David
,
S. K.
,
Earhart
,
C. A.
,
McCraith
,
D. B.
, &
Riska-Williams
,
L.
(
2007
).
Manual for the Allen Cognitive Level Screen—5 (ACLS–5) and Large Allen Cognitive Level Screen—5 (LACLS–5)
.
Camarillo, CA
:
ACLS and LACLS Committee
.
Blankevoort
,
C. G.
,
van Heuvelen
,
M. J. G.
,
Boersma
,
F.
,
Luning
,
H.
,
de Jong
,
J.
, &
Scherder
,
E. J. A.
(
2010
).
Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia
.
Dementia and Geriatric Cognitive Disorders
,
30
,
392
402
. https://doi.org/10.1159/000321357
Brenske
,
S.
,
Rudrud
,
E. H.
,
Schulze
,
K. A.
, &
Rapp
,
J. T.
(
2008
).
Increasing activity attendance and engagement in individuals with dementia using descriptive prompts
.
Journal of Applied Behavior Analysis
,
41
,
273
277
. https://doi.org/10.1901/jaba.2008.41-273
Chiu
,
T.
, &
Oliver
,
R.
(
2006
).
Factor analysis and construct validity of the SAFER–HOME
.
OTJR: Occupation, Participation and Health
,
26
,
132
142
.
Chiu
,
T.
,
Oliver
,
R.
,
Ascott
,
P.
,
Choo
,
L. C.
,
Davis
,
T.
,
Gaya
,
A.
, . . .
Letts
,
M.
(
2006
).
Safety Assessment of Function and the Environment for Rehabilitation—Health Outcome Measurement and Evaluation (SAFER–HOME) (Version 3)
.
Toronto
:
COTA Health
.
Cohen-Mansfield
,
J.
(
1986
).
Agitated behaviors in the elderly: II. Preliminary results in the cognitively deteriorated
.
Journal of the American Geriatrics Society
,
34
,
722
727
. https://doi.org/10.1111/j.1532-5415.1986.tb04303.x
Corbett
,
A.
,
Stevens
,
J.
,
Aarsland
,
D.
,
Day
,
S.
,
Moniz-Cook
,
E.
,
Woods
,
R.
, . . .
Ballard
,
C.
(
2012
).
Systematic review of services providing information and/or advice to people with dementia and/or their caregivers
.
International Journal of Geriatric Psychiatry
,
27
,
628
636
. https://doi.org/10.1002/gps.2762
Dechamps
,
A.
,
Fasotti
,
L.
,
Jungheim
,
J.
,
Leone
,
E.
,
Dood
,
E.
,
Allioux
,
A.
, . . .
Kessels
,
R. P. C.
(
2011
).
Effects of different learning methods for instrumental activities of daily living in patients with Alzheimer’s dementia: A pilot study
.
American Journal of Alzheimer’s Disease and Other Dementias
,
26
,
273
281
. https://doi.org/10.1177/1533317511404394
Ducharme
,
F. C.
,
Lévesque
,
L. L.
,
Lachance
,
L. M.
,
Kergoat
,
M. J.
,
Legault
,
A. J.
,
Beaudet
,
L. M.
, &
Zarit
,
S. H.
(
2011
).
“Learning to become a family caregiver” efficacy of an intervention program for caregivers following diagnosis of dementia in a relative
.
Gerontologist
,
51
,
484
494
. https://doi.org/10.1093/geront/gnr014
Earhart
,
C. A.
(
2006
).
Allen Diagnostic Module—Second Edition
.
Colchester, CT
:
S&S Worldwide
.
Egan
,
M.
,
Bérubé
,
D.
,
Racine
,
G.
,
Leonard
,
C.
, &
Rochon
,
E.
(
2010
).
Methods to enhance verbal communication between individuals with Alzheimer’s disease and their formal and informal caregivers: A systematic review
.
International Journal of Alzheimer’s Disease
,
2010
,
906818
. https://doi.org/10.4061/2010/906818
Elliott
,
A. F.
,
Burgio
,
L. D.
, &
DeCoster
,
J.
(
2010
).
Enhancing caregiver health: Findings from the Resources for Enhancing Alzheimer’s Caregiver Health II intervention
.
Journal of the American Geriatrics Society
,
58
,
30
37
. https://doi.org/10.1111/j.1532-5415.2009.02631.x
Fleming
,
R.
, &
Purandare
,
N.
(
2010
).
Long-term care for people with dementia: Environmental design guidelines
.
International Psychogeriatrics
,
22
,
1084
1096
. https://doi.org/10.1017/S1041610210000438
Forbes
,
D.
,
Thiessen
,
E. J.
,
Blake
,
C. M.
,
Forbes
,
S. C.
, &
Forbes
,
S.
(
2013
).
Exercise programs for people with dementia
.
Cochrane Database of Systematic Reviews
,
12
,
CD006489
. https://doi.org/10.1002/14651858.CD006489.pub3
Gélinas
,
I.
,
Gauthier
,
L.
,
McIntyre
,
M.
, &
Gauthier
,
S.
(
1999
).
Development of a functional measure for persons with Alzheimer’s disease: The Disability Assessment for Dementia
.
American Journal of Occupational Therapy
,
53
,
471
481
. https://doi.org/10.5014/ajot.53.5.471
Gitlin
,
L. N.
,
Winter
,
L.
,
Dennis
,
M. P.
,
Hodgson
,
N.
, &
Hauck
,
W. W.
(
2010a
).
A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: The COPE randomized trial
.
JAMA
,
304
,
983
991
. https://doi.org/10.1001/jama.2010.1253
Gitlin
,
L. N.
,
Winter
,
L.
,
Dennis
,
M. P.
,
Hodgson
,
N.
, &
Hauck
,
W. W.
(
2010b
).
Targeting and managing behavioral symptoms in individuals with dementia: A randomized trial of a nonpharmacological intervention
.
Journal of the American Geriatrics Society
,
58
,
1465
1474
. https://doi.org/10.1111/j.1532-5415.2010.02971.x
Hodgkinson
,
B.
,
Koch
,
S.
,
Nay
,
R.
, &
Lewis
,
M.
(
2007
).
Managing the wandering behaviour of people living in a residential aged care facility
.
International Journal of Evidence-Based Healthcare
,
5
,
406
436
.
Holm
,
M. B.
, &
Rogers
,
J. C.
(
2008
).
The Performance Assessment of Self-Care Skills (PASS)
. In
B. J.
Hemphill-Pearson
(Ed.),
Assessments in occupational therapy mental health
(2nd ed., pp.
101
112
).
Thorofare, NJ
:
Slack
.
Jensen
,
L. E.
, &
Padilla
,
R.
(
2017
).
Effectiveness of environment-based interventions on behavior, perception, and falls for people with Alzheimer’s disease and related disorders
.
American Journal of Occupational Therapy
,
71
,
105180030
. https://doi.org/10.5014/ajot.2017.027409
Kim
,
S. Y.
,
Yoo
,
E. Y.
,
Jung
,
M. Y.
,
Park
,
S. H.
, &
Park
,
J. H.
(
2012
).
A systematic review of the effects of occupational therapy for persons with dementia: A meta-analysis of randomized controlled trials
.
NeuroRehabilitation
,
31
,
107
115
.
Kouri
,
K. K.
,
Ducharme
,
F. C.
, &
Giroux
,
F.
(
2011
).
A psycho-educational intervention focused on communication for caregivers of a family member in the early stage of Alzheimer’s disease: Results of an experimental study
.
Dementia
,
10
,
435
453
. https://doi.org/10.1177/1471301211408124
Kuo
,
L. M.
,
Huang
,
H. L.
,
Huang
,
H. L.
,
Liang
,
J.
,
Chiu
,
Y. C.
,
Chen
,
S. T.
, . . .
Shyu
,
Y. I.
(
2013
).
A home-based training program improves Taiwanese family caregivers’ quality of life and decreases their risk for depression: A randomized controlled trial
.
International Journal of Geriatric Psychiatry
,
28
,
504
513
. https://doi.org/10.1002/gps.3853
Lancioni
,
G. E.
,
Singh
,
N. N.
,
O’Reilly
,
M. F.
,
Green
,
V. A.
,
Ferlisi
,
G.
,
Ferrarese
,
G.
, . . .
Zonno
,
N.
(
2013
).
Self-regulated music stimulation for persons with Alzheimer’s disease: Impact assessment and social validation
.
Developmental Neurorehabilitation
,
16
,
17
26
. https://doi.org/10.3109/17518423.2012.707693
Lee
,
G. Y.
,
Yip
,
C. C. K.
,
Yu
,
E. C. S.
, &
Man
,
D. W. K.
(
2013
).
Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer’s disease in Hong Kong: A pilot study
.
Clinical Interventions in Aging
,
8
,
623
633
.
Livingston
,
G.
,
Barber
,
J.
,
Rapaport
,
P.
,
Knapp
,
M.
,
Griffin
,
M.
,
King
,
D.
, . . .
Cooper
,
C.
(
2013
).
Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: Pragmatic randomised controlled trial
.
BMJ
,
347
,
f6276
. https://doi.org/10.1136/bmj.f6276
Marques
,
A.
,
Cruz
,
J.
,
Barbosa
,
A.
,
Figueiredo
,
D.
, &
Sousa
,
L. X.
(
2013
).
Motor and multisensory care-based approach in dementia: Long-term effects of a pilot study
.
American Journal of Alzheimer’s Disease and Other Dementias
,
28
,
24
34
. https://doi.org/10.1177/1533317512466691
Maseda
,
A.
,
Sánchez
,
A.
,
Marante
,
M. P.
,
González-Abraldes
,
I.
,
Buján
,
A.
, &
Millán-Calenti
,
J. C.
(
2014
).
Effects of multisensory stimulation on a sample of institutionalized elderly people with dementia diagnosis: A controlled longitudinal trial
.
American Journal of Alzheimer’s Disease and Other Dementias
,
29
,
463
473
. https://doi.org/10.1177/1533317514522540
McLaren
,
A. N.
,
Lamantia
,
M. A.
, &
Callahan
,
C. M.
(
2013
).
Systematic review of non-pharmacologic interventions to delay functional decline in community-dwelling patients with dementia
.
Aging and Mental Health
,
17
,
655
666
. https://doi.org/10.1080/13607863.2013.781121
Olazarán
,
J.
,
Reisberg
,
B.
,
Clare
,
L.
,
Cruz
,
I.
,
Peña-Casanova
,
J.
,
Del Ser
,
T.
, . . .
Muñiz
,
R.
(
2010
).
Nonpharmacological therapies in Alzheimer’s disease: A systematic review of efficacy
.
Dementia and Geriatric Cognitive Disorders
,
30
,
161
178
. https://doi.org/10.1159/000316119
Padilla
,
R.
(
2011a
).
Effectiveness of environment-based interventions for people with Alzheimer’s disease and related dementias
.
American Journal of Occupational Therapy
,
65
,
514
522
. https://doi.org/10.5014/ajot.2011.002600
Padilla
,
R.
(
2011b
).
Effectiveness of interventions designed to modify the activity demands of the occupations of self-care and leisure for people with Alzheimer’s disease and related dementias
.
American Journal of Occupational Therapy
,
65
,
523
531
. https://doi.org/10.5014/ajot.2011.002618
Patrick
,
D. L.
,
Danis
,
M.
,
Southerland
,
L. I.
, &
Hong
,
G.
(
1988
).
Quality of life following intensive care
.
Journal of General Internal Medicine
,
3
,
218
223
. https://doi.org/10.1007/BF02596335
Piersol
,
C. V.
, &
Jensen
,
L.
(
2017
).
Occupational therapy practice guidelines for adults with Alzheimer’s disease and related major neurocognitive disorders
.
Bethesda, MD
:
AOTA Press
.
Piersol
,
C. V.
,
Canton
,
K.
,
Connor
,
S. E.
,
Giller
,
I.
,
Lipman
,
S.
, &
Sager
,
S.
(
2017
).
Effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders: A systematic review
.
American Journal of Occupational Therapy
,
71
,
7105180020
. https://doi.org/10.5014/ajot.2017.027581
Pitkälä
,
K. H.
,
Pöysti
,
M. M.
,
Laakkonen
,
M.-L.
,
Tilvis
,
R. S.
,
Savikko
,
N.
,
Kautiainen
,
H.
, &
Strandberg
,
T. E.
(
2013
).
Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX): A randomized controlled trial
.
JAMA Internal Medicine
,
173
,
894
901
. https://doi.org/10.1001/jamainternmed.2013.359
Potter
,
R.
,
Ellard
,
D.
,
Rees
,
K.
, &
Thorogood
,
M.
(
2011
).
A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia
.
International Journal of Geriatric Psychiatry
,
26
,
1000
1011
. https://doi.org/10.1002/gps.2641
Rao
,
A. K.
,
Chou
,
A.
,
Bursley
,
B.
,
Smulofsky
,
J.
, &
Jezequel
,
J.
(
2014
).
Systematic review of the effects of exercise on activities of daily living in people with Alzheimer’s disease
.
American Journal of Occupational Therapy
,
68
,
50
56
. https://doi.org/10.5014/ajot.2014.009035
Riley-Doucet
,
C. K.
, &
Dunn
,
K. S.
(
2013
).
Using multisensory technology to create a therapeutic environment for people with dementia in an adult day center: A pilot study
.
Research in Gerontological Nursing
,
6
,
225
233
. https://doi.org/10.3928/19404921-20130801-01
Rowe
,
M. A.
,
Kelly
,
A.
,
Horne
,
C.
,
Lane
,
S.
,
Campbell
,
J.
,
Lehman
,
B.
, . . .
Benito
,
A. P.
(
2009
).
Reducing dangerous nighttime events in persons with dementia by using a nighttime monitoring system
.
Alzheimer’s and Dementia
,
5
,
419
426
. https://doi.org/10.1016/j.jalz.2008.08.005
Sánchez
,
A.
,
Millán-Calenti
,
J. C.
,
Lorenzo-López
,
L.
, &
Maseda
,
A.
(
2013
).
Multisensory stimulation for people with dementia: A review of the literature
.
American Journal of Alzheimer’s Disease and Other Dementias
,
28
,
7
14
. https://doi.org/10.1177/1533317512466693
Sheikh
,
J. I.
, &
Yesavage
,
J. A.
(
1986
).
Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version
. In
T. L.
Brink
(Ed.),
Clinical gerontology: A guide to assessment and intervention
(pp.
165
173
).
Binghamton, NY
:
Haworth Press
.
Smallfield
,
S.
, &
Syrovatla-Keckenlaible
,
C.
(
2017
).
Effectiveness of occupational therapy interventions to enhance occupational performance for adults with Alzheimer’s disease and related disorders: A systematic review
.
American Journal of Occupational Therapy
,
71
,
7105180010
. https://doi.org/10.5014/ajot.2017.024752
Tchalla
,
A. E.
,
Lachal
,
F.
,
Cardinaud
,
N.
,
Saulnier
,
I.
,
Rialle
,
V.
,
Preux
,
P. M.
, &
Dantoine
,
T.
(
2013
).
Preventing and managing indoor falls with home-based technologies in mild and moderate Alzheimer’s disease patients: Pilot study in a community dwelling
.
Dementia and Geriatric Cognitive Disorders
,
36
,
251
261
. https://doi.org/10.1159/000351863
van Tilborg
,
I. A.
,
Kessels
,
R. P.
, &
Hulstijn
,
W.
(
2011
).
How should we teach everyday skills in dementia? A controlled study comparing implicit and explicit training methods
.
Clinical Rehabilitation
,
25
,
638
648
. https://doi.org/10.1177/0269215510396738
Yesavage
,
J. A.
,
Brink
,
T. L.
,
Rose
,
T. L.
,
Lum
,
O.
,
Huang
,
V.
,
Adey
,
M.
, &
Leirer
,
V. O.
(
1982
).
Development and validation of a geriatric depression screening scale: A preliminary report
.
Journal of Psychiatric Research
,
17
,
37
49
. https://doi.org/10.1016/0022-3956(82)90033-4
Zimmerman
,
S.
,
Anderson
,
W. L.
,
Brode
,
S.
,
Jonas
,
D.
,
Lux
,
L.
,
Beeber
,
A. S.
, . . .
Sloane
,
P. D.
(
2013
).
Systematic review: Effective characteristics of nursing homes and other residential long-term care settings for people with dementia
.
Journal of the American Geriatrics Society
,
61
,
1399
1409
. https://doi.org/10.1111/jgs.12372