Unpaid caregivers are often expected to help family members or friends overcome activity limitations and participation restrictions to successfully age in place. Caregivers assume multiple responsibilities, such as managing their own physical and psychosocial needs and navigating a complex health care system, and many feel ill equipped to fulfill the necessary health care responsibilities for their care recipients. Underprepared caregivers may cause poor outcomes for care recipients. Federal and state policy proposals call attention to the need to better support caregivers, especially as their numbers increase. Occupational therapy practitioners are well positioned to effectively engage caregivers as they navigate the health care system. The occupational therapy process looks broadly at the functional abilities, environmental contexts, and occupational demands that play a pivotal role in successful aging in place for clients and better outcomes for their caregivers. Now is the time to define occupational therapy’s distinct value to this area.

Importance: Neuropsychiatric behaviors of persons with dementia, including agitation, aggression, and rejection of care, are almost universal; occur throughout the disease process; and have negative consequences for both persons with dementia and their caregivers. Nonpharmacological approaches are now recognized as first-line treatment to address these behaviors. One promising approach is activity tailored to the person’s interests, abilities, and physical and social environment. An evidence-based program, New Ways for Better Days: Tailoring Activities for Persons With Dementia and Their Caregivers (TAP), draws on occupational therapy principles (person–environment–occupation fit, activity analysis) to meaningfully engage persons with dementia. Objective: This case report describes the TAP protocol and clinical reasoning processes underlying use of tailored activities as a therapeutic modality to address dementia-related neuropsychiatric behaviors. Design: This is a case study of an African-American woman in her 60s caring for her father, age 92, who has severe dementia and multiple behaviors. Outcomes and Measures: Primary outcomes in this case report include the person with dementia’s engagement in an activity and the reported neuropsychiatric behaviors. In addition, the caregiver’s confidence in using activities is reported. These and other measures from the TAP protocol are described in full. Results: After working with an occupational therapist for eight sessions, the person with dementia’s engagement in activity increased by 50% and his frequency of vocal disturbance decreased, and the caregiver felt more confident in using activities with her father. Conclusion and Relevance: This case report illustrates how occupational therapists working with families of persons with dementia can use the TAP protocol to help them manage neuropsychiatric behaviors by tailoring activities. What This Article Adds: Occupational therapists are uniquely qualified to systematically assess the cognitive functioning of persons with dementia, caregivers, and home environments and to integrate this information to derive and implement activities tailored to the person’s capacities and context, thereby reducing neuropsychiatric behaviors and increasing engagement in meaningful activity.

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.

OBJECTIVE. The goal of the evidence review was to evaluate the effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders that facilitate the ability to maintain participation in the caregiver role. METHOD. Scientific literature published in English between January 2006 and April 2014 was reviewed. Databases included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. RESULTS. Of 2,476 records screened, 43 studies met inclusion criteria. Strong evidence shows that multicomponent psychoeducational interventions improve caregiver quality of life (QOL), confidence, and self-efficacy and reduce burden; cognitive reframing reduces caregiver anxiety, depression, and stress; communication skills training improves caregiver skill and QOL in persons with dementia; mindfulness-based training improves caregiver mental health and reduces stress and burden; and professionally led support groups enhance caregiver QOL. CONCLUSION. Strong evidence exists for a spectrum of caregiver interventions. Translation of effective interventions into practice and evaluation of sustainability is necessary.

The last comprehensive examination of the Level I fieldwork experience was performed 15 years ago (Shalik, 1990) and addressed the different types of settings in which fieldwork occurred; amounts and types of supervision; structure and scheduling of the Level I experiences; and the effects of supervising Level I students on productivity. Although every occupational therapy and occupational therapy assistant student encounters a number of Level I fieldwork opportunities, little is available describing the process and contexts of the Level I fieldwork experience today. This study, which examines 1,002 student reports on Level I fieldwork experiences, finds that Level I fieldwork today occurs in a wide variety of physical disability, pediatric, mental health, and emerging practice settings. Findings also indicate that, whereas most fieldwork educators are occupational therapy practitioners, more fieldwork educators are non–occupational therapists than in the past. Furthermore, although students reported opportunities to practice observation and communication across all settings, practice of other clinical skills was specific to type of settings, and opportunities to practice were limited. Student perceptions about opportunities for experiencing occupation-based practice, observation of theory in practice, and how students value different types of fieldwork experiences are addressed. In addition, this study explores the expansion of Level I fieldwork into emerging practice arenas and how students perceive those experiences.