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A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial


Gitlin, Laura N, Winter, Laraine, Dennis, Marie P., Hodgson, Nancy, Hauck, Walter W.


JAMA, Volume: 304, No.: 9, Pages.: 983-991

Year of Publication



Context: Optimal treatment to postpone functional decline in patients with dementia is not established.; Objective: To test a nonpharmacologic intervention realigning environmental demands with patient capabilities.; Design, Setting, and Participants: Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania.; Interventions: Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits; obtained blood and urine samples; and trained families in home safety, simplifying tasks, and stress reduction. Control group caregivers received 3 telephone calls and educational materials.; Main Outcome Measures: Functional dependence, quality of life, frequency of agitated behaviors, and engagement for patients and well-being, confidence using activities, and perceived benefits for caregivers at 4 months.; Results: Of 284 dyads screened, 270 (95%) were eligible and 237 (88%) randomized. Data were collected from 209 dyads (88%) at 4 months and 173 (73%) at 9 months. At 4 months, compared with controls, COPE patients had less functional dependence (adjusted mean difference, 0.24; 95% CI, 0.03-0.44; P = .02; Cohen d = 0.21) and less dependence in instrumental activities of daily living (adjusted mean difference, 0.32; 95% CI, 0.09-0.55; P = .007; Cohen d = 0.43), measured by a 15-item scale modeled after the Functional Independence Measure; COPE patients also had improved engagement (adjusted mean difference, 0.12; 95% CI, 0.07-0.22; P = .03; Cohen d = 0.26), measured by a 5-item scale. COPE caregivers improved in their well-being (adjusted mean difference in Perceived Change Index, 0.22; 95% CI, 0.08-0.36; P = .002; Cohen d = 0.30) and confidence using activities (adjusted mean difference, 0.81; 95% CI, 0.30-1.32; P = .002; Cohen d = 0.54), measured by a 5-item scale. By 4 months, 64 COPE dyads (62.7%) vs 48 control group dyads (44.9%) eliminated 1 or more caregiver-identified problems (chi(2/1) = 6.72, P = . 01).; Conclusion: Among community-living dyads, a nonpharmacologic biobehavioral environmental intervention compared with control resulted in better outcomes for COPE dyads at 4 months. Although no group differences were observed at 9 months for patients, COPE caregivers perceived greater benefits.; Trial Registration: Identifier: NCT00259454.;

Bibtex Citation

@article{Gitlin_2010, doi = {10.1001/jama.2010.1253}, url = {}, year = 2010, month = {sep}, publisher = {American Medical Association ({AMA})}, volume = {304}, number = {9}, pages = {983}, author = {Laura N. Gitlin and Laraine Winter and Marie P. Dennis and Nancy Hodgson and Walter W. Hauck}, title = {A Biobehavioral Home-Based Intervention and the Well-being of Patients With Dementia and Their Caregivers}, journal = {{JAMA}} }


activities of daily living, aged, aged, 80 and over, behavior therapy, caregivers, complications, dementia, female, health status, home care services, humans, interpersonal relations, intervention studies, male, middle aged, nursing, physiopathology, prospective studies, quality of life, therapy, treatment outcome

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

ADLs/IADLs, Behaviour, Other carer outcomes (e.g. financial burden and more), Quality of Life of Carer, Quality of Life of Person With Dementia



Type of Interventions

Intervention for Carers, Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Occupational Therapy

Carer Focussed Interventions

Training programmes / workshops including behavioural training