VA Healthcare-VISN 4
SAGE QUERI Mentation -- Employing Tailored Activity (TAP) Program
“Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.” – IHI Age-Friendly Health System
The “Tailored Activities Program” (or TAP) improves functional capabilities and quality of life for Veterans with dementia, allowing them to age in place while also reducing caregiver burden. This intervention focuses on “mentation” but also takes into account “mobility” by optimizing functional capability and “what matters” by focusing on Veterans’ preferred activities.
Most older adults wish to “age in place” by remaining in their home environment. For people with dementia, however, behavioral symptoms such as agitation and aggression can interfere with this goal, and difficulty managing these symptoms is one of the strongest predictors of long-term institutional care. Family members provide 80% of care at home for people with dementia and are instrumental in delaying or avoiding institutional care.
More than 10,000 Veterans receiving care in the VISN4 VA health network have dementia, and this number is expected to grow. There is an urgent need to improve functional status and quality of life for Veterans with dementia while educating and supporting family caregivers in strategies to reduce challenging behaviors. Implementing TAP into VA clinical practice has been shown to significantly reduce Veterans’ functional dependence, leading to reductions in the time caregivers spend providing care and improvements in caregiver wellbeing.
Dr. Laura Gitlin’s Tailored Activity Program (TAP) is a 4-month, structured, manualized occupational therapy intervention that trains caregivers to deliver activities tailored to the care recipient’s interests and capabilities. These “activity prescriptions” are a central component of this individualized, family-centered program. Since many challenging behaviors occur in response to an environment that is too demanding or under-stimulating, this approach helps to maximize the fit between an individual’s preserved capabilities and environmental demands, promoting adaptive positive behaviors across multiple stages of dementia to proactively reduce challenging behaviors. In addition, TAP trains caregivers to be responsive to emergent and changing behavioral problems associated with dementia over time.
TAP’s effectiveness is supported by multiple randomized controlled trials (RCTs), including a RCT of 160 dyads within the VA. These trials have demonstrated statistically and clinically significant improvements in quality of life and reductions in functional dependency and disruptive behavioral symptom frequency among persons with dementia. Significant reductions in caregiver time providing care and improved caregiver wellbeing have also been observed.
FIND OUT MORE ABOUT TAP
Visit the Tailored Activity Program (TAP) website to learn more about the program and available training opportunities:
Tailored Activity Program’s (TAP) co-creator Dr. Laura Gitlin talks about aging, dementia, and why our healthcare system needs to adapt to the aging population: