An approach from community-based occupational therapy to prevent the institutionalization of Persons with Cognitive impairment

Background: The rising prevalence of dementia demands an urgent shift from traditional institutional care toward person-centered, integrated services that prioritize autonomy and enable sustained community living for Persons with Dementia (PwD). This study addresses critical gaps in the care continuum: the lack of specialized step-down support following hospitalization and insufficient community-based interventions to proactively prevent institutionalization. The primary objective was to evaluate the feasibility and preliminary outcomes of a novel Home-Based Intervention for Persons with Cognitive Impairment (EAC_TC) model.

 

Methods: The EAC_TC service is led by an Occupational Therapist with support from a multidisciplinary team (social worker, geriatric nurse, doctor) and delivers comprehensive, preference-driven care. Inclusion criteria required a diagnosis of Mild Cognitive Impairment (MCI) or dementia and the presence of an active informal caregiver. To ensure robust continuity of care, referrals were accepted from diverse points across the integrated health and social care system, including primary care and intermediate care settings (Day Unit, Psycho-Geriatric Long-Term Units, and specialized Outpatient services).

 

The intervention comprised a maximum of 5 home sessions and 3 phone follow-ups over 90 days. Its design was personalized and determined following a comprehensive, in-home assessment of both the patient and the caregiver, thereby ensuring ecological validity. Outcomes were measured for both PwD (QoL, functionality, behavior, cognitive status) and caregivers (QoL, burnout, satisfaction) using validated instruments (Euroqol-5D, NPI-Q, Zarit Test) and customized checklists, covering five sub-programmes: Autonomy Promotion, Safe and Dementia-Friendly Home, Assistive Devices Training, Caregiver Empowerment, and Routine Activation.

 

Results: Preliminary findings from 106 individuals (68% women) demonstrated a positive impact and high feasibility. Interventions focused on home safety led to a 33% reduction in participants' perception of fall risk. Functional and behavioral stability was maintained, with 50% of caregivers reporting perceived increased autonomy in PwD following communication and compensatory strategy training. Notably, occupational balance significantly improved in 70% of participants, yielding functional, cognitive, and emotional benefits. Furthermore, contacts with primary care centers increased to proactively manage complications related to dementia (e.g., dysphagia, behavioral alterations). Satisfaction was universally high, with over 90% of users and caregivers rating all sub-programmes as "useful" or "very useful."

 

Implications: Key Learning Points and relevance for international delegates

The EAC_TC model successfully demonstrates the feasibility and effectiveness of deploying specialized multidisciplinary teams (led by Occupational Therapy) to the home setting to deliver complex, person-centered care. The most important finding is the significant success in preventing institutionalization and acute service use, as only two individuals required hospital admission during the four-month period. This low rate provides strong evidence that proactive, tailored home interventions are highly effective step-down strategies that maintain individuals in the community, suggesting the potential for major cost savings for health systems. Finally, the model successfully integrates caregiver empowerment and addresses their burden, recognizing the informal caregiver as an essential partner in ensuring the stability and sustainability of long-term community living.