Preserving Identity and Planning for Advance Care (PIPAC): preliminary outcomes from a patient-centered intervention for individuals with mild dementia

Abstract

Objectives: The purpose of this pilot study was to conduct limited-efficacy testing of the newly developed Preserving Identity and Planning for Advance Care (PIPAC) intervention on self-reported and proxy-reported emotional and health-related outcomes of individuals in the early stages of dementia.

Method: A two-group comparison design was implemented. Blocked randomization was used to assign individuals with mild dementia and a family contact to either (1) the four-session, multi-component intervention group focused on reminiscence and future planning or (2) the minimal support phone contact comparison group. Of the 19 enrolled dyads, 18completed post-treatment assessments (i.e. 10 intervention and 8 comparison group). Individuals with dementia were M= 82.8 (SD = 6.46) years old; 31.6% were men and 68.4% were women. Participants were predominantly white/Caucasian (n = 18, 94.7%) with one black/African-American (5.3%).

Results: Analyses of covariance controlling for baseline differences revealed clinically meaningful differences (with medium to large effect sizes) between groups at post-treatment for depressive symptoms, quality of life, health-related quality of life indicators, and decisional conflict. Individuals in the intervention group were also observed to exhibit higher levels of coping. Feasibility data collected from participants and interventionists were encouraging.

Conclusion: Emotion-focused, patient-centered interventions like PIPAC hold promise for advancing treatment options in the early and mild stages of dementia. A full-scale, randomized clinical trial of this intervention is warranted to determine both short-term and long-term impacts on clinical outcomes including improved depressive symptomatology, quality of life, and health-related factors that impact daily functioning in social environments.

Keywords:

• pilot study
• coping
• stress process
• quality of life
• depression

Acknowledgements

Preliminary results of this project were presented at the 63rd Annual Scientific Meeting of the Gerontological Society of America, New Orleans, LA, in November 2010. We wish to acknowledge and thank Grant Harris, MA, and Philip Haley, PhD, who served as interventionists for this study as well as Patricia Parmelee, PhD, for facilitating focus groups with interventionists (results to be reported elsewhere). Study authors report no perceived or actual conflicts of interest.

Additional information

Funding

This work was supported by The University of Alabama's Center for Mental Health and Aging Summer Research Fellowship (2008 and 2009), awarded to the first author for completion of her doctoral dissertation at The University of Alabama in the Department of Psychology. Dissemination of this work was supported in part by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research and Development Service [Award #1 IK1 RX000791-01A1 Hilgeman, PI] and with resources and the use of facilities at the Tuscaloosa VA Medical Center.