This randomized clinical trial tested a new self-directed educational intervention to improve caregiver competence to create a safer home environment for persons with dementia living in the community. The sample included 108 patient/caregiver dyads: the intervention group ( ) received the Home Safety Toolkit (HST), including a new booklet based on health literacy principles, and sample safety items to enhance self-efficacy to make home safety modifications. The control group ( ) received customary care. Participants completed measures at baseline and at twelve-week follow-up. Multivariate Analysis of Covariance (MANCOVA) was used to test for significant group differences. All caregiver outcome variables improved in the intervention group more than in the control. Home safety was significant at , caregiver strain at , and caregiver self-efficacy at . Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group ( ). The self-directed use of this Home Safety Toolkit activated the primary family caregiver to make the home safer for the person with dementia of Alzheimer's type (DAT) or related disorder. Improving the competence of informal caregivers is especially important for patients with DAT in light of all stakeholders reliance on their unpaid care. 1. Introduction Dementia of the Alzheimer’s type is a growing public health problem. An estimated 35.6 million people were living with dementia in 2010, and the number is expected to double every 20 years to 65.7 million in 2030 and 115.4 million in 2050 [1]. In the United States, an estimated 5.2 million people have dementia of the Alzheimer’s type (DAT), a number that is projected to grow to 13.8 million by 2050 [2]. Other population studies estimate that 13% or 1 in 8 Americans aged 71 or older suffers from this disease [3], the sixth leading cause of death in the United States for which there is no treatment or cure [4]. A person with DAT will live an average of four to eight years and as long as 20 years after the onset of symptoms [5] during which 80% of their care is provided by family and friends [6]. These family caregivers absorb the largest costs of care in both dollars and emotional distress. In high-income countries, informal care accounts for 45% of the worldwide costs of dementia, $604 billion USD, and, in low-income and lower-middle-income countries, the costs of informal (unpaid) care by family caregivers account for the majority of costs [7]. Further, because of the demands of caring for a person with DAT, family caregivers have negative health
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