Feasibility of the tailored activity program to bridge hospital and community care for people living with dementia and behavioral disorders: The “Continu-A-Mente” project

The Tailored Activity Program (TAP) effectively manages Behavioral and Psychological Symptoms of Dementia (BPSD), yet its feasibility across the hospital-to-home care continuum for people living with dementia (PLwD) has not been tested. To assess the feasibility of TAP-Continu-A-Mente intervention for managing BPSD in PLwD transitioning from hospital to home, either following a short-stay observation or a memory clinic evaluation. Secondary aims were to evaluate changes in PLwD BPSD, caregiver distress and sense of competence, healthcare use, dyad satisfaction. This single-arm interventional feasibility study enrolled 50 dyads (PLwD and caregivers) at IRCCS San Gerardo Hospital (Monza, Italy). PLwD inclusion criteria were age ≥65, dementia diagnosis, Neuropsychiatric Inventory (NPI) ≥6 in at least one item, independence in at least two basic activities of daily living, fluency in Italian. The intervention consisted of eight sessions over three months (two in hospital and six at home) delivered by occupational therapists. The primary outcome was the proportion of dyads completing the program (dyad retention). Secondary outcomes, assessed at baseline and four months, included NPI, Clinical Frailty Scale (CFS), motor-functional status (Katz Index, TUG), caregiver self-efficacy (SCQ), and dyad satisfaction. PLwD had a median age of 81 (Q1–Q3: 77–86), and 52% were female. Patient baseline median CFS was 6 (Q1–Q3: 6–7), and 78% received ≥12 hours/day of caregiver assistance. Caregivers were mostly female (76%) with a median age of 59 (Q1–Q3: 55.5–74). Dyad retention was 84% (42/50), with dropouts mainly older females. Among completers, NPI total scores decreased at follow-up (frequency x severity 42.5 vs 20.5, and caregiver distress 21 vs 14; p < 0.001), while SCQ score increased (52 vs 65; p < 0.001). CNS-active medication use increased overall, from 1 to 2. Katz Index declined from 4 to 3, whereas TUG remained stable (15.5 vs 16.3). No institutionalizations occurred, and one hospitalization was recorded. More than half of patients and caregivers rated their experience as 5/5. TAP-Continu-A-Mente was a feasible hospital-to-home model of care for PLwD with BPSD. The observed reductions in NPI scores should be considered hypothesis-generating, warranting further investigation. The study protocol was approved by the Ethics Committee “Comitato Etico Brianza” (approval no. 4173, 12.01.2023).