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Gitlin LN, Cigliana J, Krauss MJ, Jacobsen HA, Piersol CV. Acceptability and Effectiveness of a Dementia-Care Program Delivered by Community-Based Agency Staff. THE GERONTOLOGIST 2024; 64:gnae045. [PMID: 38769713 DOI: 10.1093/geront/gnae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few proven dementia-care programs are integrated into community-based agencies. We report on the acceptability and effectiveness of an evidence-based program, Care of People in their Environment (COPE), delivered by community-based agency staff. RESEARCH DESIGN AND METHODS Pretest/post-test design with 3 data points (baseline, 3-month program completion, 6-month follow-up). COPE was delivered by 6 occupational therapists and 4 social workers at 2 agency sites with people living with dementia and caregivers. Staff assessed the interests and abilities of people living with dementia, home safety, caregiver challenges, and readiness to learn strategies. Staff provided dementia education, stress reduction, and nonpharmacological techniques tailored to caregiver-identified challenges. Acceptability (3- and 6-months), included completed sessions, upset with and confidence managing care challenges, strategies used, and program satisfaction. Effectiveness (3- and 6-months) included people living with dementia's health events (falls, emergency room visits, hospitalizations, and 911 calls), rehospitalization risk and functional dependence; and caregiver well-being and readiness. Benefits by in-person (n = 188) versus virtual/hybrid (n = 46) delivery due to Coronavirus Disease-2019 were evaluated. RESULTS Of 843 dyads screened, 271 (32.1%) enrolled, 246 (90.8%) completed COPE, and 234 (95.1%) completed ≥1 follow-up. Regarding acceptability, caregivers completed about 8 sessions, reported improved confidence and upset (p < .001), most implemented strategies 3-months (72.8%) and 6-months (83.5%), and expressed high program satisfaction. For effectiveness, compared to baseline, odds of people living with dementia's health events were lower including rehospitalization risk, although functional dependence increased; caregiver well-being (3-, 6-months, p < .001) and readiness (3-months, p < .01) improved. Outcomes did not differ by delivery mode. DISCUSSION AND IMPLICATIONS Acceptability and effectiveness were strong. COPE resulted in tangible improvements for families regardless of delivery mode.
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Affiliation(s)
- Laura N Gitlin
- AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jill Cigliana
- Memory Care Home Solutions, St. Louis, Missouri, USA
| | - Melissa J Krauss
- Brown School Evaluation Center, Washington University, St. Louis, Missouri, USA
| | - Heather A Jacobsen
- Brown School Evaluation Center, Washington University, St. Louis, Missouri, USA
| | - Catherine Verrier Piersol
- Jefferson Elder Care, College of Rehabilitation Sciences, Thomas Jefferson University Philadelphia, Philadelphia, Pennsylvania, USA
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Hwang Y, Hodgson NA, Gitlin LN. Implementing Dementia Caregiver Programs in Real-World Settings: Fidelity Considerations. J Am Med Dir Assoc 2024; 25:34-40.e11. [PMID: 38036027 PMCID: PMC10872702 DOI: 10.1016/j.jamda.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023]
Abstract
Testing interventions in real-world settings requires fidelity monitoring to ensure implementation integrity. However, strategies to enhance, monitor, and measure fidelity deployed in efficacy trials may not be feasible in pragmatic trials or sustainable in practice. This paper reviews published translational or pragmatic studies of dementia caregiver support interventions to understand how fidelity was previously treated in order to derive recommendations for future pragmatic-like trials. A search using SCOPUS, EMBASE, and Google Scholar identified 31 translational caregiver intervention studies of which 20 (64.5%) referenced fidelity. Of these 20, 11 (55.0%) reported fidelity measurement, whereas 9 (45.0%) only recognized its importance. Of the 11 studies, fidelity was assessed using investigator-developed scoring forms, audio/video recordings, evaluations from caregivers and interventionists, and by comparing outcomes with the original efficacy trial. Additionally, 7 (63.6%) of 11 studies reported fidelity results, representing only 22.5% of 31 studies reporting outcomes demonstrating the inconsistency in the field concerning the reporting outcomes of fidelity. We conclude that fidelity methods used in translational studies to date are not practical nor sustainable for ongoing monitoring of evidence-based programs in real-world settings and that only 2 aspects of fidelity, intervention and adherence, are considered. New approaches are needed to ensure fidelity integrity in pragmatic trials and which can be sustained thereafter.
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Affiliation(s)
- Yeji Hwang
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura N Gitlin
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Fredriksen-Goldsen KI, Jones BR, Hoy-Ellis C, Kim HJ, Emlet CA, La Fazia D, McKenzie G, Petros R, Teri L. Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA). Contemp Clin Trials Commun 2023; 35:101169. [PMID: 37638227 PMCID: PMC10448412 DOI: 10.1016/j.conctc.2023.101169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods This paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. Results The virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. Discussion The virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.
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Affiliation(s)
| | - Brittany R. Jones
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles Hoy-Ellis
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Charles A. Emlet
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - David La Fazia
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Ryan Petros
- University of Washington, School of Social Work, 1410 15th Ave NE, Seattle, WA, 98105, USA
| | - Linda Teri
- University of Washington, School of Nursing, 1410 NE Campus Parkway, Seattle, WA, 98195, USA
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Lindauer A, Smith S, Gothard S, Mattek N, Tran L, Mooney A. 'There's no straight line…' a consumer-informed intervention for FTD family care partners: the STELLA-FTD pilot study. Aging Ment Health 2023; 27:2000-2010. [PMID: 37655616 PMCID: PMC10518812 DOI: 10.1080/13607863.2023.2250741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Behavioral symptoms and communication challenges are particularly apparent in frontotemporal degenerative (FTD) dementias. There is a paucity of psychoeducation programming specifically tailored to the needs of families with FTD. We revised an existing intervention to meet the needs of these families. METHODS We used a quasi-experimental approach. In Phase 1, we sought consumer input about an existing intervention. In Phase 2, we modified the intervention based on the qualitative findings from Phase 1 and tested the revised intervention (STELLA-FTD) for feasibility, acceptability and early-stage efficacy. Outcome for Phase 2 included feasibility data and care partner reactivity to upsetting behaviors. Secondary outcomes included data from unobtrusive sleep monitoring. An inductive analysis of transcripts from the Phase 2 STELLA-FTD focus group provides guidance for future revisions. RESULTS Fifteen family care partners participated in the Phase 1 focus groups; sixteen care partners enrolled in Phase 2. Testing in Phase 2 revealed that the care partners found our consumer-informed revised intervention both feasible and acceptable. The post-intervention findings suggest STELLA-FTD has the potential to reduce care partner reactivity to upsetting behaviors and to decrease care partner burden. Sleep did not change over the 8-week intervention. CONCLUSIONS The revised STELLA-FTD intervention was found to be feasible and acceptable, and has potential to improve care partner burden for families living with FTD. Providing the intervention via telehealth maximized access and engaged rehabilitation specialists in providing disease management content. Future revisions will include examination of efficacy and mechanism of action (OHSU IRB # 00022721, ClinicalTrials.gov NCT05338710).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Samantha Smith
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Leslie Tran
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
| | - Aimee Mooney
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Oregon, Portland
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Fredriksen-Goldsen K, Teri L, Kim HJ, La Fazia D, McKenzie G, Petros R, Jung HH, Jones BR, Brown C, Emlet CA. Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners. Contemp Clin Trials 2023; 128:107143. [PMID: 36893987 PMCID: PMC10639124 DOI: 10.1016/j.cct.2023.107143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.
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Affiliation(s)
| | - Linda Teri
- University of Washington, School of Nursing, Box 357260, Seattle, WA 98195, USA.
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - David La Fazia
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3076, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, USA.
| | - Ryan Petros
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Hailey H Jung
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Brittany R Jones
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Char Brown
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Charles A Emlet
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
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Kim HJ, Fredriksen-Goldsen K, Jung HH. Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment. J Aging Health 2023; 35:138-150. [PMID: 35766354 PMCID: PMC9771910 DOI: 10.1177/08982643221108658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.
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Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Hailey H. Jung
- School of Social Work, University of Washington, Seattle, WA, USA
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Gao W, Zhang T, Wang H, Wang S, Liu Y, Pang X. Supporting caregivers of people with dementia: A systematic review of guidelines. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e305-e324. [PMID: 34750910 DOI: 10.1111/hsc.13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Caregivers of people with dementia (PwD) frequently experience poor physical, mental and social health. Over the past decade, several guidelines have offered recommendations on supporting caregivers to improve their health outcomes. This systematic review aimed to assess the quality and evidence base of guidelines on supporting caregivers of PwD and review the content of their recommendations on caregiver support to facilitate the adoption and implementation of a specific guideline among policymakers and practitioners. A systematic search for guidelines on supporting caregivers of PwD was performed using journal databases, websites of guideline development organisations and professional dementia-related societies from inception to 30 June 2020. Four independent reviewers performed the quality assessment of the included guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. A thematic synthesis was used to analyse the content of recommendations on caregiver support extracted from the included guidelines by two independent reviewers. The strength of recommendations and level of evidence were reclassified and analysed. Literature searches identified nine guidelines. Their quality was variable. The applicability domain on AGREE II yielded the lowest median score (62.2%; range: 18.6%-86.6%), suggesting that some guidelines lacked applicability in certain fields, leaving them open to interpretation. Most evidence underlying the extracted recommendations was rated as Levels 3 (51.3%) and 4 (31.1%). High-quality evidence is required to fortify these recommendations. The nine guidelines covered six themes-assessment, education, skill training, information provision, psychosocial support and general support policies-which can guide future policies and interventions of caregiver support. The recommendations extracted were consistent across guidelines, but each guideline failed to cover all six themes. Thus, more applicable and comprehensive guidelines that fully address all themes of support for caregivers of PwD are needed.
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Affiliation(s)
- Weijie Gao
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tieling Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongyun Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuling Liu
- Community Health Service Centers of Jieyuan Dao, Tianjin, China
| | - Xiaoli Pang
- Office of Academic Studies, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Boll AM, Ensey MR, Bennett KA, O'Leary MP, Wise-Swanson BM, Verrall AM, Vitiello MV, Cochrane BB, Phelan EA. A Feasibility Study of Primary Care Liaisons: Linking Older Adults to Community Resources. Am J Prev Med 2021; 61:e305-e312. [PMID: 34497030 DOI: 10.1016/j.amepre.2021.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Programs and services available through the aging services network can help community-dwelling older adults to age in place but are often not discussed in routine primary care. The primary care liaison was developed as a novel integration intervention to address this disconnect. METHODS Employed by an Area Agency on Aging, primary care liaisons performed outreach to primary care with the goal of raising awareness of community-based programs, resources, and services available to older adults and their caregivers and facilitating referrals. The evaluation of the primary care liaison model, conducted from December 2015 to February 2019, used the Reach, Effectiveness, Adoption, Implementation, Maintenance framework and assessed reach (number of clinics contacted), adoption (number of referrals to the Area Agency on Aging), implementation (number of follow-up contacts with a practice), and effectiveness (proportion of referrals reached and provided relevant resources). RESULTS The primary care liaisons contacted a median of 18.5 clinics per month (IQR=15-31). Primary care referrals averaged >100 per month, and referrals increased over time. Successful follow-up outreach visits had a median of 3 (IQR=2-10), and follow-up contacts had a median of 3 (IQR=1-7) per practice. Three quarters of caregivers for people with dementia reached by Area Agency on Aging staff were provided with information about relevant resources. CONCLUSIONS The primary care liaison model is feasible, fosters ongoing interactions between primary care and Area Agencies on Aging, and connects older adults and their caregivers to relevant programs and services. Adoption of the primary care liaison model by other Area Agencies on Aging across the U.S. may help further the vision of optimized health and well-being of older adults.
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Affiliation(s)
- Allison M Boll
- Aging and Disability Services (ADS) Seattle King-County, Seattle, Washington
| | - Melissa R Ensey
- Area Agency on Aging & Disabilities of Southwest Washington, Vancouver, Washington
| | - Katherine A Bennett
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Mary P O'Leary
- Aging and Disability Services (ADS) Seattle King-County, Seattle, Washington
| | | | - Aimee M Verrall
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington.
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
| | - Barbara B Cochrane
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington
| | - Elizabeth A Phelan
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
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Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies. Int Psychogeriatr 2021; 33:947-975. [PMID: 33190660 DOI: 10.1017/s1041610220001702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. DESIGN This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. RESULTS Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change - the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. CONCLUSIONS Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.
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Dobbs D, Zimmerman S, Carder P, Beeber AS, Palmertree SJ. Staff Reports of Behavioral Expressions of Persons with Dementia in 250 Assisted Living Communities. THE GERONTOLOGIST 2021; 62:169-180. [PMID: 33993241 DOI: 10.1093/geront/gnab059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Assisted living (AL) residents with dementia commonly exhibit behavioral expressions (BEs), yet no study has examined how AL staff perceive of and respond to BEs in terms of the "ABC" model of antecedents, behaviors and consequences, or how perceptions relate to organizational characteristics. Understanding staff perceptions may inform interventions. RESEARCH DESIGN AND METHODS A convergent, mixed-methods design was used in a study of health care supervisors from 250 AL communities in seven states who reported 366 cases of resident BEs (one successful and one unsuccessful case). Qualitative analysis identified antecedents, BEs, staff responses, resident outcomes, and disposition (aging in place or discharge). Content analysis identified themes and compared case types. Descriptive statistics examined organizational characteristics associated with identifying antecedents. RESULTS One-quarter of cases recognized antecedents; slightly more were identified in successful (28%) compared to unsuccessful cases (20%); staff in dementia-only and smaller communities identified antecedents more often. Combativeness and anxiety were the most frequently reported BEs. The majority of both types of cases reported staff responses. Medication management was enacted as a response in 40% of cases compared to psychiatric assessment in 33% of cases. DISCUSSION AND IMPLICATIONS Staff training is indicated to increase AL staff recognition of antecedents; doing so might reduce use of antipsychotic medications. Psychiatric assessment plays an important role in dementia care in AL and warrants further examination. Results could be helpful for applied behavioral researchers interested in developing ways to improve identification of antecedents of BEs of persons with dementia.
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Affiliation(s)
- Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paula Carder
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Anna S Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie J Palmertree
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ramirez M, Duran MC, Pabiniak CJ, Hansen KE, Kelley A, Ralston JD, McCurry SM, Teri L, Penfold RB. Family Caregiver Needs and Preferences for Virtual Training to Manage Behavioral and Psychological Symptoms of Dementia: Interview Study. JMIR Aging 2021; 4:e24965. [PMID: 33565984 PMCID: PMC8081155 DOI: 10.2196/24965] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are associated with increased stress, burden, and depression among family caregivers of people with dementia. STAR-Caregivers Virtual Training and Follow-up (STAR-VTF) is adapted from an evidence-based, in-person program that trains family caregivers to manage BPSD. We used a human-centered design approach to obtain feedback from family caregivers about STAR-VTF. The program will be evaluated using a pragmatic randomized trial. OBJECTIVE The objective of the study was to understand the needs of family caregivers for improving BPSD management and the extent to which caregivers perceived that STAR-VTF could address those needs. METHODS Between July and September 2019, we conducted 15 semistructured interviews with family caregivers of people with dementia who receive care at Kaiser Permanente Washington in the Seattle metropolitan area. We identified participants from electronic health records, primarily based on a prescription for antipsychotic medication for the person with dementia (a proxy for caregivers dealing with BPSD). We showed caregivers low-fidelity prototypes of STAR-VTF online self-directed materials and verbally described potential design elements. We obtained caregiver feedback on these elements, focusing on their needs and preferences and perceived barriers to using STAR-VTF. We used a hybrid approach of inductive and deductive coding and aggregated codes to develop themes. RESULTS The idea of a virtual training program for learning to manage BPSD appealed to caregivers. They said health care providers did not provide adequate education in the early disease stages about the personality and behavior symptoms that can affect people with dementia. Caregivers found it unexpected and frustrating when the person with dementia began experiencing BPSD, symptoms they felt unprepared to manage. Accordingly, caregivers expressed a strong desire for the health care organization to offer programs such as STAR-VTF much sooner. Caregivers had already put considerable effort into problem solving challenging behaviors. They anticipated deriving less value from STAR-VTF at that point. Nonetheless, many were interested in the virtual aspect of the training due to the convenience of receiving help from home and the perception that help from a virtual program would be timelier than traditional service modalities (eg, face to face). Given caregivers' limited time, they suggested dividing the STAR-VTF content into chunks to review as time permitted. Caregivers were interested in having a STAR-VTF provider for additional support in managing challenging behaviors. Caregivers reported a preference for having the same coach for the program duration. CONCLUSIONS Caregivers we interviewed would likely accept a virtual training program such as STAR-VTF to obtain information about BPSD and receive help managing it. Family caregivers anticipated deriving more value if STAR-VTF was offered earlier in the disease course.
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Affiliation(s)
- Magaly Ramirez
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Miriana C Duran
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
| | - Chester J Pabiniak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Kelly E Hansen
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Ann Kelley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - James D Ralston
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Susan M McCurry
- Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, United States
| | - Linda Teri
- University of Washington School of Nursing, Seattle, WA, United States
| | - Robert B Penfold
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, United States
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
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Vigliotti AA, Chinchilli VM, George DR. Evaluating the Benefits of the TimeSlips Creative Storytelling Program for Persons With Varying Degrees of Dementia Severity. Am J Alzheimers Dis Other Demen 2019; 34:163-170. [PMID: 30295037 PMCID: PMC10852417 DOI: 10.1177/1533317518802427] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES To evaluate the benefits of TimeSlips, a group creative storytelling intervention used in residential care settings, on quality of life (QOL), interactions with caregivers, and Mini-Mental State Examination (MMSE) scores for persons with varying degrees of dementia severity. DESIGN A mixed-methods approach was used weekly over a 6-month period to measure QOL and resident-caregiver relationships. SETTING A dementia care unit in Pennsylvania. PARTICIPANTS Twenty-two residents with mild-to-severe dementia. MEASUREMENTS Dementia severity and QOL were assessed using the MMSE and Greater Cincinnati Chapter Well-Being Observational Tool. Resident-caregiver interactions were analyzed using a modified version of the Quality of Interactions Schedule. Semistructured interviews were conducted upon the study's conclusion. RESULTS Quantitatively, participants initially classified with mild-moderate dementia were significantly more likely to experience positive benefits compared to those initially classified with severe dementia. There were no significant changes in dementia severity over time. There was also no change in QOL or resident-caregiver relationships for those with mild-moderate dementia over time, although there was a decrease in certain measures of QOL and resident-caregiver relationships for those with severe dementia. Qualitative analysis identified consistent benefits for residents with both mild-moderate and severe dementia over time. CONCLUSIONS Mixed-methods analyses helped identify benefits of TimeSlips for persons at all levels of dementia severity, but particularly for those with milder dementia. Such an observation helps demonstrate how arts-based programs like TimeSlips can uniquely benefit people with advanced memory impairments and thereby support QOL.
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Affiliation(s)
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R. George
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
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Enhancing Quality of Life and Caregiver Interactions for Persons with Dementia Using TimeSlips Group Storytelling: A 6-Month Longitudinal Study. Am J Geriatr Psychiatry 2018; 26:507-508. [PMID: 29117914 DOI: 10.1016/j.jagp.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/20/2022]
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McCurry SM, Logsdon RG, Pike KC, LaFazia DM, Teri L. Training Area Agencies on Aging Case Managers to Improve Physical Function, Mood, and Behavior in Persons With Dementia and Caregivers: Examples from the RDAD-Northwest Study. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:45-60. [PMID: 29135358 PMCID: PMC5939562 DOI: 10.1080/01634372.2017.1400486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Reducing Disability in Alzheimer's Disease (RDAD) program has been shown to be an effective tool for teaching caregivers strategies to improve mood, behavior, and physical function in persons with dementia. This paper describes how RDAD has been translated and implemented for use by Area Agencies on Aging (AAA) case managers across Washington and Oregon. Modifications to the original RDAD program as part of its community translation included decreasing the number of in-person sessions while preserving all educational content; involving caregivers in exercise activities for themselves as well as acting as exercise coaches for care-receivers; and enrolling persons with cognitive impairment due to mixed etiologies. This paper describes these changes and their rationale, the challenges faced by community agencies recruiting for and delivering evidence-based programs, and illustrates the actual RDAD implementation process through several brief case examples. Case examples also illustrate how RDAD-Northwest can be useful with care-receivers with a range of cognitive impairment severity, family caregiving situations, and levels of mood and behavioral challenges.
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Affiliation(s)
- Susan M McCurry
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Rebecca G Logsdon
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Kenneth C Pike
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - David M LaFazia
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
| | - Linda Teri
- a Department of Psychosocial and Community Health , University of Washington , Seattle WA , USA
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Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet 2017; 390:2673-2734. [PMID: 28735855 DOI: 10.1016/s0140-6736(17)31363-6] [Citation(s) in RCA: 3448] [Impact Index Per Article: 492.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Department of Old Age Psychiatry, King's College London, London, UK
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia; Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair Burns
- Centre for Dementia Studies, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Fox
- Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Lon S Schneider
- Department of Neurology and Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
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Fredriksen-Goldsen KI, Kim HJ, McKenzie GL, Krinsky L, Emlet CA. Plan of Action for Real-World Translation of LGBTQ Health and Aging Research. LGBT Health 2017; 4:384-388. [PMID: 29099666 DOI: 10.1089/lgbt.2017.0185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite accumulating evidence of health disparities, there exists limited translational research to enhance optimal health and aging of lesbian, gay, bisexual, transgender, and queer-identified * (LGBTQ) older adults. Based on the Health Equity Promotion Model that addresses the distinct needs and strengths of LGBTQ older adults, we underscore the important role of collaborations among researchers, practitioners, and communities to build community capacity. Given the rapidly shifting context, we advance principles to guide future work that will enhance translational research and the development of evidence-based practice so that LGBTQ older adults can reach their full health potential.
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Affiliation(s)
| | - Hyun-Jun Kim
- 1 School of Social Work, University of Washington , Seattle, Washington
| | - Glenise L McKenzie
- 2 School of Nursing Portland Campus, Oregon Health & Science University , Portland, Oregon
| | - Lisa Krinsky
- 3 LGBT Aging Project, The Fenway Institute , Boston, Massachusetts
| | - Charles A Emlet
- 4 School of Social Work, University of Washington , Tacoma, Washington
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Lord K, Rapaport P, Cooper C, Livingston G. Disseminating START: training clinical psychologists and admiral nurses as trainers in a psychosocial intervention for carers of people with dementia's depressive and anxiety symptoms. BMJ Open 2017; 7:e017759. [PMID: 28827274 PMCID: PMC5724092 DOI: 10.1136/bmjopen-2017-017759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To put into practice and to evaluate an initial dissemination programme for the Strategies for Relatives (START), a clinically and cost-effective manualised intervention for family carers of people with dementia. SETTING We offered 3-hour 'train-the-trainer' sessions through the British Psychological Society and Dementia UK. PARTICIPANTS Clinical psychologists and admiral nurses across the UK. PRIMARY AND SECONDARY OUTCOME MEASURES After the training session, attendees completed an evaluation. Attendees were asked how they had implemented START 6 and 12 months later, and to participate in telephone interviews about their experiences of what helps or hinders implementation 1 year after training. RESULTS We trained 134 clinical psychologists and 39 admiral nurses through 14 training sessions between October 2014 and September 2015 in nine UK locations and made materials available online. The 40 survey respondents had trained 75 other staff. By this time, 136 carers had received START across 11 service areas. Findings from 13 qualitative interviews indicated that some clinical psychologists had begun to implement START, facilitated by buy-in from colleagues, existing skills in delivering this type of intervention, availability of other staff to deliver the intervention and support from the research team. Admiral nurses did not supervise other staff and were unable to cascade the intervention. Where START has not been used, common barriers included lack of staff to deliver the intervention and family carer support not being a service priority. Participants wanted the training to be longer. CONCLUSIONS We trained clinical psychologists and admiral nurses to deliver and implement START locally. Results from survey respondents show that it was cascaded further and used in practice in some areas, but we do not know whether START was implemented by non-respondents. Future dissemination requires management buy-in, availability of practitioners and supervisors and consideration of other ways of delivery.
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Affiliation(s)
- Kathryn Lord
- Faculty of Health Studies, School of Dementia Studies, University of Bradford, Bradford, UK
| | - Penny Rapaport
- Division of Psychiatry, Department of Old Age Psychiatry, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, Department of Old Age Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, Department of Old Age Psychiatry, University College London, London, UK
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Dawson N, Menne H. Can Interpreting Nonsignificant Findings Inform the Lessons Learned From an Intervention? Am J Lifestyle Med 2017; 11:354-360. [PMID: 30202354 PMCID: PMC6125100 DOI: 10.1177/1559827615614571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reducing Disability in Alzheimer's Disease (RDAD) is an evidenced-based intervention for individuals with dementia and their caregivers aimed at reducing the psychosocial strain of the caregiver and improving functional ability of the individual with dementia. Overall efficacy, acceptability, and feasibility outcomes have been published regarding RDAD; however, no specific outcome information has been published on the objective physical performance measures (PPM) of gait speed, functional reach, and balance. Data from the Replication of RDAD (n = 508) was utilized to test the hypothesis that each PPM would show change for participants who completed the program. No significant changes were identified in 3 PPM: gait speed (t = .24, P =.81), balance (t = .23, P = .82), and functional reach (t = -.55, P = .58). To strengthen the research about exercise interventions for individuals with dementia, discussion and interpretation of nonfindings is important for improving intervention designs and methodologies. In the case of RDAD, the intervention protocol may require a sufficient dosage of exercise with respect to fundamental exercise science principles, or there may be misalignment between the intervention and outcome measures.
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Affiliation(s)
- Nicole Dawson
- Nicole Dawson, PT, PhD, GCS, Doctor of Physical Therapy Program, Department of Health Professions, University of Central Florida, 12805 Pegasus Drive, HPA I, Room 258A, Orlando, FL 32828-2205; e-mail:
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Abstract
This report describes the public health impact of Alzheimer's disease, including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. It also examines in detail the financial impact of Alzheimer's on families, including annual costs to families and the difficult decisions families must often make to pay those costs. An estimated 5.4 million Americans have Alzheimer's disease. By mid-century, the number of people living with Alzheimer's disease in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's disease every 66 seconds. By 2050, one new case of Alzheimer's is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2013, official death certificates recorded 84,767 deaths from Alzheimer's disease, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥ 65 years. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer's disease increased 71%. The actual number of deaths to which Alzheimer's disease contributes is likely much larger than the number of deaths from Alzheimer's disease recorded on death certificates. In 2016, an estimated 700,000 Americans age ≥ 65 years will die with Alzheimer's disease, and many of them will die because of the complications caused by Alzheimer's disease. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of care to people with Alzheimer's and other dementias, a contribution valued at more than $221 billion. Average per-person Medicare payments for services to beneficiaries age ≥ 65 years with Alzheimer's disease and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2016 for health care, long-term care and hospice services for people age ≥ 65 years with dementia are estimated to be $236 billion. The costs of Alzheimer's care may place a substantial financial burden on families, who often have to take money out of their retirement savings, cut back on buying food, and reduce their own trips to the doctor. In addition, many family members incorrectly believe that Medicare pays for nursing home care and other types of long-term care. Such findings highlight the need for solutions to prevent dementia-related costs from jeopardizing the health and financial security of the families of people with Alzheimer's and other dementias.
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Milders M, Bell S, Lorimer A, Jackson H, McNamee P. Improving access to a multi-component intervention for caregivers and people with dementia. DEMENTIA 2016; 18:347-359. [PMID: 27758958 DOI: 10.1177/1471301216672745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to the increasing social and economic costs of dementia, there are urgent calls to develop accessible and sustainable care for people with dementia and their caregivers. Multi-component non-pharmacological interventions (NPIs) appear effective in improving or maintaining daily functioning and well-being, but are typically labour-intensive for health care professionals, thus hindering access. The current study aimed to explore the feasibility and acceptability of a novel approach to widen access to NPI by involving caregivers to present part of the intervention and with staff from local support organizations instructed to train the caregivers. Trainers and caregivers were shown to comply with training instructions and the direct intervention costs were low. Feedback from trainers and caregivers was positive and well-being ratings from people with dementia and caregivers remained stable over time and caregivers' sense of competence improved. The findings suggest that involving caregivers and trained non-professionals to provide the intervention is feasible and acceptable and could be a cost-effective solution to improve access to care.
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Laws R, Hesketh KD, Ball K, Cooper C, Vrljic K, Campbell KJ. Translating an early childhood obesity prevention program for local community implementation: a case study of the Melbourne InFANT Program. BMC Public Health 2016; 16:748. [PMID: 27502184 PMCID: PMC4977772 DOI: 10.1186/s12889-016-3361-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background While there is a growing interest in the field of research translation, there are few published examples of public health interventions that have been effectively scaled up and implemented in the community. This paper provides a case study of the community-wide implementation of the Melbourne Infant, Feeding, Activity and Nutrition Trial (InFANT), an obesity prevention program for parents with infants aged 3–18 months. The study explored key factors influencing the translation of the Program into routine practice and the respective role of policy makers, researchers and implementers. Methods Case studies were conducted of five of the eight prevention areas in Victoria, Australia who implemented the Program. Cases were selected on the basis of having implemented the Program for 6 months or more. Data were collected from January to June 2015 and included 18 individual interviews, one focus group and observation of two meetings. A total of 28 individuals, including research staff (n = 4), policy makers (n = 2) and implementers (n = 22), contributed to the data collected. Thematic analysis was conducted using cross case comparisons and key themes were verified through member checking. Results Key facilitators of implementation included availability of a pre-packaged evidence based program addressing a community need, along with support and training provided by research staff to local implementers. Partnerships between researchers and policy makers facilitated initial program adoption, while local partnerships supported community implementation. Community partnerships were facilitated by local coordinators through alignment of program goals with existing policies and services. Workforce capacity for program delivery and administration was a challenge, largely overcome by embedding the Program into existing roles. Adapting the Program to fit local circumstance was critical for feasible and sustainable delivery, however balancing this with program fidelity was a critical issue. The lack of ongoing funding to support translation activities was a barrier for researchers continued involvement in community implementation. Conclusion Policy makers, researchers and practitioners have important and complementary roles to play in supporting the translation of effective research interventions into practice. New avenues need to be explored to strengthen partnerships between researchers and end users to support the integration of effective public health research interventions into practice. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3361-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia. .,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia. .,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - K D Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia
| | - C Cooper
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - K Vrljic
- Prevention and Population Health, Department of Health and Human Services, Melbourne, Australia
| | - K J Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Sydney, Australia.,Centre of Research Excellence in Early Prevention of Obesity in Childhood, Sydney, Australia
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Recent Updates of Therapeutic Intervention Programs for Caregivers of Patient with Dementia: Proposal of Hospital-Based Individual Therapy. Dement Neurocogn Disord 2016; 15:29-36. [PMID: 30906337 PMCID: PMC6427980 DOI: 10.12779/dnd.2016.15.2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 11/27/2022] Open
Abstract
Caring for people with dementia is associated with multiple devastating social, financial, physical, and psychological challenges. There is strong evidence that multicomponent tailored caregiver intervention is effective in improving caregiver well-being and delaying institutionalization. In US, the government is actively funding for developing caregiver program and to prove its efficacy through randomized controlled trials (RCTs) to translate into practice. Even with the introduction of Korean Long-term Care Plan, still, the most of the patients with dementia are being cared by the family members. The distress of caregiving is enormous, but structured therapeutic intervention program which efficacy is proven through RCT is very insufficient in Korea. The purpose of this article is to review the caregiver intervention programs of ongoing clinical trials comparing US and Korea, and to propose a tailored, therapeutic intervention program (I-CARE; A multicenter, randomized trial to assess efficacy of therapeutic intervention programs for decreasing caregiver burden in dementia caregiver) for hospital-care in Korea.
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- rkdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'-- bmov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- bcpd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 2364=4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336-- yvja] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))-- pgrd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)-- zwlx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 5109=2486-- lenk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
This report discusses the public health impact of Alzheimer’s disease (AD), including incidence and prevalence, mortality rates, costs of care and the overall effect on caregivers and society. It also examines the challenges encountered by health care providers when disclosing an AD diagnosis to patients and caregivers. An estimated 5.3 million Americans have AD; 5.1 million are age 65 years, and approximately 200,000 are age <65 years and have younger onset AD. By mid-century, the number of people living with AD in the United States is projected to grow by nearly 10 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops AD every 67 seconds. By 2050, one new case of AD is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year, and the estimated prevalence is expected to range from 11 million to 16 million. In 2013, official death certificates recorded 84,767 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age 65 years. Between 2000 and 2013, deaths resulting from heart disease, stroke and prostate cancer decreased 14%, 23% and 11%, respectively, whereas deaths from AD increased 71%. The actual number of deaths to which AD contributes (or deaths with AD) is likely much larger than the number of deaths from AD recorded on death certificates. In 2015, an estimated 700,000 Americans age 65 years will die with AD, and many of them will die from complications caused by AD. In 2014, more than 15 million family members and other unpaid caregivers provided an estimated 17.9 billion hours of care to people with AD and other dementias, a contribution valued at more than $217 billion. Average per-person Medicare payments for services to beneficiaries age 65 years with AD and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2015 for health care, long-term care and hospice services for people age 65 years with dementia are expected to be $226 billion. Among people with a diagnosis of AD or another dementia, fewer than half report having been told of the diagnosis by their health care provider. Though the benefits of a prompt, clear and accurate disclosure of an AD diagnosis are recognized by the medical profession, improvements to the disclosure process are needed. These improvements may require stronger support systems for health care providers and their patients.
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Menne HL, Bass DM, Johnson JD, Kearney KR, Bollin S, Teri L. Program Components and Outcomes of Individuals With Dementia: Results From the Replication of an Evidence-Based Program. J Appl Gerontol 2015; 36:537-552. [DOI: 10.1177/0733464815591212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines whether the delivery of three components, (a) exercise training, (b) behavior management skill building, and (c) dementia-related education, in an evidence-based program are differentially associated with changes in outcomes for individuals with dementia (IWDs) after 3 months. Data come from 508 IWDs participating in the community replication of the evidence-based “Reducing Disability in Alzheimer’s Disease” program. Regression results indicate that after 3 months, more exercise sessions are associated with improvements in physical functioning, mobility, minutes exercising, and symptoms of depression; more dementia education sessions are related to fewer restricted activity days; and more behavior management sessions are related to more symptoms of depression. As resource-strapped agencies look to best serve participants, further analysis and consideration is needed to determine the ideal balance of program efficacy, feasibility, and resources, as well as program benefits for IWDs and caregivers.
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Affiliation(s)
| | - David M. Bass
- Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | | | | | - Salli Bollin
- Alzheimer’s Association, Northwest Ohio Chapter, Toledo, USA
| | - Linda Teri
- University of Washington, School of Nursing, Seattle, USA
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