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Teresi JA, Ocepek-Welikson K, Eimicke JP, Ramirez M, Liu S, Silver S, Luchsinger JA. Measurement of Allostatic Load in Caregivers of Older Hispanic People With Alzheimer Disease and Related Disorders. Alzheimer Dis Assoc Disord 2024; 38:178-188. [PMID: 38751023 PMCID: PMC11149728 DOI: 10.1097/wad.0000000000000625] [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: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Allostatic load (AL) has been studied in the context of biomarkers that may be affected by environmental and contextual stressors, including social determinants of health. The specific stressor studied here is the provision of caregiving to older persons with Alzheimer disease and related disorders. The aims were to examine the factor structure of stress and nonstress biomarkers, different methods for calculating AL, and the relationship of AL with other variables. METHODS Latent variable models were used to examine biomarkers. Regression analyses were performed with the outcomes: AL calculated as percentile-based and clinically-based for both stress and nonstress components. The sample was 187 Hispanic caregivers to individuals with dementia. RESULTS The results of the confirmatory factor analyses (CFAs) suggested defining 2 factors: nonstress and stress-related. Performance was better for the CFA results and the associations with covariates when stress and nonstress components were examined separately. Despite some limitations, this is one of the first studies of biomarkers in Hispanic caregivers to patients with dementia. It was possible to explain almost 30% of the variance in the nonstress AL component. CONCLUSION It may be important to differentiate among biomarkers indicative of cardiovascular, metabolic, and immune response as contrasted with the more stress-related biomarkers.
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Affiliation(s)
- Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute
- Department of Medicine, Columbia University Irving Medical Center
| | | | | | - Mildred Ramirez
- Department of Medicine, Columbia University Irving Medical Center
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - Shelley Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Stephanie Silver
- Department of Medicine, Columbia University Irving Medical Center
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Baruah U, Varghese M, Loganathan S, Mehta KM, Gallagher-Thompson D, Zandi D, Dua T, Pot AM. Feasibility and preliminary effectiveness of an online training and support program for caregivers of people with dementia in India: a randomized controlled trial. Int J Geriatr Psychiatry 2021; 36:606-617. [PMID: 33491811 DOI: 10.1002/gps.5502] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Internet-based interventions involving elements of cognitive behavior therapy, psychoeducation, relaxation and skills training for caregivers of people with dementia have been found to be promising in Western countries. Given these outcomes, the adapted version of a multi-component online caregiver skills training and support program of the World Health Organization, called iSupport, was tested for feasibility and preliminary effectiveness in India. METHODS One hundred fifty-one caregivers of family members with a diagnosis of Alzheimer's disease or dementia were randomized to either the intervention arm (iSupport; n = 74) or to the control group (an education-only e-book program; n = 77). Participants were assessed using self-rated measures of depression and perceived burden, which were the primary outcome measures, at baseline and 3-month follow-up. Person-centered attitude, self-efficacy, mastery and self-rated health were also assessed. RESULTS Fifty-five caregivers (29 in the iSupport group and 26 in the control condition) completed the study. The recruitment and retention rate of the study were 44.67% and 36.42% respectively. No significant differences were found between the two groups at 3-month follow-up on the primary outcomes. Among the secondary outcomes, significant improvement was only seen in caregivers' person-centered attitude towards persons with dementia in the iSupport group (t = 2.228; p < 0.05). CONCLUSIONS Despite efforts to recruit and retain participants to the online program, this study had a low recruitment and retention rate, which require closer attention and indicates a need for further adaptations of the Indian version of the iSupport program to improve its acceptability and accessibility. The lessons learned from this study will guide the further development of caregiver training and support interventions in India. The trial was registered with the Clinical Trials Registry-India (Trial Registration No. CTRI/2017/02/007876).
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Affiliation(s)
- Upasana Baruah
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Santosh Loganathan
- Department of Psychiatry, Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Betty Irene Moore School of Nursing, University of California, Davis, California, USA
| | - Diana Zandi
- Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
| | - Anne Margriet Pot
- Department of Mental Health and Substance Use, World Health Organization (WHO), Geneva, Switzerland
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Teresi JA, Ocepek-Welikson K, Ramirez M, Kleinman M, Ornstein K, Siu A, Luchsinger J. Evaluation of the measurement properties of the Perceived Stress Scale (PSS) in Hispanic caregivers to patients with Alzheimer's disease and related disorders. Int Psychogeriatr 2020; 32:1073-1084. [PMID: 32312342 PMCID: PMC8259452 DOI: 10.1017/s1041610220000502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The Perceived Stress Scale (PSS) is the most widely used measure of perceived stress; however, minimal psychometric evaluation has been performed among Hispanic respondents, and even less among Hispanic caregivers to persons with Alzheimer's disease and related disorders (ADRDs). DESIGN Secondary data analysis. SETTING New York City, NY, USA. PARTICIPANTS A sample of 453 community dwelling Hispanic caregivers to patients with ADRD. MEASUREMENTS Latent variable models were used to evaluate the PSS. Exploratory and confirmatory factor analyses were used to examine unidimensionality. Differential item functioning (DIF) was examined for age, education, and language using the graded item response model. RESULTS The factor and bifactor analyses results supported essential unidimensionality of the item set; however, positively worded items were observed using response item theory to be less informative than the negatively worded items. Reliability estimates were high. Salient DIF was not observed for age, education, or language of interview using the primary DIF detection method. Sensitivity analyses using a second DIF detection method identified uniform language-DIF for the item, "In the last month, how often have you felt that you were on top of things?" However, the non-compensatory DIF value was below the threshold considered salient. CONCLUSIONS In summary, the 10-item PSS performed well in a sample of English- and Spanish-speaking Hispanic caregivers to patients with ADRD. Very little DIF, and none of high magnitude and impact, was observed. However, the negatively worded items, perhaps because they are more directly reflective of stress, were more informative. In the context of a short-form measure or computerized adaptive test, more informative items are those that would be selected for inclusion.
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Affiliation(s)
- Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, Riverdale, New York, NY, USA
- Measurement and Data Management Core, Mount Sinai Pepper Older Americans Independence Center, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Analytic Core, Columbia University Alzheimer's Disease Resource Center for Minority Aging Research and Stroud Center, New York State Psychiatric Institute, New York, NY, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, USA
| | | | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, Riverdale, New York, NY, USA
- Measurement and Data Management Core, Mount Sinai Pepper Older Americans Independence Center, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Analytic Core, Columbia University Alzheimer's Disease Resource Center for Minority Aging Research and Stroud Center, New York State Psychiatric Institute, New York, NY, USA
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Marjorie Kleinman
- Analytic Core, Columbia University Alzheimer's Disease Resource Center for Minority Aging Research and Stroud Center, New York State Psychiatric Institute, New York, NY, USA
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Institute for Translational Epidemiology Mount Sinai School of Medicine, New York, NY, USA
| | - Albert Siu
- Department of Geriatrics and Palliative Medicine, General Internal Medicine, Health Evidence and Policy, Mount Sinai Medical Center, New York, NY, USA
| | - Jose Luchsinger
- Department of Medicine, Columbia University, New York, NY, USA
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Mason NR, Sox HC, Whitlock EP. A Patient-Centered Approach to Comparative Effectiveness Research Focused on Older Adults: Lessons From the Patient-Centered Outcomes Research Institute. J Am Geriatr Soc 2018; 67:21-28. [PMID: 30586155 PMCID: PMC7379603 DOI: 10.1111/jgs.15655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
The mission of the Patient-Centered Outcomes Research Institute (PCORI) is to fund the production of high-quality evidence that will enable patients and clinicians to make informed, personalized healthcare decisions. Since 2012, the PCORI has invested $177 million in patient-centered comparative effectiveness research (CER) that specifically targets the health needs of older adults, with additional relevant studies in its broader portfolio. Developing the PCORI's research portfolio has provided us with significant insights into what factors to consider when conducting CER in older adult populations. When comparing the net benefit of two or more interventions for older adults, investigators should consider the following: absolute risk difference, competing risks, life expectancy, the difference between chronologic and physiologic age, the importance of patient preferences, and other potential drivers of variable treatment effects. Investigators should also engage older adults and their caregivers as partners throughout the research process. Their input helps to identify key outcomes of interest and insights about the conduct of the research. As the PCORI continues to support research that addresses the healthcare decisions of the rapidly growing older adult population, it needs to partner with patients and researchers to identify the most important questions to address. J Am Geriatr Soc 67:21-28, 2019.
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Affiliation(s)
- Noah R Mason
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
| | - Harold C Sox
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
| | - Evelyn P Whitlock
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
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Luchsinger JA, Burgio L, Mittelman M, Dunner I, Levine JA, Hoyos C, Tipiani D, Henriquez Y, Kong J, Silver S, Ramirez M, Teresi JA. Comparative Effectiveness of 2 Interventions for Hispanic Caregivers of Persons with Dementia. J Am Geriatr Soc 2018; 66:1708-1715. [PMID: 30084133 DOI: 10.1111/jgs.15450] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the effectiveness of 2 caregiver interventions with known efficacy: the Resources for Enhancing Caregiver Health-Offering Useful Treatment (REACH-OUT) and the New York University Caregiver Intervention (NYUCI). DESIGN 1:1 randomized pragmatic trial. SETTING New York City. PARTICIPANTS Informal Hispanic caregivers of persons with dementia (N=221; mean age 58.2, 82.8% female, 63.3% adult children, 31.7% spouses). INTERVENTION Participants were randomized to 6 months of NYUCI (n=110) or REACH-OUT (n=111), balanced on characteristics at baseline. All participants were referred for social supportive services. MEASUREMENTS The primary outcomes were changes between baseline and 6 months in depressive symptoms, measured using the Geriatric Depression Scale (GDS), and caregiver burden, measured using the Zarit Caregiver Burden Scale (ZCBS). RESULTS There were no differences in outcomes between NYUCI and REACH-OUT. Both interventions showed a reduction in burden (REACH-OUT: 5.2 points, 95% confidence interval (CI)=2.2-8.1, p<.001; NYUCI: 4.6-points, 95% CI=1.7-7.5, p=.002). There were no significant changes on the GDS. Effects for the ZCBS were significant only for spouses and older caregivers. CONCLUSION Although there were no significant intervention group differences, both interventions resulted in significantly reduced burden for Hispanic caregivers at 6 months, particularly for spouses and older caregivers.
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Affiliation(s)
- José A Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, New York.,Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Louis Burgio
- Burgio Geriatric Consulting, Tuscaloosa, Alabama
| | - Mary Mittelman
- Department of Psychiatry, School of Medicine, New York University, New York, New York.,Department of Rehabilitation Medicine, School of Medicine, New York University, New York, New York
| | - Ilana Dunner
- Riverstone Senior Life Services, New York, New York
| | | | - Carolina Hoyos
- New York City Department for the Aging, New York, New York
| | - Dante Tipiani
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Yefrenia Henriquez
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jian Kong
- Hebrew Home at Riverdale, Research Division, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Stephanie Silver
- Hebrew Home at Riverdale, Research Division, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mildred Ramirez
- Hebrew Home at Riverdale, Research Division, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Jeanne A Teresi
- Hebrew Home at Riverdale, Research Division, New York, New York.,Weill Cornell Medical College, New York, New York.,Stroud Center at New York State Psychiatric Institute, Columbia University, New York, New York
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Mehta KM, Gallagher-Thompson D, Varghese M, Loganathan S, Baruah U, Seeher K, Zandi D, Dua T, Pot AM. iSupport, an online training and support program for caregivers of people with dementia: study protocol for a randomized controlled trial in India. Trials 2018; 19:271. [PMID: 29739423 PMCID: PMC5941472 DOI: 10.1186/s13063-018-2604-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/14/2018] [Indexed: 11/25/2022] Open
Abstract
Background Dementia has a huge physical, psychological, social and economic impact upon caregivers, families and societies at large. There has been a growing impetus to utilize Internet interventions given the potential scalability, and presumed cost-effectiveness and accessibility. In this paper, we describe the design of a randomized controlled trial (RCT) aiming to study the impact of online self-help programs on caregivers of people with dementia in India. The experimental group will receive an interactive training and support program and the comparison group will receive an education-only e-book. It will be among the first online support intervention RCTs for a mental health condition in a lower-middle income country. Methods and design Two hundred and eight participants are expected to be recruited via several strategies (email, Internet and social media, telephone and face-to-face) starting in the Bangalore region of India. The inclusion criteria for participation in the trial are: (1) being 18 years or older, (2) being a self-reported caregiver of a person with dementia, (3) self-report that a family member has a diagnosis of dementia (AD8 ≥ 2), and experience caregiver distress (≥ 4 on a 1-item burden scale ranging from 1 to 10 or ≥ 4 or < 20 on the Center for Epidemiologic Study-Depression (CES-D) scale (10-item) or ≥ 4 or < 15 on the Generalized Anxiety Disorder Scale (7-item). The intervention group will be offered iSupport, an online self-help training and support program, enabling a personalized education plan with a maximum of 23 lessons. These modules present a range of topics from “what is dementia?” to “dealing with challenging behaviors like aggression.” The comparison group will receive an education-only e-book containing similar content. The outcomes of this trial are: caregiver burden as measured by the 22-item Zarit Burden Scale, depressive symptoms, anxiety symptoms (primary outcomes), quality of life, person-centered attitude, self-efficacy and mastery (secondary outcomes). Discussion Based on the findings of this trial, we will examine the potential use and scale up of iSupport for caregiver distress in India. This style of online self-help programs could be expanded to other regions or countries or to other suitable caregiver groups. Trial registration Clinical Trials Registry—India (CTRI), ID: CTRI/2017/02/007876. Electronic supplementary material The online version of this article (10.1186/s13063-018-2604-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Mathew Varghese
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Santosh Loganathan
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Upasana Baruah
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Katrin Seeher
- World Health Organization (WHO), Geneva, Switzerland
| | - Diana Zandi
- World Health Organization (WHO), Geneva, Switzerland
| | - Tarun Dua
- World Health Organization (WHO), Geneva, Switzerland
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Liang CK, Chou MY, Chen LY, Wang KY, Lin SY, Chen LK, Lin YT, Liu TY, Loh CH. Delaying cognitive and physical decline through multidomain interventions for residents with mild-to-moderate dementia in dementia care units in Taiwan: A prospective cohort study. Geriatr Gerontol Int 2018; 17 Suppl 1:36-43. [PMID: 28436184 DOI: 10.1111/ggi.13035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
AIM To develop experimental multi-domain interventions for older people with mild-to-moderate dementia, and to evaluate the effect of delaying cognitive and physical decline, and improvement or prevention of geriatric syndromes during 1-year follow up. METHODS Participants aged 65 years and older with mild-to-moderate dementia (clinical dementia rating [CDR] 1 or 2) were grouped as intervention in Jia-Li Veterans Home and usual care model in the community (Memory clinic). All residents in Jia-Li Veterans Home received comprehensive intervention, including Multi-disciplinary team consultation and intervention, Multi-component non-pharmacological management, geriatric syndromes survey and intervention by CGA, and a dementia friendly medical Green channel Approach (2MCGA). The decline of cognitive and physical function are determined by the change of Mini-Mental State Examination score, CDR and the sum of CDR box, as well as activities of daily living based on the Barthel Index. We also screened geriatric syndromes at baseline and 1 year later. RESULTS Participants in the intervention group were older and had a lower educational level, lower body mass index, poor baseline activities of daily living function, lower visual impairment, and higher rates of hearing impairment, polypharmacy and risk of malnutrition. The residents receiving 2MCGA had lower baseline Mini-Mental State Examination scores, and higher CDR. For residents in Jia-Li Veterans Home, all cognitive measurements except Mini-Mental State Examination were significantly associated with delaying the decline of cognition after analyzing by multiple linear regression, and multivariate logistic regression also showed that patients living in the community was independently associated with a higher odds ratio for activities of daily living decline (3.180, 95% CI 1.384-7.308, P = 0.006). There are also more improvement in their baseline geriatric syndromes and suffered less from new geriatric syndromes, including falls, urinary incontinence, and risk of malnutrition. CONCLUSIONS The 2MCGA intervention shows strong delays in the decline of cognition and physical function for older residents with mild-to-moderate dementia. Furthermore, this strategy can also improve or prevent the onset of new geriatric syndromes, especially fall episodes, urinary incontinence and risk of malnutrition. Geriatr Gerontol Int 2017; 17 (Suppl. 1): 36-43.
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Affiliation(s)
- Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuei-Yu Wang
- JiaLi Veterans Home, Veterans Affairs Council, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Yun Liu
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Healthcare and Medical care, Veterans Affairs Council, Taiwan
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