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The Malay version of the caregiver assessment of function and upset instrument (Malay-CAFU): a translation and validation study among informal stroke caregivers. BMC Public Health 2023; 23:198. [PMID: 36717840 PMCID: PMC9885385 DOI: 10.1186/s12889-023-15076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level. OBJECTIVE This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia. METHODS A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity. RESULTS All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively. CONCLUSION The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.
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Chen D, Jutkowitz E, Gross AL. Statistical harmonization of everyday functioning and dementia-related behavioral measures across nine surveys and trials. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12412. [PMID: 36935763 PMCID: PMC10017408 DOI: 10.1002/dad2.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
Introduction Efforts to harmonize measures of everyday function and dementia-related behaviors are needed to synthesize across studies in dementia research. There have been some psychometric attempts to harmonize everyday function for secondary analysis, but far less for dementia-related behaviors. Methods Statistical co-calibration was performed to generate factor scores representing everyday function and dementia-related behaviors for participants with dementia. We evaluated convergent criterion validity of factor scores and mapped the scores onto established clinical instruments. Results Factor analyses of included items fit well to available data. Harmonized factors showed expected associations with the Global Clinical Dementia Rating (CDR) score, with greater impairment (higher Global CDR score) corresponding to higher (more severe) levels on factor scores. Discussion We used large, well-characterized samples to derive harmonized factors representing everyday functions and dementia-related behaviors. These harmonized factors can be used to tackle questions about dementia phenotypes which require either large samples or unique subpopulations.
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Affiliation(s)
- Diefei Chen
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
| | - Eric Jutkowitz
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Center of Innovation in Long Term Services and SupportsProvidence VA Medical CenterProvidenceRhode IslandUSA
- Evidence Synthesis Program CenterProvidence VA Medical CenterProvidenceRhode IslandUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
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Dessy A, Zhao AJ, Kyaw K, Vieira D, Salinas J. Non-Pharmacologic Interventions for Hispanic Caregivers of Persons with Dementia: Systematic Review and Meta-Analysis. J Alzheimers Dis 2022; 89:769-788. [PMID: 35938246 DOI: 10.3233/jad-220005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population. Objective: A systematic review and meta-analysis was conducted to 1) provide an updated review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research. Methods: Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively. Results: Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = –0.31, 95% CI –0.46 to –0.16; I2 = 50.16%) and burden (SMD = –0.28, 95% CI –0.37 to –0.18; I2 = 11.06%). Conclusion: Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.
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Affiliation(s)
- Alexa Dessy
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Amanda J. Zhao
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kay Kyaw
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Dorice Vieira
- New York University Health Sciences Library, New York University Grossman School of Medicine, New York, NY, USA
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
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Di Lorito C, Bosco A, Rai H, Craven M, McNally D, Todd C, Booth V, Cowley A, Howe L, Harwood RH. A systematic literature review and meta-analysis on digital health interventions for people living with dementia and Mild Cognitive Impairment. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5730. [PMID: 35588315 PMCID: PMC9321868 DOI: 10.1002/gps.5730] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Digital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI. METHODS/DESIGN Searches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta-analyses were performed to pool data on intervention effectiveness. RESULTS Twenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = -0.03 to 0.76; I2 = 61%), and a negative moderate effect on basic ADLs (SMD = -0.40; 95% CI = -0.86 to 0.05; I2 = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions. CONCLUSION Supervised intervention delivery is linked to greatest benefits. A mix of remote and face-to-face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end-users must be pre-requisites for the development of future successful services.
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Affiliation(s)
| | | | - Harleen Rai
- Computer and Information SciencesUniversity of StrathclydeGlasgowUK
| | | | - Donal McNally
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | - Chris Todd
- School of Health SciencesUniversity of ManchesterManchesterUK
| | - Vicky Booth
- School of MedicineUniversity of NottinghamNottinghamUK
| | - Alison Cowley
- Nottingham University Hospitals NHS TrustNottinghamUK
| | - Louise Howe
- School of MedicineUniversity of NottinghamNottinghamUK
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Effects of the tailored activity program (TAP) on dementia-related symptoms, health events and caregiver wellbeing: a randomized controlled trial. BMC Geriatr 2021; 21:581. [PMID: 34670502 PMCID: PMC8527762 DOI: 10.1186/s12877-021-02511-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background People living with dementia (PLWD) and caregivers are adversely impacted by lack of meaningful activity leading to worse symptoms and impaired quality-of-life. There is a critical need to develop effective and well-tolerated treatments that mitigate clinical symptoms, engage PLWD and support caregiver wellbeing. We tested whether, compared to attention control, the Tailored Activity Program (TAP) reduced clinical symptoms and health-related events, and improved caregiver wellbeing, and if TAP activities were well-tolerated. Methods We conducted a single-blind randomized controlled trial among 250 dyads recruited from Baltimore-Washington DC (2012–2016) with a dementia diagnosis and clinically significant agitation/aggression. Dyads were randomized to TAP (n = 124) or attention control (n = 126), and interviewed at baseline, 3 (endpoint) and 6-months (follow-up) by interviewers masked to group allocation. TAP assessed PLWD abilities/interests, instructed caregivers in using prescribed activities, and provided dementia education and stress reduction techniques. Attention controls received disease education and home safety tips. Both groups had up to 8 home visits over 3-months. The primary outcome was frequency by severity scores for agitation/aggression subscales of Neuropsychiatric Inventory-Clinician using caregiver ratings. Secondary outcomes included number of instrumental (IADL) and activities of daily living (ADL) needing assistance, caregiver wellbeing, and confidence using activities. Health-related events (PLWD death, hospitalizations, caregiver hospitalization, depression) and perceived study benefits were captured over 6 months. PLWD tolerability of prescribed activities was examined. Results Of 250 dyads, most caregivers were female (81.2 %, n = 203), non-spouses (54.4 %, n = 136), white (59.2 %, n = 145) or African American (36.7 %, n = 90) with mean age = 65.4 (SD = 12.6). PLWD were mostly female (63.2 %, n = 158) with mean age = 81.4 (SD = 7.9), and mean MMSE = 14.3 (SD = 7.8). At 3-months, compared to controls, TAP conferred no benefit to agitation/aggression (p = 0.43, d = 0.11), but resulted in less IADL (p = 0.02, d=-0.33), and ADL (p = 0.04, d=-0.30) assistance, improved caregiver wellbeing (p = 0.01, d = 0.39), and confidence using activities (p = 0.02, d = 0.32). By 6-months, 15 PLWD in TAP had ≥ 1 health-related event versus 28 PLWD in control, demonstrating 48.8 % improvement in TAP (p = 0.03). TAP caregivers were more likely to perceive study benefits. Prescribed activities were well-tolerated. Conclusions Although TAP did not benefit agitation/aggression, it impacted important outcomes that matter to families warranting its use in dementia care. Clinical trial registration Clinicaltrials.gov # NCT01892579 at https://clinicaltrials.gov/; Date of clinical trial registration: 04/07/2013; Date first dyad enrolled: 15/11/2013.
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Mendez KJW, Budhathoki C, Labrique AB, Sadak T, Tanner EK, Han HR. Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study. JMIR Mhealth Uhealth 2021; 9:e27926. [PMID: 34463637 PMCID: PMC8441609 DOI: 10.2196/27926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 12/19/2022] Open
Abstract
Background In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management.
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Affiliation(s)
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Alain Bernard Labrique
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Tatiana Sadak
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Elizabeth K Tanner
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Leggett AN, Bugajski BC, Gitlin LN, Kales HC. Characterizing dementia caregiver style in managing care challenges: Cognitive and behavioral components. DEMENTIA 2021; 20:2188-2204. [PMID: 33517792 PMCID: PMC9725115 DOI: 10.1177/1471301220988233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caring for a person living with dementia can take a physical and emotional toll, but understudied is the process by which family caregivers actually provide care. Caregiver management styles may vary and affect care decision-making, experiences, receptivity to and participation in interventions, and outcomes for the caregiver and person living with dementia. METHODS Participants included 100 primary family caregivers for persons with dementia who were on average 64 years old and had been providing care for 55 months, 74% women, and 18% nonwhite. Participants were interviewed in Michigan and Ohio regarding their cognitive and behavioral management of a recent care challenge and values guiding their decision-making. The rigorous and accelerated data reduction technique was used to analyze qualitative data leading to the identification of caregiving styles. Styles were compared across sample characteristics using chi-square and ANOVA tests. FINDINGS Five distinct styles emerged: "Externalizers" (superficial understanding, self-focused, and frequent expressions of anger or frustration), "Individualists" (provide care by going alone, emotionally removed, and lack management strategies), "Learners" (recognize need to change their approach but are stuck and emotionally turbulent), "Nurturers" (positive affect and empathy toward care and reflect natural mastery), and "Adapters" (arsenal of acquired management strategies and adapt to challenges). Style groups differed significantly in terms of age and use of formal care supports. DISCUSSION We identified five distinct styles by which caregivers addressed care challenges using a robust qualitative methodology. Styles may be important to identify in order to better tailor interventions to needs and abilities.
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Affiliation(s)
| | - Benjamin C Bugajski
- Ambulatory and Chronic Disease Clinical Trial Support Unit, University of Michigan, USA
| | - Laura N Gitlin
- 15775Drexel University College of Nursing and Health Professions, USA
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, 8789University of California Davis, USA; Department of Psychiatry, 1259University of Michigan, USA
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Jutkowitz E, Pizzi LT, Popp J, Prioli KK, Scerpella D, Marx K, Samus Q, Piersol CV, Gitlin LN. A longitudinal evaluation of family caregivers' willingness to pay for an in-home nonpharmacologic intervention for people living with dementia: results from a randomized trial. Int Psychogeriatr 2021; 33:419-428. [PMID: 33757615 PMCID: PMC8635284 DOI: 10.1017/s1041610221000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the willingness-to-pay (WTP) of family caregivers to learn care strategies for persons living with dementia (PLwD). DESIGN Randomized clinical trial. SETTING Community-dwelling PLwD and their caregivers (dyads) in Maryland and Washington, DC. PARTICIPANTS 250 dyads. INTERVENTION Tailored Activity Program (TAP) compared to attention control. TAP provides activities tailored to the PLwD and instructs caregivers in their use. MEASUREMENT At baseline, 3 and 6 months, caregivers were asked their WTP per session for an 8-session 3-month in-home nonpharmacologic intervention to address behavioral symptoms and functional dependence. RESULTS At baseline, 3 and 6 months, caregivers assigned to TAP were willing to pay $26.10/session (95%CI:$20.42, $33.00), $28.70 (95%CI:$19.73, $39.30), and $22.79 (95%CI: $16.64, $30.09), respectively; attention control caregivers were willing to pay $37.90/session (95%CI: $27.10, $52.02), $30.92 (95%CI: $23.44, $40.94), $27.44 (95%CI: $20.82, $35.34), respectively. The difference in baseline to 3 and 6 months change in WTP between TAP and the attention control was $9.58 (95%CI: -$5.00, $25.47) and $7.15 (95%CI: -$5.72, $21.81). The difference between TAP and attention control in change in the proportion of caregivers willing to pay something from baseline to 3 and 6 months was -12% (95%CI: -28%, -5%) and -7% (95%CI:-25%, -11%), respectively. The difference in change in WTP, among caregivers willing to pay something, between TAP and attention control from baseline to 3 and 6 months was $17.93 (95%CI: $0.22, $38.30) and $11.81 (95%CI: -$2.57, $28.17). CONCLUSIONS Family caregivers are willing to pay more for an intervention immediately following participation in a program similar to which they were asked to value.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
- Providence Veterans Affairs (VA) Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Jonah Popp
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Katherine K Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Danny Scerpella
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Katherine Marx
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Perion J, Steiner V, Ames A. "It makes me feel like good inside because I helped him do stuff" - Perceptions of psychological well-being in adolescents providing dementia care. J Aging Stud 2021; 56:100908. [PMID: 33712093 DOI: 10.1016/j.jaging.2020.100908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022]
Abstract
According to a 2018 report by the Alzheimer's Association, an estimated 250,000 children help support a family member with dementia, but few studies exist that describe their experience as family carers. This qualitative descriptive study sought to understand the perceived psychological well-being of adolescents who assist with providing care to family members with dementia. Eleven adolescents ages 12 to 17 caring for older non-parental family members with dementia in northwest Ohio participated in one of three focus group discussions. An adult family member was surveyed about family background and level of assistance provided. The data from the two questionnaires were analyzed using descriptive statistics. Focus group transcripts were analyzed using thematic content analysis. Thematic analysis revealed six themes related to psychological well-being: 1) Feeling compassion for the family member; 2) Finding connection through fun, humor, and mutual affection; 3) Helping even though it is not always pleasant; 4) Feeling good inside about helping family "do stuff"; 5) Believing no one can do it like family; and 6) Reflecting that it is just something that they do. The findings of this study provide new insight into adolescents' experiences of dementia family care and how it affects their psychological well-being. An examination of the themes suggests that secondary caring roles were mostly positive in nature and may help adolescents forge closer family relationships, find opportunities for personal growth and development, and overcome challenges to grow more confident. These findings may also suggest ways to include adolescents in family care as a means of positive growth opportunities.
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Affiliation(s)
- Jennifer Perion
- The University of Toledo School of Population Health HH 1000c, Mail Stop 119, Toledo, OH, United States of America.
| | - Victoria Steiner
- The University of Toledo School of Population Health HH 1000c, Mail Stop 119, Toledo, OH, United States of America.
| | - April Ames
- The University of Toledo School of Population Health HH 1000c, Mail Stop 119, Toledo, OH, United States of America.
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Petrovsky DV, Sefcik JS, Hodgson NA, Gitlin LN. Harsh communication: characteristics of caregivers and persons with dementia. Aging Ment Health 2020; 24:1709-1716. [PMID: 31549521 PMCID: PMC7089818 DOI: 10.1080/13607863.2019.1667296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/20/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Objectives: While ways to reduce caregiver burden have dominated dementia care research, there is little understanding of daily communication and its relationship to caregiver burden and depression. In this study, we sought to: (1) describe the frequency of harsh communication used by caregivers; (2) examine the relationship between harsh communication, caregiver and person with dementia characteristics; and (3) determine the contributions of caregiver depression and burden on such communication.Method: Cross-sectional baseline data were drawn from 250 dyads, who participated in the Dementia Behavior Study (NCT01892579). Hierarchical linear regression models were used to examine the relationship between dyad characteristics and harsh communication scores (using the 6-item Negative Communication Scale), controlling for three groups of covariates: sociodemographic, relationship characteristics and health factors.Results: More than half of the caregivers (mean age = 65.4, 81.2% women, 45.6% spouses) reported they felt like screaming/yelling (N = 138, 55.2%) or used a harsh tone (N = 129, 51.6%) at persons with dementia (Mini Mental Status Examination mean = 14.3, SD: 7.8) at least sometimes. When controlling for all covariates, for each unit increase in caregiver burden, harsh communication increased by 0.486 units (p < 0.001); similarly, for each unit increase in caregiver depression, harsh communication increased by 0.301units (p < 0.001).Conclusion: Over half of dementia caregivers reported they felt like or used one or more harsh forms of communication. Caregiver burden and depression were incrementally associated with greater use of negative communication. Providing caregivers with knowledge, support and specific communication skills may lessen the frequency of harsh communication and possibly reduce burden and depression.
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Affiliation(s)
| | - Justine S Sefcik
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Does Telehealth Delivery of a Dyadic Dementia Care Program Provide a Noninferior Alternative to Face-To-Face Delivery of the Same Program? A Randomized, Controlled Trial. Am J Geriatr Psychiatry 2020; 28:673-682. [PMID: 32234275 DOI: 10.1016/j.jagp.2020.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine whether delivery of a dyadic intervention using telehealth was noninferior to delivery of the same program using traditional face-to-face delivery through home visits. DESIGN We conducted a noninferiority randomized controlled trial. PARTICIPANTS Participants had a diagnosis of dementia, were living in the community, and had an informal caregiver who reported difficulties in managing activities of daily living or behavioral symptoms. INTERVENTION Participants were randomized to receive either telehealth or home visit delivery of the same intervention program. MEASUREMENTS The primary outcome was the Caregiving Mastery Index, secondary outcomes included caregiver's perceptions of change, activities of daily living function, and type and frequency of behavioral symptoms of persons living with dementia. Therapists delivering the intervention recorded the time spent delivering the intervention as well as travel time. RESULTS Sixty-three dyads were recruited and randomized. Both groups reported improvements for the primary outcome, however, these were not statistically significant. There were no significant differences between groups for the primary outcome (mean difference 0.09 (95% confidence interval -1.26 to 1.45) or the secondary outcomes at 4 months. Both groups reported significant improvements in caregiver's perceptions of change. The amount of time spent delivering the content of the program was similar between groups, however offering the intervention via telehealth significantly reduced travel time (mean 255.9 minutes versus mean 77.2 minutes, p <0.0001). CONCLUSION It is feasible to offer dyadic interventions via telehealth and doing so reduces travel time and results in similar benefits for families.
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Choi SSW, Budhathoki C, Gitlin LN. Impact of three dementia-related behaviors on caregiver depression: The role of rejection of care, aggression, and agitation. Int J Geriatr Psychiatry 2019; 34:966-973. [PMID: 30897238 PMCID: PMC6579654 DOI: 10.1002/gps.5097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/17/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The relationship of specific dementia-related behaviors to caregiver depression and moderating factors is unclear. We examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. METHODS The method used was a cross-sectional, secondary analysis using baseline data from two community-based clinical trials. We examined frequency of occurrence of presenting behaviors and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioral clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioral symptom clusters and caregiver depression. RESULTS Three of four symptom clusters (all three behaviors [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02-4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06-6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17-5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioral clusters and caregiver depression. CONCLUSION Caregiver depression was associated with different combinations of behaviors but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.
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Affiliation(s)
- Scott Seung W. Choi
- Towson University Department of Nursing 8000 York Road Towson, MD 21252 Phone: (410) 704-3160
| | - Chakra Budhathoki
- The Johns Hopkins University School of Nursing, 525 North Wolfe Street, Room 425 Baltimore, MD 21205 Phone: (410) 614-5320
| | - Laura N. Gitlin
- Drexel University College of Nursing and Health Professions, Three Parkway Building, Room 1092 Philadelphia, PA 19102 Phone: (267) 359-5957
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Marx KA, Scott JB, Piersol CV, Gitlin LN. Tailored Activities to Reduce Neuropsychiatric Behaviors in Persons With Dementia: Case Report. Am J Occup Ther 2019; 73:7302205160p1-7302205160p9. [PMID: 30915977 DOI: 10.5014/ajot.2019.029546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Neuropsychiatric behaviors of persons with dementia, including agitation, aggression, and rejection of care, are almost universal; occur throughout the disease process; and have negative consequences for both persons with dementia and their caregivers. Nonpharmacological approaches are now recognized as first-line treatment to address these behaviors. One promising approach is activity tailored to the person's interests, abilities, and physical and social environment. An evidence-based program, New Ways for Better Days: Tailoring Activities for Persons With Dementia and Their Caregivers (TAP), draws on occupational therapy principles (person-environment-occupation fit, activity analysis) to meaningfully engage persons with dementia. OBJECTIVE This case report describes the TAP protocol and clinical reasoning processes underlying use of tailored activities as a therapeutic modality to address dementia-related neuropsychiatric behaviors. DESIGN This is a case study of an African-American woman in her 60s caring for her father, age 92, who has severe dementia and multiple behaviors. OUTCOMES AND MEASURES Primary outcomes in this case report include the person with dementia's engagement in an activity and the reported neuropsychiatric behaviors. In addition, the caregiver's confidence in using activities is reported. These and other measures from the TAP protocol are described in full. RESULTS After working with an occupational therapist for eight sessions, the person with dementia's engagement in activity increased by 50% and his frequency of vocal disturbance decreased, and the caregiver felt more confident in using activities with her father. CONCLUSION AND RELEVANCE This case report illustrates how occupational therapists working with families of persons with dementia can use the TAP protocol to help them manage neuropsychiatric behaviors by tailoring activities. WHAT THIS ARTICLE ADDS Occupational therapists are uniquely qualified to systematically assess the cognitive functioning of persons with dementia, caregivers, and home environments and to integrate this information to derive and implement activities tailored to the person's capacities and context, thereby reducing neuropsychiatric behaviors and increasing engagement in meaningful activity.
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Affiliation(s)
- Katherine A Marx
- Katherine A. Marx, PhD, MPH, is Research Associate, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD;
| | - Janie B Scott
- Janie B. Scott, MA, OT/L, FAOTA, is Occupational Therapist, Johns Hopkins School of Nursing, Baltimore, MD
| | - Catherine Verrier Piersol
- Catherine Verrier Piersol, PhD, OTR/L, FAOTA, is Chair, Department of Occupational Therapy; Associate Professor, Department of Occupational Therapy; and Director, Jefferson Elder Care, Jefferson College of Rehabilitation Sciences, Philadelphia, PA
| | - Laura N Gitlin
- Laura N. Gitlin, PhD, is Dean and Distinguished University Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, PA
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Fields NL, Xu L, Miller VJ. Caregiver Burden and Desire for Institutional Placement-The Roles of Positive Aspects of Caregiving and Religious Coping. Am J Alzheimers Dis Other Demen 2019; 34:199-207. [PMID: 30700106 PMCID: PMC10852480 DOI: 10.1177/1533317519826217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Based on stress coping theory, this study investigated whether and how positive aspects of caregiving (PAC) and religiosity buffered the association between caregiving burden and desire to institutionalize (DTI). Secondary data (N = 637) were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II project. Descriptive analysis, bivariate correlation, and multiple linear regressions were conducted. The results indicated that higher levels of caregiver burden, daily care bother, and Revised Memory and Behavioral Problem Checklist bother were all significantly associated with higher level of DTI. Both PAC and religious coping were negatively associated with DTI; however, only PAC was significant. Only the interaction between daily care bother and religious coping was significant, which indicated that the harmful effect of daily care bother on DTI was significantly buffered among those who have religiosity. Study findings have important implications for policy makers and for providers who serve dementia family caregivers.
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Affiliation(s)
- Noelle L. Fields
- The University of Texas at Arlington, School of Social Work, Arlington, TX, USA
| | - Ling Xu
- The University of Texas at Arlington, School of Social Work, Arlington, TX, USA
| | - Vivian J. Miller
- The University of Texas at Arlington, School of Social Work, Arlington, TX, USA
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Care partner problem solving training (CP-PST) for care partners of adults with traumatic brain injury during inpatient rehabilitation: Study protocol for a multisite, randomized, single-blind clinical feasibility trial. Contemp Clin Trials 2019; 80:9-15. [DOI: 10.1016/j.cct.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/02/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
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Leggett A, Kales HC, Gitlin L. Finding fault: Criticism as a care management strategy and its impact on outcomes for dementia caregivers. Int J Geriatr Psychiatry 2019; 34:571-577. [PMID: 30556172 PMCID: PMC6420398 DOI: 10.1002/gps.5052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite a large literature on the stress process, little attention has focused on how caregivers for persons living with dementia (PLWDs) provide care and how this may impact care outcomes. Criticism is a management strategy caregivers may use to respond to behavioral symptoms. We consider whether criticism is associated with caregivers' mental health and service utilization. METHODS Data are drawn from the Advancing Caregiver Training intervention study including 256 informal caregivers living with a PLWD. In multiple linear regressions controlling for caregivers' demographics and PLWDs' clinical factors, we consider criticism (criticism subscale of the Dementia Management Strategies Scale) as a predictor of caregiver burden, depressive symptoms, desire to institutionalize the PLWD, level of frustration with care, and the number of home-based, social, and health services utilized. RESULTS On average, 15% of the sample sometimes reported using criticism as a management strategy to manage the challenges of care. Greater use of criticism was associated with significantly more caregiver burden (β = 0.26, P < 0.001) and frustration with caregiving (β = 0.66, P < 0.001), but not depressive symptoms or a desire to institutionalize the PLWD. Criticism was also associated with significantly greater utilization of home-based (β = 0.14, P < 0.05) and social services (β = 0.15, P < 0.05), but not health care services. CONCLUSION Criticism appears to be used by more burdened and frustrated caregivers. The association of criticism with social and home-based services potentially reflects a need for greater support among this group of caregivers. Behavioral interventions that can help caregivers manage behavioral symptoms with positive, empirically validated strategies may be helpful.
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Affiliation(s)
- Amanda Leggett
- Program for Positive Aging and Department of Psychiatry, University of Michigan
| | - Helen C. Kales
- Program for Positive Aging and Department of Psychiatry, University of Michigan
| | - Laura Gitlin
- Distinguished University Professor and Dean, Drexel University, Adjunct Professor, Johns Hopkins School of Nursing
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Jutkowitz E, Scerpella D, Pizzi LT, Marx K, Samus Q, Piersol CV, Gitlin LN. Dementia Family Caregivers' Willingness to Pay for an In-home Program to Reduce Behavioral Symptoms and Caregiver Stress. PHARMACOECONOMICS 2019; 37:563-572. [PMID: 30877638 PMCID: PMC6465140 DOI: 10.1007/s40273-019-00785-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our objective was to determine whether family caregivers of people with dementia (PwD) are willing to pay for an in-home intervention that provides strategies to manage behavioral symptoms and caregiver stress and to identify predictors of willingness-to-pay (WTP). METHODS During baseline interviews of a randomized trial and before treatment assignment, caregivers were asked how much they were willing to pay per session for an eight-session program over 3 months. We stratified the sample into those who refused to provide a WTP, those willing to pay $US0, and those willing to pay > $US0. We used a two-part model, controlling for demographic characteristics, to predict adjusted mean WTP and to examine associations between WTP, clinical features (cognition, function, behavioral symptoms), and time spent assisting PwD with daily activities. First, we used logistic regression to model the probability a caregiver was willing to pay > $US0. Second, we used a generalized linear model (log link and Gamma distribution) to estimate the amount caregivers were willing to pay conditional on WTP > $US0. RESULTS Of 250 dyads enrolled, 226 (90%) had complete data and were included in our analyses. Of 226 dyads, 26 (11%) refused to provide a WTP value, 72 (32%) were willing to pay $US0, and 128 (57%) were willing to pay > $US0. In the combined model, mean adjusted WTP was $US36.00 (95% confidence interval [CI] 26.72-45.27) per session. Clinical features were not significantly associated with WTP. One additional hour providing PwD assistance was associated with a $US1.64 (95% CI 0.23-3.04) increase in WTP per session. CONCLUSION As caregivers spend more time assisting with daily activities, they are willing to pay more for a supportive program. CLINICAL TRIAL REGISTRATION NUMBER NCT01892579.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Box G-S121-6, 121 S. Main Street, 6th Floor, Providence, RI, 02912, USA.
| | - Danny Scerpella
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Katherine Marx
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura N Gitlin
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Thunborg C, Söderlund A, Wågert PVH. Functional behaviour analysis guided interventions might improve transfer-related behaviour in dementia care dyads: a single case study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1549591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Charlotta Thunborg
- Department of Neurobiology Care Sciences and Society, Center for Alzheimer Research Karolinska Institute, Stockholm,Sweden
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Fowler NR, Schonberg MA, Sachs GA, Schwartz PH, Gao S, Lane KA, Inger L, Torke AM. Supporting breast cancer screening decisions for caregivers of older women with dementia: study protocol for a randomized controlled trial. Trials 2018; 19:678. [PMID: 30541634 PMCID: PMC6292112 DOI: 10.1186/s13063-018-3039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/03/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) impact a woman's life expectancy and her ability to participate in medical decision-making about breast cancer screening, necessitating the involvement of family caregivers. Making decisions about mammography screening for women with ADRD is stressful. There are no data that suggest that breast cancer screening helps women with ADRD live longer or better. Decision aids may improve the quality of decision-making about mammography for ADRD patients and may inform family caregivers about the risks, benefits, and need for decision-making around mammography screening. METHODS/DESIGN The Decisions about Cancer Screening in Alzheimer's Disease (DECAD) trial, a randomized controlled clinical trial, will enroll 426 dyads of older women with ADRD (≥75 years) and a family caregiver from clinics and primary-care practices in Indiana to test a novel, evidence-based decision aid. This decision aid includes information about the impact of ADRD on life expectancy, the benefit of mammograms, and the impact on the quality of life for older women with ADRD. Dyads will be randomized to receive the decision aid or active control information about home safety. This trial will examine the effect on the caregiver's decisional conflict (primary outcome) and the caregiver's decision-making self-efficacy (secondary outcome). A second follow-up at 15 months will include a brief, semi-structured interview with the caregiver regarding the patient's experience with mammograms and decision-making about mammograms. At the same time, a review of the patient's electronic medical record (EMR) will look at discussions about mammography with their primary-care physician and mammogram orders, receipt, results, and burden (e.g., additional diagnostic procedures due to false-positive results, identification of an abnormality on the screening exam but further work-up declined, and identification of a clinically unimportant cancer). A third follow-up at 24 months will extract EMR data on mammogram orders, occurrences, results, and the burden of mammograms. DISCUSSION We hypothesize that caregivers who receive the decision aid will have lower levels of decisional conflict and higher levels of decision-making self-efficacy compared to the control group. We also hypothesize that the DECAD decision aid will reduce mammography use among older women with ADRD. TRIAL REGISTRATION Clinical Trials Register, NCT03282097 . Registered on 13 September 2017.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Sandra Eskenazi Center for Brain Care Innovation, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Mara A. Schonberg
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Greg A. Sachs
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Sandra Eskenazi Center for Brain Care Innovation, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Peter H. Schwartz
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Sujuan Gao
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Department of Biostatistics, 410 W. 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Kathleen A. Lane
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Department of Biostatistics, 410 W. 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Lev Inger
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
| | - Alexia M. Torke
- Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Division of General Internal Medicine and Geriatrics, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN 46202 USA
- Center for Bioethics, 1101 West 10th Street, Indianapolis, IN 46202 USA
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Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point? Int Psychogeriatr 2018; 30:1099-1107. [PMID: 29143722 PMCID: PMC7103581 DOI: 10.1017/s104161021700237x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. METHODS Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. RESULTS Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). CONCLUSIONS Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
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Delay in Seeking Care for Pelvic Floor Disorders Among Caregivers. Female Pelvic Med Reconstr Surg 2018; 26:458-463. [PMID: 30045052 DOI: 10.1097/spv.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In 2015, 44 million adults were informal, unpaid caregivers to an adult or child. Caregiving (CG) is associated with poor self-care, higher depression rates, and decreased quality of life. Our primary objective was to determine if CG is associated with a delay in seeking care for pelvic floor disorders (PFDs). METHODS We performed a cross-sectional survey of new urogynecology patients from September 2015 to January 2016. Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Reported Outcomes Measurement Information System-Depression surveys, and a survey of care-seeking practices. Caregiving was defined as considering one's self a primary caregiver and assisting with 2 or more activities and instrumental activities of daily living. Multiple logistic regression identified variables associated with delayed care-seeking for 1 or more year. RESULTS Two hundred fifty-six patients completed the survey, 82 caregivers (32%) and 174 noncaregivers (NCGs). Sixty-seven percent of caregivers cared for a child and 33% for an adult. There was no difference between caregivers and NCGs in PFD symptom duration, Pelvic Floor Distress Inventory, or Patient Reported Outcomes Measurement Information System depression scores. Caregiving had higher mean Pelvic Floor Impact Questionnaire scores (69.6 vs 51.0, P = 0.02). There was no difference in proportion of patients who delayed care for 1 year or more (42% vs 54%, P = 0.08). A higher proportion of caregivers for an adult waited for 1 year or more (75% vs 42% NCG, P = 0.001). On multiple logistic regression, CG for adults only was associated with delaying care for 1 year or more (adjusted odds ratio, 3.73; confidence interval, 1.33-10.44; P = 0.01). CONCLUSIONS One third of patients presenting to a urogynecology practice are caregivers. Caregiving for an adult was associated with a delay in seeking care for PFDs.
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Meyer OL, Liu X(L, Tancredi D, Ramirez AS, Schulz R, Hinton L. Acculturation level and caregiver outcomes from a randomized intervention trial to enhance caregivers' health: evidence from REACH II. Aging Ment Health 2018; 22:730-737. [PMID: 28436694 PMCID: PMC5654701 DOI: 10.1080/13607863.2017.1317330] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Latinos comprise a growing segment of the caregiver population and vary widely in acculturation, yet little is known regarding how acculturation might affect caregiver stress or intervention outcomes. This study examined the relationship between acculturation and burden, bother, and depression in Latino dementia caregivers at baseline and following an intervention. METHODS This was a secondary data analysis of 211 Latino caregivers of older adults with dementia from Resources for Enhancing Alzheimer's Caregiver Health (REACH) II, a multisite randomized trial of caregiver interventions. Baseline and follow-up data were used to run mixed-effects models examining the main and moderating effect of acculturation on caregiver stress. RESULTS No significant main effect of acculturation was found for any of the outcome measures, controlling for demographic covariates. Acculturation moderated the effect of the intervention on caregiver burden: those who were more acculturated benefited more from the intervention. CONCLUSION Differential acculturation for Latino caregivers was not directly associated with caregiver burden, bother, or depression, but was associated with reducing burden from the intervention. Future research should explore by what mechanism acculturation influences caregiver burden following an intervention.
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Grace EL, Allen RS, Ivey K, Knapp SM, Burgio LD. Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States. Aging Ment Health 2018; 22:458-467. [PMID: 28282730 PMCID: PMC11293273 DOI: 10.1080/13607863.2017.1286451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. METHOD Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. RESULTS Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. CONCLUSION Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.
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Affiliation(s)
- Elsie L Grace
- a Center for Social Epidemiology and Population Health , School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Rebecca S Allen
- b Alabama Research Institute on Aging and Department of Psychology , University of Alabama , Tuscaloosa , AL , USA
| | - Keisha Ivey
- b Alabama Research Institute on Aging and Department of Psychology , University of Alabama , Tuscaloosa , AL , USA
| | - Shannon M Knapp
- c Statistics Consulting Lab , Bio5 Institute, University of Arizona , Tucson , AZ , USA
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Regier NG, Gitlin LN. Dementia-related restlessness: relationship to characteristics of persons with dementia and family caregivers. Int J Geriatr Psychiatry 2018; 33:185-192. [PMID: 28332736 PMCID: PMC6964249 DOI: 10.1002/gps.4705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Dementia-related restlessness is commonly endorsed by caregivers but not well understood. This study examines differences in characteristics (demographics, cognitive status, physical function, pain, and mood) of persons with dementia whose caregivers endorse restlessness versus those who do not. We also examine the relationship of restlessness to caregiver well-being including burden, upset with behaviors, mastery, and depressive symptomatology. METHODS We combined baseline data from three caregiver intervention studies of community-dwelling persons with dementia who exhibited neuropsychiatric symptoms (n = 569) as measured by the Agitated Behaviors in Dementia Scale. We conducted bivariate correlations and independent t-tests by using the Agitated Behaviors in Dementia Scale restlessness item. RESULTS Nearly 65% (n = 367) of dementia caregivers reported restlessness. There were no significant differences between those with and without (n = 202) reported restlessness concerning functional status (physical or cognitive). However, persons with restlessness had significantly higher pain scores (p < 0.01), were more likely to be on behavioral medications (p < 0.001), and had more neuropsychiatric symptoms as compared with persons without restlessness (M = 11.11, nonrestless; M = 6.61, restless) (p < 0.001). Caregivers of persons with dementia-related restlessness reported greater burden (p < 0.001), behavioral upset (p < 0.001), depression (p < 0.001), and lower mastery providing care (p < 0.01) compared with caregivers of persons without dementia-related restlessness. CONCLUSIONS Restlessness is a common neuropsychiatric symptom that appears to be associated with poorer functioning in persons with dementia and greater distress in their caregivers. Further research is needed to understand the unique contributions of restlessness to care burden and quality of life of persons with dementia, as well as ways to address this distressing symptom. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Natalie G. Regier
- School of Nursing, Center for Innovative Care in Aging; Johns Hopkins University; Baltimore MD USA
| | - Laura N. Gitlin
- School of Nursing, Center for Innovative Care in Aging; Johns Hopkins University; Baltimore MD USA
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Gitlin LN, Arthur P, Piersol C, Hessels V, Wu SS, Dai Y, Mann WC. Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial. J Am Geriatr Soc 2017; 66:339-345. [PMID: 29192967 DOI: 10.1111/jgs.15194] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Dementia-related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home-based activity program (Tailored Activity Program; TAP-VA) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden. DESIGN Single-blind (interviewer), parallel, randomized, controlled trial (Clinicaltrials.gov: NCT01357564). SETTING Veteran's homes. PARTICIPANTS Veterans with dementia and their family caregivers (N = 160 dyads). INTERVENTION Dyads in TAP-VA underwent 8 sessions with occupational therapists to customize activities to the interests and abilities of the veterans and educate their caregivers about dementia and use of customized activity. Caregivers assigned to attention control received up to 8 telephone-based dementia education sessions with a research team member. MEASUREMENTS Primary outcomes included number of behaviors and frequency of their occurrence multiplied by severity of occurrence; secondary outcomes were functional dependence, pain, emotional well-being, caregiver burden (time spent caregiving, upset with behaviors) and affect at 4 (primary endpoint) and 8 months. RESULTS Of 160 dyads (n = 76 TAP-VA; n = 84 control), 111 completed 4-month interviews (n = 51 TAP-VA; n = 60 control), and 103 completed 8-month interviews (n = 50 TAP-VA; n = 53 control). At 4 months, compared to controls, the TAP-VA group showed reductions in number (difference in mean change from baseline = -0.68, 95% CI = -1.23 to -0.13) and frequency by severity (-24.3, 95% CI = -45.6 to -3.1) of behavioral symptoms, number of activities needing assistance with (-0.80, 95% CI = -1.41 to -0.20), functional dependence level (4.09, 95% CI = 1.06, 7.13), and pain (-1.18, 95% CI = -2.10 to -0.26). Caregivers of veterans in TAP-VA reported less behavior-related distress. Benefits did not extend to 8 months. CONCLUSION TAP-VA had positive immediate effects and no adverse events. Because TAP-VA reduces behavioral symptoms, slows functional dependence, and alleviates pain and caregiver distress, it is a viable treatment option for families.
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Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Paul Arthur
- Department of Occupational Therapy, St. Catherine University, Minneapolis, Minnesota.,Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida
| | - Catherine Piersol
- Department of Occupational Therapy and Jefferson Elder Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Virginia Hessels
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - William C Mann
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida.,Department of Occupational Therapy, University of Florida, Gainesville, Florida
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Gitlin LN, Kales HC, Marx K, Stanislawski B, Lyketsos C. A randomized trial of a web-based platform to help families manage dementia-related behavioral symptoms: The WeCareAdvisor™. Contemp Clin Trials 2017; 62:27-36. [PMID: 28800895 PMCID: PMC6428066 DOI: 10.1016/j.cct.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022]
Abstract
Dementia-related behavioral symptoms are challenging clinical features occurring across etiologies and disease progression. They are associated with increased healthcare utilization, nursing home placement, family upset and burden. Families typically manage behavioral symptoms without requisite knowledge, skills and guidance. We designed WeCareAdvisor™ as an easy-to-use, evidence-informed web-based platform. It provides families knowledge about dementia, daily tips, and a systematic approach to describe behaviors, investigate modifiable contributors, create treatment plans (WeCareAdvisor™ Prescription) consisting of management tips tailored to symptom presentation, and evaluate effectiveness. WeCareAdvisor™ is being tested in a randomized trial to assess acceptability, usability and immediate impact on caregiver confidence managing and upset with behavioral symptoms, and secondarily, frequency of behavioral occurrences. Fifty-seven caregivers will be enrolled from communities and medical clinics at two sites (University of Michigan; Johns Hopkins University). Families reporting behavioral symptoms in a telephone screen are consented and interviewed at home. Following the interview, an envelope is opened by interviewers to reveal group assignment (immediate vs one-month delayed treatment group). Those receiving WeCareAdvisor™ immediately are provided an iPad and instruction in its use; those in the delayed treatment group are informed of next study steps. All caregivers are reassessed at home one month from baseline. The delayed treatment group then receives iPad instructions and are re-interviewed one month thereafter. During treatment phase, participants receive 3 weekly check-in calls to encourage tool use and troubleshoot. Key outcomes include number of times using WeCareAdvisor™ and for which behaviors, self-efficacy and upset managing behavioral symptoms, and frequency of behavioral occurrences. Clinical trial registration #: NCT02420535.
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Affiliation(s)
- Laura N Gitlin
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolf Street, Baltimore, MD 21205, United States.
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI, United States; Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
| | - Katherine Marx
- Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, 525 Wolf Street, Baltimore, MD 21205, United States.
| | - Barbara Stanislawski
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States; Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI, United States; Geriatric Research, Education and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, United States.
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Regier NG, Hodgson NA, Gitlin LN. Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages. THE GERONTOLOGIST 2017; 57:987-997. [PMID: 27986794 PMCID: PMC5881689 DOI: 10.1093/geront/gnw133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioral symptoms. Design and Methods Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorized as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal-Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal-Wallis tests, pairwise comparisons utilized the Mann-Whitney U test. Results Activity categories and instructions for set up were significantly related to cognitive and functional levels. Persons with mild dementia were most often prescribed complex arts and crafts and cognitive activities. Persons with moderate dementia were most often prescribed music/entertainment. Persons with severe dementia were most often prescribed simple physical exercises and manipulation/sensory/sorting activities. Average time prescribed for activities was less for those in severe (15min) versus moderate (24min) and mild (28min) stages. The severe group required more assistance with activity initiation and cueing/redirection. Implications Type of activity, recommended cueing, and engagement time differed by dementia stage. Findings provide guidance as to how to use and set up activities across the dementia trajectory.
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Affiliation(s)
- Natalie G Regier
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nancy A Hodgson
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Armstrong NM, Gitlin LN, Parisi JM, Carlson MC, Rebok GW, Gross AL. E pluribus unum: Harmonization of physical functioning across intervention studies of middle-aged and older adults. PLoS One 2017; 12:e0181746. [PMID: 28753644 PMCID: PMC5533461 DOI: 10.1371/journal.pone.0181746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
Abstract
Common scales for physical functioning are not directly comparable without harmonization techniques, complicating attempts to pool data across studies. Our aim was to provide a standardized metric for physical functioning in adults based on basic and instrumental activities of daily living scaled to NIH PROMIS norms. We provide an item bank to compare the difficulty of various physical functioning activities. We used item response theory methods to place 232 basic and instrumental activities of daily living questions, administered across eight intervention studies of middle-aged and older adults (N = 2,556), on a common metric. We compared the scale’s precision to an average z-score of items and evaluated criterion validity based on objective measures of physical functioning and Fried’s frailty criteria. Model-estimated item thresholds were widely distributed across the range of physical functioning. From test information plots, the lowest precision in each dataset was 0.80. Using power calculations, the sample size needed to detect 25% physical functional decline with 80% power based on the physical functioning factor was less than half of what would be needed using an average z-score. The physical functioning factor correlated in expected directions with objective measurements from the Timed Up and Go task, tandem balance, gait speed, chair stands, grip strength, and frailty status. Item-level harmonization enables direct comparison of physical functioning measures across existing and potentially future studies and across levels of function using a nationally representative metric. We identified key thresholds of physical functioning items in an item bank to facilitate clinical and epidemiologic decision-making.
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Affiliation(s)
- Nicole M Armstrong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
| | - Laura N Gitlin
- Division of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.,Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Jeanine M Parisi
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michelle C Carlson
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - George W Rebok
- Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, United States of America
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Choi SSW, Budhathoki C, Gitlin LN. Co-Occurrence and Predictors of Three Commonly Occurring Behavioral Symptoms in Dementia: Agitation, Aggression, and Rejection of Care. Am J Geriatr Psychiatry 2017; 25:459-468. [PMID: 27914870 DOI: 10.1016/j.jagp.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/16/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate co-occurrences of agitation, aggression, and rejection of care in community-dwelling families living with dementia. METHODS Cross-sectional, secondary analysis from a randomized controlled trial testing a nonpharmacological intervention to reduce behavioral symptoms. We examined frequency of occurrence of presenting behaviors at baseline and their combination. Omnibus tests compared those exhibiting combinations of behaviors on contributory factors. Multinomial logistic regression analyses examined relationships of contributory factors to combinations of behaviors. RESULTS Of 272 persons with dementia (PwDs), 41 (15%) had agitation alone (Agi), 3 (1%) had aggression alone, 5 (2%) had rejection of care alone. For behavioral combinations, 65 (24%) had agitation and aggression (Agi+Aggr), 35 (13%) had agitation and rejection (Agi+Rej), 1 (0%) had aggression and rejection, and 106 (39%) had all three behaviors (All). Four behavioral subgroups (Agi, Agi+Aggr, Agi+Rej, and All) were examined. Kruskal-Wallis tests showed that there were significant group differences in PwD cognition, functional dependence, and caregiver frustration. PwDs in Agi+Rej and All were more cognitively impaired than those in Agi and Agi+Aggr. Also, caregivers in All were more frustrated than those in Agi. In logistic regression analyses, compared with Agi, greater cognitive impairment was a significant predictor of Agi+Rej and All, but not Agi+Aggr. In contrast, greater caregiver frustration was a significant predictor of Agi+Aggr and All, but not Agi+Rej. CONCLUSIONS We found that agitation, aggression, and rejection are common but distinct behaviors. Combinations of these behaviors have different relationships with contributory factors, suggesting the need for targeting treatment approaches to clusters.
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Affiliation(s)
| | | | - Laura N Gitlin
- Johns Hopkins University School of Nursing, Baltimore, MD
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Grace EL, Burgio LD, Allen RS, DeCoster J, Aiello AE, Algase DL. Caregiver and care recipient characteristics as predictors of psychotropic medication use in community-dwelling dementia patients. Aging Ment Health 2016; 20:1297-1304. [PMID: 26304301 PMCID: PMC6684031 DOI: 10.1080/13607863.2015.1075960] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The current practice of prescribing psychotropic medication for the management of dementia-related behavioral disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. We hypothesized that caregiving burden and patient characteristics, particularly behavior disturbances and pain, would be positively associated with psychotropic medication use. METHODS Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N = 598). Caregiver characteristics, such as confidence managing problematic behaviors, and care recipient characteristics including pain, problem behaviors, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. RESULTS Contrary to our hypothesis, behavioral disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. CONCLUSION These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community.
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Affiliation(s)
- Elsie L. Grace
- The University of Michigan, School of Public Health, Center for Social Epidemiology and Population Health, Ann Arbor, MI
| | - Louis D. Burgio
- University of Michigan, School of Social Work, Ann Arbor, MI
| | - Rebecca S. Allen
- The University of Alabama, Alabama Research Institute on Aging, Tuscaloosa, AL.,The University of Alabama, Department of Psychology, Tuscaloosa, AL
| | - Jamie DeCoster
- The University of Virginia, Curry School of Education, Charlottesville, VA
| | - Allison E. Aiello
- The University of Michigan, School of Public Health, Center for Social Epidemiology and Population Health, Ann Arbor, MI
| | - Donna L. Algase
- The University of Michigan, School Nursing, Ann Arbor, MI., Address correspondence to: Louis D. Burgio, Burgio Geriatric Consulting, 4199 126th Ave, Allegan, MI 49010. Phone: (205) 394-1647.
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Piersol CV, Herge EA, Copolillo AE, Leiby BE, Gitlin LN. Psychometric Properties of the Functional Capacity Card Sort for Caregivers of People With Dementia. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:126-33. [DOI: 10.1177/1539449216666063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregiver appraisal influences care decisions and may place the person with dementia at risk. The Functional Capacity Card Sort (FCCS) was developed to determine caregiver appraisal. The objective of this study was to examine FCCS psychometric properties and utility, using data from a cross-sectional study ( N = 86). The FCCS had moderately positive association (convergent validity) with a related activities of daily living (ADL) index ( r = .43, p < .0001), weak negative association (discriminant validity) with an unrelated neuropsychiatric symptom index ( r = −.14, p = .16), and strong caregiver agreement (interrater reliability) in ranking cards from high to low function, Kendall’s W(5, 72) = 0.83, p = .0001. When compared with occupational therapy assessment, the FCCS distinguished caregiver concordant estimation (17%), underestimation (22%), and overestimation (61%) of function. The FCCS is a valid and reliable tool used in conjunction with formal assessment to identify caregiver over- or underestimation, which has implications for patient safety and caregiver education.
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Affiliation(s)
- Catherine Verrier Piersol
- Department of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - E. Adel Herge
- Department of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Albert E. Copolillo
- Department of Occupational Therapy, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin E. Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Ciro CA, Stoner J, Prodan C, Hershey L. Skill-building through Task-Oriented Motor Practice (STOMP) intervention for activities of daily living: study protocol for a randomized, single blinded clinical trial. ACTA ACUST UNITED AC 2016; 1:45-50. [PMID: 29071307 DOI: 10.4103/2468-5658.184743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Progressive disability in activities of daily living (ADL) is inevitable for people with Alzheimer's disease and related dementias (ADRD). Attempts to slow or prevent ADL disability have been unsuccessful despite making progress in behavioral training methods. Missing from this research is an emphasis on how we maximize a patient's engagement during training and the rigorous examination of implementation protocols (dosing and training methods) which may advantage learning in people with ADRD. Our team addressed this gap with the development of the STOMP (Skill-building through Task-Oriented Motor Practice) intervention which creates methods for obtaining ADL goals that support "personhood" and tests high-intensity protocols that appear to advantage learning and sustained learning over time. Through this study, we aim to evaluate differential outcomes by dose levels as well as assess the moderating effects of attention to task during training. METHODS/DESIGN Randomized-controlled trial with 32 participants with dementia assigned to either the original, intensive STOMP protocol (3 hours/day, 5 days/week for 2 weeks) or a less-intensive STOMP protocol (1 hour/day, 2 days/week for 2 weeks) delivered by an occupational therapy assistant in the home. ADL training is delivered using motor learning theory techniques of blocked practice, continuous verbal praise, errorless learning and intense dosing schedules. Inclusion criteria: English speaking, adults 50-80 years old that live with a legally-authorized representative that can provide consent, who can follow a one-step command, have three ADL goals they want to address and can participate in an intense therapy protocol. Exclusions include diagnoses of Creutzfeldt-Jakob Dementia, delirium or receptive/global aphasia. Recruitment will occur through direct mailing, physician referral and media/support group presentations. Blinded occupational therapists will complete baseline, post-intervention and 3-month follow-up assessments in the home. Repeated measures ANOVA and graphs will be used to interpret and display results. DISCUSSION Through this protocol, we will examine differential outcomes by dose for the STOMP ADL intervention. Our results will inform dosing parameters for future intervention studies for people with ADRD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02356055. ETHICAL APPROVAL This study protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#4648) and will be performed in accordance with the Declaration of Helsinki.
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Affiliation(s)
- C A Ciro
- College of Allied Health, 1200 N. Stonewall Ave, OKC, OK 73117
| | - J Stoner
- College of Public Health, 801 NE 13, OKC, OK 73104
| | - C Prodan
- College of Medicine, 1100 N Lindsay, OKC, OK 73104
| | - L Hershey
- College of Medicine, 1100 N Lindsay, OKC, OK 73104
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Gitlin LN, Piersol CV, Hodgson N, Marx K, Roth DL, Johnston D, Samus Q, Pizzi L, Jutkowitz E, Lyketsos CG. Reducing neuropsychiatric symptoms in persons with dementia and associated burden in family caregivers using tailored activities: Design and methods of a randomized clinical trial. Contemp Clin Trials 2016; 49:92-102. [PMID: 27339865 PMCID: PMC4969112 DOI: 10.1016/j.cct.2016.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/16/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
Among over 5million people in the USA with dementia, neuropsychiatric symptoms (NPS) are almost universal, occurring across disease etiology and stage. If untreated, NPS can lead to significant morbidity and mortality including increased cost, distress, depression, and faster disease progression, as well as heightened burden on families. With few pharmacological solutions, identifying nonpharmacologic strategies is critical. We describe a randomized clinical trial, the Dementia Behavior Study, to test the efficacy of an activity program to reduce significant existing NPS and associated caregiver burden at 3 and 6months compared to a control group intervention. Occupational therapists deliver 8 in-home sessions over 3months to assess capabilities and interests of persons with dementia, home environments, and caregiver knowledge, and readiness from which activities are developed and families trained in their use. Families learn to modify activities for future declines and use strategies to address care challenges. The comparison group controls for time and attention and involves 8 in-home sessions delivered by health educators who provide dementia education, home safety recommendations, and advanced care planning. We are randomizing 250 racially diverse families (person with dementia and primary caregiver dyads) recruited from community-based social services, conferences and media announcements. The primary outcome is change in agitation/aggression at 3 and 6months. Secondary outcomes assess quality of life of persons with dementia, other behaviors, burden and confidence of caregivers, and cost and cost effectiveness. If benefits are supported, this activity intervention will provide a clinically meaningful approach to prevent, reduce, and manage NPS.
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Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Nancy Hodgson
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Katherine Marx
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - David L Roth
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Deidre Johnston
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Quincy Samus
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Pizzi
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Eric Jutkowitz
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
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Wales K, Clemson L, Lannin N, Cameron I. Functional Assessments Used by Occupational Therapists with Older Adults at Risk of Activity and Participation Limitations: A Systematic Review. PLoS One 2016; 11:e0147980. [PMID: 26859678 PMCID: PMC4747506 DOI: 10.1371/journal.pone.0147980] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 01/10/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction The use of functional assessments to evaluate patient change is complicated by a lack of consensus as to which assessment is most suitable for use with older adults. Objective: To identify and appraise the properties of assessments used to evaluate functional abilities in older adults. Methods A systematic review of randomised controlled trials of occupational therapy interventions was conducted up to 2012 to identify assessments used to measure function. Two authors screened and extracted data independently. A second search then identified papers investigating measurement properties of each assessment. Studies from the second search were included if: i) published in English, ii) the assessment was not modified from its original published form, iii) study aim was to evaluate the quality of the tool, iv) and was original research. Translated versions of assessments were excluded. Measurement quality was rated using the COSMIN checklist and Terwee criteria. Results Twenty-eight assessments were identified from the systematic search of occupational therapy interventions provided to older adults. Assessments were of varied measurement quality and many had been adapted (although still evaluated as though the original tool had been administered) potentially altering the conclusions drawn about measurement quality. Synthesis of best evidence established 15 functional assessments have not been tested in an older adult population. Conclusions The Functional Autonomy Measurement System (SMAF) appears to be a promising assessment for use with older adults. Only two tools (the SMAF and the Assessment of Motor and Process Skills (AMPS)) were deemed to be responsive to change when applied to older adults. Health professionals should use functional assessments that have been validated with their population and in their setting. There are reliable and valid assessments to capture the functional performance of older adults in community and hospital settings, although further refinement of these assessments may be necessary.
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Affiliation(s)
- Kylie Wales
- Ageing Work and Health Research Unit and Centre of Excellence in Population Ageing Research, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- * E-mail:
| | - Lindy Clemson
- Ageing Work and Health Research Unit and Centre of Excellence in Population Ageing Research, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Natasha Lannin
- School of Allied Health, La Trobe University and Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
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Thunborg C, Heideken Wågert PV, Ivarsson AB, Söderlund A. Inter- and Intra-Rater Reliability of a Newly Developed Assessment Scale: The Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS). PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2015. [DOI: 10.3109/02703181.2015.1065939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gohil R, Crosby-Nwaobi R, Forbes A, Burton B, Hykin P, Sivaprasad S. Caregiver Burden in Patients Receiving Ranibizumab Therapy for Neovascular Age Related Macular Degeneration. PLoS One 2015; 10:e0129361. [PMID: 26056840 PMCID: PMC4461306 DOI: 10.1371/journal.pone.0129361] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/08/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the caregiver burden and factors determining the burden in patients receiving ranibizumab therapy for neovascular AMD (nAMD). Methods This is a cross-sectional questionnaire survey of 250 matched patient caregiver dyads across three large ophthalmic treatment centres in United Kingdom. The primary outcome was the subjective caregiver burden measured using caregiver reaction assessment scale (CRA). Objective caregiver burden was determined by the caregiver tasks and level of care provided. The factors that may predict the caregiver burden such as the patient’s visual acuity of the better eye and vision related quality of life, demographics, satisfaction and support provided by the healthcare and the health status of the dyads were also collected and assessed in a hierarchical regression model. Results The mean CRA score was 3.2±0.5, similar to the score reported by caregivers for atrial fibrillation who require regular hospital appointments for monitoring their thromboprophylaxis. Caregiver tasks including accompanying for hospital appointments for eye treatment and patient’s visual acuity in the better eye were the biggest contributors to the caregiver burden hierarchical model explaining 18% and 11% of the variance respectively. Conclusion Ranibizumab therapy for nAMD is associated with significant caregiver burden. Both disease impact and treatment frequency contributed to the overall burden.
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Affiliation(s)
- Rishma Gohil
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- King’s College London, London, United Kingdom
| | - Roxanne Crosby-Nwaobi
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- King’s College London, London, United Kingdom
- King’s College Hospital, London, United Kingdom
| | - Angus Forbes
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Ben Burton
- James Paget University Hospital, Great Yarmouth, United Kingdom
| | - Phil Hykin
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- King’s College London, London, United Kingdom
- King’s College Hospital, London, United Kingdom
- * E-mail:
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Thunborg C, von Heideken Wågert P, Götell E, Ivarsson AB, Söderlund A. Development of a new assessment scale for measuring interaction during staff-assisted transfer of residents in dementia special care units. BMC Geriatr 2015; 15:6. [PMID: 25884797 PMCID: PMC4333260 DOI: 10.1186/s12877-015-0003-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/20/2015] [Indexed: 11/20/2022] Open
Abstract
Background Mobility problems and cognitive deficits related to transferring or moving persons suffering from dementia are associated with dependency. Physical assistance provided by staff is an important component of residents’ maintenance of mobility in dementia care facilities. Unfortunately, hands-on assistance during transfers is also a source of confusion in persons with dementia, as well as a source of strain in the caregiver. The bidirectional effect of actions in a dementia care dyad involved in transfer is complicated to evaluate. This study aimed to develop an assessment scale for measuring actions related to transferring persons with dementia by dementia care dyads. Methods This study was performed in four phases and guided by the framework of the biopsychosocial model and the approach presented by Social Cognitive Theory. These frameworks provided a starting point for understanding reciprocal effects in dyadic interaction. The four phases were 1) a literature review identifying existing assessment scales; 2) analyses of video-recorded transfer of persons with dementia for further generation of items, 3) computing the item content validity index of the 93 proposed items by 15 experts; and 4) expert opinion on the response scale and feasibility testing of the new assessment scale by video observation of the transfer situations. Results The development process resulted in a 17-item scale with a seven-point response scale. The scale consists of two sections. One section is related to transfer-related actions (e.g., capability of communication, motor skills performance, and cognitive functioning) of the person with dementia. The other section addresses the caregivers’ facilitative actions (e.g., preparedness of transfer aids, interactional skills, and means of communication and interaction). The literature review and video recordings provided ideas for the item pool. Expert opinion decreased the number of items by relevance ratings and qualitative feedback. No further development of items was performed after feasibility testing of the scale. Conclusions To enable assessment of transfer-related actions in dementia care dyads, our new scale shows potential for bridging the gap in this area. Results from this study could provide health care professionals working in dementia care facilities with a useful tool for assessing transfer-related actions. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0003-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotta Thunborg
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden. .,School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | | | - Eva Götell
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden.
| | - Ann-Britt Ivarsson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
| | - Anne Söderlund
- School of Health, Care and Social Welfare Mälardalen University, Västerås, Sweden.
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Ng S, Morgan RO, Walder A, Biswas J, Bass DM, Judge KS, Snow AL, Wilson N, Kunik ME. Functional Decline Predicts Emergency Department Use in Veterans With Dementia. Am J Alzheimers Dis Other Demen 2014; 29:362-71. [PMID: 24413540 PMCID: PMC10852555 DOI: 10.1177/1533317513518655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
BACKGROUND We examined emergency room (ER) utilization by persons with dementia (PWDs) using caregiver and patient characteristics as predictors. METHODS A secondary analysis of 296 veteran-caregiver dyads. Caregivers recorded PWD baseline characteristics and noted ER visits over the next year. Two sets of regression models analyzed categorical ER use and repeat ER use. RESULTS In the univariate analysis, categorical use of the ER was predicted by patients' functional status (P ≤ .008) and Veterans Affairs priority grouping (P ≤ .02). Repeat ER admissions were predicted by functional status (P ≤ .04), number of chronic conditions (P ≤ .01), and caregiver-reported relationship strain (P ≤ .04). In multivariate analysis, categorical ER use was predicted by functional status (P ≤ .02), priority grouping (P ≤ .03), and number of chronic conditions (P ≤ .06). CONCLUSIONS Functional status most strongly predicted ER use, highlighting the promise of home-based interventions to improve activities of daily living. Number of chronic conditions and caregiver-reported relationship strain are potential targets of intervention during discharge process.
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Affiliation(s)
- Stephanie Ng
- Baylor College of Medicine, Houston, TX, USA Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
| | - Robert O Morgan
- Management, Policy and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Annette Walder
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Jonmenjoy Biswas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - David M Bass
- Margaret Blenkner Research Institute, Benjamin Rose Institute, Cleveland, OH, USA
| | - Katherine S Judge
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
| | - A Lynn Snow
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | - Nancy Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA VA South Central Mental Illness Research, Education and Clinical Center, USA
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Use of the Tailored Activities Program to reduce neuropsychiatric behaviors in dementia: an Australian protocol for a randomized trial to evaluate its effectiveness. Int Psychogeriatr 2014; 26:857-69. [PMID: 24507481 PMCID: PMC4091660 DOI: 10.1017/s1041610214000040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group. METHODS This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by the Neuropsychiatric Inventory, and the caregiver must have at least 7 h per week contact. Participants will be randomly allocated to intervention (TAP) or control (phone-based education sessions) groups, both provided by a trained occupational therapist. Primary outcome measure will be the revised Neuropsychiatric Inventory - Clinician rating scale (NPI-C) to measure BPSD exhibited by the person with dementia. CONCLUSIONS This trial investigates the effectiveness and cost-effectiveness of TAP within an Australian population. Results will address a significant gap in the current Australian community-support base for people living with dementia and their caregivers.
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Hodgson N, Gitlin LN, Winter L, Hauck WW. Caregiver's perceptions of the relationship of pain to behavioral and psychiatric symptoms in older community-residing adults with dementia. Clin J Pain 2014; 30:421-7. [PMID: 24281271 PMCID: PMC3995132 DOI: 10.1097/ajp.0000000000000018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain is underrecognized and undermanaged in older adults with dementia. Because dementia patients have a diminished capacity to communicate discomfort, untreated pain may be expressed in the form of behavioral and psychiatric symptoms. The goal of the present study was to examine the relationship between pain and behavioral and psychiatric symptoms of dementia in community-residing older adults from the perspective of the family caregiver. MATERIALS AND METHODS Dyads composed of 272 dementia patients, and their family caregivers were assessed to determine dementia patient's mental status; family caregiver's assessment of care recipient's pain, functional dependence, and number of behavioral symptoms; analgesic use; and demographic information. RESULTS Hierarchical multiple regression analysis controlling for age, marital status, race, functional disability, and analgesic use showed that pain explained a small but significant percent of variance in the number of behavioral symptoms (3%, P<0.001). Pain had a stronger influence on the number of behavioral and psychiatric symptoms of dementia among those with severe cognitive impairment (F1,69=11.75, P<0.001) compared with those with low to moderate cognitive impairment (F1,199=4.543, P=0.034.). DISCUSSION The findings indicate that pain is a risk factor for behavioral symptoms in individuals with dementia and suggest that pain is a more significant predictor of behavior for individuals with severe dementia, compared with those with mild/moderate stage dementia. These results reinforce the importance of proper pain assessment and its management as part of dementia care planning.
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Martín-Carrasco M, Domínguez-Panchón AI, Muñoz-Hermoso P, González-Fraile E, Ballesteros-Rodríguez J. [Assessment tools to measure burden in the informal caregiver of patients with dementia]. Rev Esp Geriatr Gerontol 2013; 48:276-84. [PMID: 24161356 DOI: 10.1016/j.regg.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 06/14/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The complexity of dementia caregiver burden concept has led to a significant number of assessment tests using various approaches. For this reason, a review of these measurementss could be useful for clinical or research purposes. OBJECTIVE The objective of the study is to perform an updated review on the tools available, classifying them according to the burden criterion by studying their characteristics and psychometric properties, and providing those most relevant for application. METHOD The method applied consisted of a database search -Pubmed, PsycINFO, Embase and Psicodoc (1980-2012). RESULTS A total of 31 assessment tools were selected, grouped on the basis of the burden concept evaluated: objective/subjective burden, burden from a multidimensional approach, and as distress associated with patient impairment. CONCLUSIONS This study provides a suitable tool for using caregiver burden assessment tools accurately. A marked conclusion is the need to establish agreements in the assessment methods, in order to develop standard knowledge and application to healthcare practice.
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Affiliation(s)
- Manuel Martín-Carrasco
- Instituto de Investigaciones Psiquiátricas (IIP), Fundación M. Josefa Recio, CIBERSAM, G10, Bilbao, España.
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Sun F, Durkin DW, Hilgeman MM, Harris G, Gaugler JE, Wardian J, Allen RS, Burgio LD. Predicting desire for institutional placement among racially diverse dementia family caregivers: the role of quality of care. THE GERONTOLOGIST 2013; 53:418-29. [PMID: 22961466 PMCID: PMC3697938 DOI: 10.1093/geront/gns110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 07/09/2012] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Literature on institutionalization of patients with dementia has not considered the role of caregivers' quality of care, which encompasses caregivers' exemplary care (EC) behaviors and caregivers' potentially harmful behaviors (PHBs) toward care recipients. This study sought to understand the role of quality of care in mediating between caregiving stressors and caregiver desire to institutionalize (DTI) a patient with dementia. DESIGN AND METHODS A sample of 612 family caregivers from diverse racial/ethnic backgrounds was drawn from the baseline data of the Resources for Enhancing Alzheimer's Caregiver Heath (REACH II) project. Multiple mediator models were run using Preacher and Hayes asymptotic and resampling strategies to assess direct and indirect effects of caregiver stressors (daily care bother, behavioral bother, and burden) on caregiver desire to institutionalize a patient with dementia. RESULTS Overall, PHB was positively related to caregiver desire to institutionalize their care recipients. Specifically, PHB was found to mediate the relationship between caregiving stressors and DTI in the Caucasian and Latino groups, whereas only the mediation effect of EC was significant in the African American group. IMPLICATIONS Caregivers' perceptions of quality of care helped explain their desire to institutionalize their care recipients with dementia. Including assessment of EC and PHB in clinical and social service settings is recommended for all ethnic groups. Interventions should facilitate EC behaviors among African American caregivers and address concerns of PHBs in Caucasian and Latino caregivers.
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Affiliation(s)
- Fei Sun
- School of Social Work, Arizona State University, Phoenix, Arizona,
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Hodge DR, Sun F. Positive feelings of caregiving among Latino Alzheimer's family caregivers: understanding the role of spirituality. Aging Ment Health 2012; 16:689-98. [PMID: 22512416 DOI: 10.1080/13607863.2012.678481] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study used structural equation modeling to examine the effects of spirituality on positive aspects of caregiving (PAC) among a sample of American Latino family members caring for a relative with Alzheimer's disease (AD). Participants consisted of 209 Latino caregivers (CGs) drawn from baseline data from the Resources for Enhancing Alzheimer's Caregivers Health II study. The findings indicate that spirituality is positively related to PAC and may partially mediate the effect of subjective stress on PAC. AD CGs typically provide better care when they perceive the caregiving experience to be satisfying and rewarding. Toward this end, gerontological practitioners should adopt a proactive stance to ensure Latino AD CGs can operationalize their spiritual strengths.
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Affiliation(s)
- David R Hodge
- School of Social Work, Arizona State University, Phoenix, USA
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Hodgson N, Gitlin LN, Winter L, Czekanski K. Undiagnosed illness and neuropsychiatric behaviors in community residing older adults with dementia. Alzheimer Dis Assoc Disord 2011; 25:109-15. [PMID: 20921879 PMCID: PMC3035741 DOI: 10.1097/wad.0b013e3181f8520a] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective analysis was to examine prevalence of undiagnosed acute illness and characteristics including neuropsychiatric symptoms associated with illness in community residing older adults with Alzheimer disease or related disorders. Subjects included 265 community residing older adults with dementia who participated in 1 of 2 interventions being tested in randomized clinical trials. Measures included a brief nursing assessment and laboratory evaluations including complete blood count, blood chemistry (Chem 7), and thyroid function tests of serum samples and culture and sensitivity tests of urine samples. Undiagnosed illness was identified according to currently published criteria. Neuropsychiatric behaviors were assessed using 21 behaviors derived from standard measures. Thirty-six percent (N=96) of patients had clinical findings indicative of undetected illness. Conditions most prevalent were bacteriuria (15%), followed by hyperglycemia (6%) and anemia (5%). The behavior most often demonstrated among those with detected illness was resisting or refusing care (66% vs. 47% for those without detected illness). Individuals with detected illness had significantly lower functional status scores [3.8 vs. 4.4, t(275)=7.01, P=0.01], lower cognitive status scores [10.5 vs. 14.4, t(275)=12.1, P<0.01], and were more likely to be prescribed psychotropic medications for behavior (41% vs. 26%, χ=3.67, P<0.05) than those without illness. Findings suggest that challenges of diagnosing acute illness with atypical presentation must be addressed to promote quality of care and the specialized needs for this vulnerable population.
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Affiliation(s)
- Nancy Hodgson
- Corresponding Author; Research Scientist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice -215-955-2163; fax- 215-923-2475;
| | - Laura N. Gitlin
- Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 513, Philadelphia, PA, 19130
| | - Laraine Winter
- Assistant Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-503-4715; fax- 215-923-2475
| | - Kathleen Czekanski
- Nurse Interventionist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-951-1322
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Harris GM, Durkin DW, Allen RS, DeCoster J, Burgio LD. Exemplary care as a mediator of the effects of caregiver subjective appraisal and emotional outcomes. THE GERONTOLOGIST 2011; 51:332-42. [PMID: 21350038 DOI: 10.1093/geront/gnr003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs. DESIGN AND METHODS We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes. RESULTS Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity. IMPLICATIONS Overall, CGs' perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care.
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Affiliation(s)
- Grant M Harris
- Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487-0315, USA.
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Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the COPE randomized trial. JAMA 2010; 304:983-91. [PMID: 20810376 PMCID: PMC4091681 DOI: 10.1001/jama.2010.1253] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Optimal treatment to postpone functional decline in patients with dementia is not established. OBJECTIVE To test a nonpharmacologic intervention realigning environmental demands with patient capabilities. DESIGN, SETTING, AND PARTICIPANTS Prospective 2-group randomized trial (Care of Persons with Dementia in their Environments [COPE]) involving patients with dementia and family caregivers (community-living dyads) recruited from March 2006 through June 2008 in Pennsylvania. INTERVENTIONS Up to 12 home or telephone contacts over 4 months by health professionals who assessed patient capabilities and deficits; obtained blood and urine samples; and trained families in home safety, simplifying tasks, and stress reduction. Control group caregivers received 3 telephone calls and educational materials. MAIN OUTCOME MEASURES Functional dependence, quality of life, frequency of agitated behaviors, and engagement for patients and well-being, confidence using activities, and perceived benefits for caregivers at 4 months. RESULTS Of 284 dyads screened, 270 (95%) were eligible and 237 (88%) randomized. Data were collected from 209 dyads (88%) at 4 months and 173 (73%) at 9 months. At 4 months, compared with controls, COPE patients had less functional dependence (adjusted mean difference, 0.24; 95% CI, 0.03-0.44; P = .02; Cohen d = 0.21) and less dependence in instrumental activities of daily living (adjusted mean difference, 0.32; 95% CI, 0.09-0.55; P = .007; Cohen d = 0.43), measured by a 15-item scale modeled after the Functional Independence Measure; COPE patients also had improved engagement (adjusted mean difference, 0.12; 95% CI, 0.07-0.22; P = .03; Cohen d = 0.26), measured by a 5-item scale. COPE caregivers improved in their well-being (adjusted mean difference in Perceived Change Index, 0.22; 95% CI, 0.08-0.36; P = .002; Cohen d = 0.30) and confidence using activities (adjusted mean difference, 0.81; 95% CI, 0.30-1.32; P = .002; Cohen d = 0.54), measured by a 5-item scale. By 4 months, 64 COPE dyads (62.7%) vs 48 control group dyads (44.9%) eliminated 1 or more caregiver-identified problems (chi(2/1) = 6.72, P = . 01). CONCLUSION Among community-living dyads, a nonpharmacologic biobehavioral environmental intervention compared with control resulted in better outcomes for COPE dyads at 4 months. Although no group differences were observed at 9 months for patients, COPE caregivers perceived greater benefits. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00259454.
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Affiliation(s)
- Laura N Gitlin
- Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S Ninth St, Ste 513, Philadelphia, PA 19130, USA.
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Elliott AF, Burgio LD, DeCoster J. Enhancing caregiver health: findings from the resources for enhancing Alzheimer's caregiver health II intervention. J Am Geriatr Soc 2010; 58:30-7. [PMID: 20122038 PMCID: PMC2819276 DOI: 10.1111/j.1532-5415.2009.02631.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN Randomized, multisite clinical trial. SETTING CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period. MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.
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Affiliation(s)
- Amanda F. Elliott
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
| | - Louis D. Burgio
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
- School of Social Work and Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Jamie DeCoster
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
- Institute for Social Science Research, University of Alabama, Tuscaloosa, Alabama
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Family caregiving and emotional strain: associations with quality of life in a large national sample of middle-aged and older adults. Qual Life Res 2009; 18:679-88. [PMID: 19421895 DOI: 10.1007/s11136-009-9482-2] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 04/10/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE This study examined the quality of life correlates of family caregiving and caregiving strain in a large national epidemiological sample. METHODS Structured telephone interviews were conducted with 43,099 participants as part of the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Participants completed the 12-item short form health survey (SF-12) and brief measures of depressive symptoms, social contacts, and caregiving strain. RESULTS Family caregiving responsibilities were reported by 12% of participants. Caregivers reported more quality of life problems than noncaregivers, but these effects were largely dependent on the perceived level of caregiving strain. High strain caregivers reported more problems with emotional distress, worse physical functioning, and fewer social contacts than noncaregivers. Conversely, caregivers who reported no strain from caregiving reported better quality of life than noncaregivers. Caregiving strain effects were not due to demographic differences or to more objective indicators of caregiving demand. CONCLUSIONS Psychological and social indices of quality of life indicate prevalent problems among family caregivers who have experienced high strain from their caregiving responsibilities. Public health programs for disabled individuals should include assessments of strain on family caregivers and support services for those who report high levels of caregiving strain.
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Hilgeman MM, Durkin DW, Sun F, DeCoster J, Allen RS, Gallagher-Thompson D, Burgio LD. Testing a theoretical model of the stress process in Alzheimer's caregivers with race as a moderator. THE GERONTOLOGIST 2009; 49:248-61. [PMID: 19363019 DOI: 10.1093/geront/gnp015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990) in a racially diverse sample of Alzheimer's caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. SAMPLE Participants included White or Caucasian (n = 212), Black or African American (n = 201), and Hispanic or Latino (n = 196) Alzheimer's CGs from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial. RESULTS SEM revealed that the Pearlin model obtains a satisfactory fit across race or ethnicity in the REACH II data, despite significant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. IMPLICATIONS Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefit for individuals of different cultural or ethnic backgrounds.
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Affiliation(s)
- Michelle M Hilgeman
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, AL 35487-0315, USA.
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Roth DL, Ackerman ML, Okonkwo OC, Burgio LD. The four-factor model of depressive symptoms in dementia caregivers: a structural equation model of ethnic differences. Psychol Aging 2008; 23:567-576. [PMID: 18808246 DOI: 10.1037/a0013287] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Previous studies have suggested that 4 latent constructs (depressed affect, well-being, interpersonal problems, somatic symptoms) underlie the item responses on the Center for Epidemiological Studies Depression (CES-D) Scale. This instrument has been widely used in dementia caregiving research, but the fit of this multifactor model and the explanatory contributions of multifactor models have not been sufficiently examined for caregiving samples. The authors subjected CES-D data (N = 1,183) from the initial Resources for Enhancing Alzheimer's Caregiver Health Study to confirmatory factor analysis methods and found that the 4-factor model provided excellent fit to the observed data. Invariance analyses suggested only minimal item-loading differences across race subgroups and supported the validity of race comparisons on the latent factors. Significant race differences were found on 3 of the 4 latent factors both before and after controlling for demographic covariates. African Americans reported less depressed affect and better well-being than White caregivers, who reported better well-being and fewer interpersonal problems than Hispanic caregivers. These findings clarify and extend previous studies of race differences in depression among diverse samples of dementia caregivers.
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Affiliation(s)
- David L Roth
- Department of Biostatistics, University of Alabama at Birmingham
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