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Pasquini S, Margaritini A, Gambella E, Di Rosa M, Maranesi E, Bevilacqua R, Civerchia P, Pelliccioni G. A psychosocial intervention for supporting the informal caregivers of older people with Alzheimer’s disease: The “INNfamiglia” study protocol (Preprint). JMIR Res Protoc 2022; 11:e37496. [DOI: 10.2196/37496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/14/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
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Lindauer A, Messecar D, McKenzie G, Gibson A, Wharton W, Bianchi A, Tarter R, Tadesse R, Boardman C, Golonka O, Gothard S, Dodge HH. The Tele-STELLA protocol: Telehealth-based support for families living with later-stage Alzheimer's disease. J Adv Nurs 2021; 77:4254-4267. [PMID: 34288013 DOI: 10.1111/jan.14980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS We aim to establish the feasibility and acceptability of the Tele-STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms. DESIGN This is a multi-component, quasi-experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia. METHODS Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8-week videoconferencing components that address behavioural symptoms-in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021. DISCUSSION Tele-STELLA fills a gap in current videoconference-based psychoeducational interventions in that it offers real-time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele-STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial. IMPACT Tele-STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele-STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (#NCT04627662).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Deborah Messecar
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Allison Gibson
- School of Social Work, University of Kentucky, Lexington, KY, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Allison Bianchi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Robin Tarter
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ruth Tadesse
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Charles Boardman
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ona Golonka
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
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Yu J, Yap P, Liew TM. The optimal short version of the Zarit Burden Interview for dementia caregivers: diagnostic utility and externally validated cutoffs. Aging Ment Health 2019; 23:706-710. [PMID: 29553806 DOI: 10.1080/13607863.2018.1450841] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Using a sample of dementia caregivers, we compared the diagnostic utility of the various short versions of the Zarit Burden Interview (ZBI) with the original scale to identify the most optimal one. Next, we established externally validated cutoffs for the various ZBI versions using probable depression cases as a reference standard. METHODS Caregivers (N = 394; 236 males; Agemean = 56 years) were administered the ZBI and a self-report depression measure. Participants who exceeded the cutoff for the latter were identified as probable depression cases. For each of the ZBI versions, a receiver operating characteristic (ROC) curve was plotted against probable depression cases. The area under these ROC curves between the short versions and the original were then compared using a non-parametric approach. RESULTS Compared to the original ZBI, the AUROC were similar for the 6-item, 7-item, and two 12-item versions, but significantly worse for the other short variants. The sensitivity and specificity of the cutoffs for all ZBI versions ranged from 77.3% to 85.2% and 60.1% to 79.8%, respectively. CONCLUSIONS The original ZBI had good utility in identifying probable depression in caregivers, while the 6-item variant can be a useful alternative when short versions are preferred.
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Affiliation(s)
- Junhong Yu
- a Department of Psychology , The University of Hong Kong , Hong Kong
| | - Philip Yap
- b Department of Geriatric Medicine , Khoo Teck Puat Hospital , Singapore.,c Geriatric Education and Research Institute , Singapore
| | - Tau Ming Liew
- d Department of Geriatric Psychiatry , Institute of Mental Health , Singapore.,e Saw Swee Hock School of Public Health , National University of Singapore , Singapore
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Lindauer A, McKenzie G, LaFazia D, McNeill L, Mincks K, Spoden N, Myers M, Mattek N, Teri LL. Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention. J Med Internet Res 2019; 21:e13599. [PMID: 31127721 PMCID: PMC6555120 DOI: 10.2196/13599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum—from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings. Objective This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR). Methods A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist. Results Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C. Conclusions We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR.
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - David LaFazia
- School of Social Work, University of Washington, Seattle, WA, United States.,Northwest Research Group on Aging, School of Nursing, University of Washington, Seattle, WA, United States
| | - Loriann McNeill
- Family Caregiver Support Program, Multnomah County, Oregon, Portland, OR, United States
| | - Kate Mincks
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Natasha Spoden
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Marcella Myers
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Nora Mattek
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, United States
| | - Linda L Teri
- Northwest Research Group on Aging, School of Nursing, University of Washington, Seattle, WA, United States.,Northwest Roybal Center, School of Nursing, University of Washington, Seattle, WA, United States
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Leung P, Orrell M, Orgeta V. Social support group interventions in people with dementia and mild cognitive impairment: a systematic review of the literature. Int J Geriatr Psychiatry 2015; 30:1-9. [PMID: 24990344 DOI: 10.1002/gps.4166] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 05/20/2014] [Accepted: 05/29/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Despite the large number of studies evaluating social support groups for people with dementia, there are no systematic reviews of current evidence. The aim of this study was to evaluate the effectiveness of social support group interventions for people with dementia and mild cognitive impairment. METHODS A systematic review was performed. We searched electronic databases for randomised controlled trials. Two reviewers worked independently to select trials, extract data and assess risk of bias. RESULTS A total of 546 studies were identified of which two met the inclusion criteria. We were not able to pool data for further analyses, as the interventions tested in the studies meeting the inclusion criteria were too dissimilar in content. The first trial (n = 136) showed a benefit of early-stage memory loss social support groups for depression and quality of life in people with dementia. The second trial (n = 33) showed that post-treatment self-reported self-esteem was higher in the group receiving a multicomponent intervention of social support compared with that in the no intervention control group. CONCLUSIONS Limited data from two studies suggest that support groups may be of psychological benefit to people with dementia by reducing depression and improving quality of life and self-esteem. These findings need to be viewed in light of the small number, small sample size and heterogeneous characteristics of current trials, indicating that it is difficult to draw any conclusions. More multicentre randomised controlled trials in social support group interventions for people with dementia are needed.
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Affiliation(s)
- Phuong Leung
- Division of Psychiatry, University College London, London, UK
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Abstract
This longitudinal study examined the predictors of dementia family caregivers' self-reported attendance at support group meetings over 6 months. First-time attendees were contacted by telephone after their first meeting and assessed for (a) perceptions of similarity between themselves and other members, (b) depressive symptoms, and (c) perceptions of social support from the facilitator and other members. Participants (N = 70) were recontacted 6 months later to obtain self-reports of attendance patterns. Self-reported attendance at any meeting during this follow-up period was predicted by perceived similarity in care recipient's stage of dementia and perceived support from group members as assessed at the first interview. Greater perceived support from group members and fewer depressive symptoms at time 1 predicted a higher frequency of support group attendance over the follow-up period. Results have implications for orienting new support group members as well as training and supporting group facilitators.
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Affiliation(s)
- Ann M Steffen
- Department of Psychology, University of Missouri-St. Louis, St. Louis, MO 63121, USA.
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Steffen AM, Jackson CS. Predicting facilitators' behaviors during Alzheimer's family support group meetings. Am J Alzheimers Dis Other Demen 2012; 27:114-20. [PMID: 22495339 PMCID: PMC10697379 DOI: 10.1177/1533317512441051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
A social ecological model was used to predict facilitators' behaviors observed during Alzheimer's Association sponsored family support group meetings (N = 66). Information about group leaders was obtained via individual telephone interview prior to the observation of their support group by trained raters. Family dementia caregivers (N = 296) provided basic demographic and caregiving-related information at the end of the observed meeting. Caregiver- and group-level variables predicted ratings of observed leader support during support group meetings. The addition of leader characteristics such as years of experience or professional roles did not significantly contribute to the model. This study lends credence to ecological models emphasizing the influence of social context. Recommendations are made for facilitator training and management of Alzheimer's Association sponsored support group meetings.
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Affiliation(s)
- Ann M Steffen
- Department of Psychology, University of Missouri-St Louis, St Louis, MO 63121, USA.
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The experience of burnout among home caregivers of patients with dementia: relations to depression and quality of life. Arch Gerontol Geriatr 2008; 49:e1-5. [PMID: 18703239 DOI: 10.1016/j.archger.2008.07.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/01/2008] [Accepted: 07/03/2008] [Indexed: 11/21/2022]
Abstract
Caregivers of patients with dementia often experience chronic and emotional strains, which may lead to emotional exhaustion and burnout. The objective of this study was to examine the relationships between burnout, depression, and quality of life in home caregivers of patients with dementia. The participants were 84 home caregivers (39 male; 45 female), and they were asked to complete three questionnaires: the Beck Depression Inventory Second Edition (BDI-II), the WHO Quality of Life 26 (WHO-QOL26), and the Pines Burnout Measure (BM). Results from a bivariate correlation showed that BM scores significantly correlated with the scores on BDI-II and WHO-QOL26. Results from ANOVA comparing the level of burnout with the scores on BDI-II and WHO-QOL26 revealed that there were differences between the burnout groups and the scores on BDI-II and WHO-QOL26. The higher levels of burnout were found to correspond to higher levels of depressive symptoms and lower QOL. These findings suggest that caregiver intervention to reduce burnout might benefit from strategies to reduce depression and increase QOL.
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Abstract
Caregivers have complex needs as they care for a loved one with cancer at the end of life. The objective of this pilot study was to determine the feasibility of conducting a brief telephone intervention, Tele-Care II, for caregivers of hospice patients. Guided by Hogan's Model of Bereavement, nurse interventionists implemented Tele-Care II via teleconference calls with caregivers. Although 14 caregivers were recruited for the study, only 5 were able to complete the intervention before the patient's death. Those completing the intervention experienced decreased depression, despair, and disorganization although the patient's condition became more serious. Late enrollment in hospice continues to be problematic for patients, family caregivers, and hospice staff because it allows little time for completion of interventions with family caregivers before the patient's death.
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Affiliation(s)
- Sandra M Walsh
- Barry University School of Nursing, Miami Shores, Fla, USA.
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Castro CM, Wilcox S, O'Sullivan P, Baumann K, King AC. An exercise program for women who are caring for relatives with dementia. Psychosom Med 2002; 64:458-68. [PMID: 12021419 DOI: 10.1097/00006842-200205000-00010] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study describes factors related to retention and adherence to an exercise program for women caregivers. METHODS One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization. RESULTS Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence. CONCLUSIONS This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.
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Affiliation(s)
- Cynthia M Castro
- Stanford Center for Research in Disease Prevention, Palo Alto, CA 94304-1583, USA.
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Karlin NJ, Bell PA, Noah JL. Long-term consequences of the Alzheimer's caregiver role: a qualitative analysis. Am J Alzheimers Dis Other Demen 2001; 16:177-82. [PMID: 11398567 PMCID: PMC10833982 DOI: 10.1177/153331750101600306] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A qualitative analysis was performed on responses of 51 participants to open-ended questions about the experience of being family caregivers for a loved one affected by Alzheimer's disease. Participants had been in the caregiver role for at least eight years. Results indicated a pattern of adapting successfully or unsuccessfully to the caregiver role, experiencing initial caregiver burden, finding relief in social support when available, and long-term distress or long-term positive change. Memories and feelings were strong about individuals and institutions that had been helpful or indifferent many years earlier as the caregivers struggled to cope with their unplanned predicament.
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Affiliation(s)
- N J Karlin
- Department of Psychology, University of Northern Colorado, Greeley, Colorado, USA
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