Thematic Analysis of Alzheimer's Medication Management Discussion in a Non-Moderated Online Forum

BACKGROUND

Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development.

OBJECTIVE

This study aimed to understand caregivers' medication management experiences by analyzing online community discussions.

METHODS

Posts were extracted from the ALZConnected® Forum using keywords "medication" and "drug" via web scraping. The researchers applied thematic analysis.

RESULTS

Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers' uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications.

CONCLUSIONS

The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer's disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers' strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses.

Comprehensive Older Adult and Caregiver Help (COACH): A person-centered caregiver intervention prevents elder mistreatment

BACKGROUND

Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia.

METHODS

We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points.

RESULTS

The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010).

CONCLUSIONS

In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.

"I Lay Awake at Night": Latino Family Caregivers' Experiences Covering Out-of-Pocket Costs When Caring for Someone Living With Dementia

BACKGROUND AND OBJECTIVES

The financial burden of caregiving has received less research attention than physical and emotional costs. This is especially true for underserved ethnic minorities. Financial strain affects mental and physical health and is unequally distributed across caregivers of different races and ethnicities. Although caregivers overall spend, on average, one quarter of their income on caregiving, Latino caregivers, the focus of this study, spend nearly half.

RESEARCH DESIGN AND METHODS

To better understand this disparity, we conducted 11 qualitative interviews with 14 Latino caregivers of persons living with dementia located in either California or Texas. Interview transcripts were thematically coded, guided by a material-psychosocial-behavioral conceptual model of financial strain.

RESULTS

We identified 3 themes: daily needs and costs, psychological distress caused by financial issues, and stressful barriers to accessing family and societal support. Furthermore, interviews revealed how Latino culture may influence spending patterns and management of costs. Findings suggest that preference by Latino families to care for a family member in the home may be met with a financial disadvantage due to the high out-of-pocket costs of care.

DISCUSSION AND IMPLICATIONS

A better understanding of the factors contributing to high costs for Latino caregivers and how these costs affect caregivers will inform approaches at both the individual and policy levels and develop culturally relevant interventions to help Latino families to lower caregiving costs. This is especially important as the number of Latinos living with dementia is expected to increase over the next 4 decades and effective interventions are lacking.

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia

OBJECTIVES

We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups.

METHODS

Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health.

RESULTS

Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia.

DISCUSSION

Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

How do family caregivers of older adults cope with relationship strain?

OBJECTIVE

Studies of families' experiences with caregiving to older adults most often focus on overall burden and stress. Yet, caregiving is also a type of relationship, and the onset of caregiving can contribute to relationship strain between care partners. Despite implications for both care partners, little is known about how caregivers cope with caregiving relationship strain.

METHODS

The authors conducted nine focus groups and 8 interviews with a purposeful sample of racially and ethnically diverse family caregivers in Los Angeles. Conventional content analysis was applied to transcripts to identify how caregivers cope with relationship strain.

RESULTS

Analyses revealed four overall coping approaches to manage relationship strain: (1) Self-Care; (2) Adapting Behaviors, (3) Adapting Feelings and Cognitions, and (4) Help and Support. Selected strategies likely vary by care recipient condition. For example, caregivers for persons living with dementia emphasize adapting their own behaviors and feelings, rather than trying to change their loved one's behaviors.

CONCLUSIONS

Findings suggest that caregivers cope with relationship strain using both interpersonal tension and care management strategies. We also identified possible variations by care recipient condition and caregiver race and ethnicity. These results suggest a need for interventions focused on caregiver coping should also be tested for effects on relationship strain.

Qualitative Evaluation of Family Caregivers' Experiences Participating in Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER): Web-Based Intervention to Improve Relationship Quality

BACKGROUND

The onset of Alzheimer disease and related dementias (AD/ADRD) can alter relationships between family caregivers and persons living with AD/ADRD, such as through the occurrence of distressful behavioral and psychological symptoms of dementia. Poorly perceived relationship quality by caregivers contributes to negative outcomes for both care partners, such as low-quality caregiving and potential mistreatment of older adults. Knowledge and Interpersonal Skills to Develop Exemplary Relationships (KINDER) is a new, web-based, asynchronous psychoeducational intervention with content informed by focus groups with family caregivers. The program was developed to prevent low-quality caregiving and potential mistreatment of older adults by focusing on building healthy caregiving relationships.

OBJECTIVE

The purpose of this study is to describe caregivers' experiences participating in KINDER to understand intervention acceptability. Of particular interest was learning how comfortable caregivers were viewing content addressing potential mistreatment, as well as whether asynchronous delivery created any barriers to participating in the intervention. Findings will inform future program refinements before efficacy testing.

METHODS

Although 23 caregivers enrolled in the KINDER parent study, only 7 of them completed the 8-week intervention. In-depth, semistructured qualitative interviews were conducted with all participants who completed the program to understand their experiences while attending KINDER and to decipher barriers to participation. We also asked participants about which program elements were most valuable and which were least valuable to them, as well as how the program could be improved. Interview transcripts were analyzed by 2 coders using thematic analysis.

RESULTS

Our findings indicate that caregivers were overall satisfied with KINDER's focus and content. Participants particularly liked how KINDER materials felt authentic and relevant to supporting healthy care relationships (Theme 1). The program's multiple components were found to be valuable, especially story-based video vignettes and readings (Theme 2). Most caregivers were comfortable viewing depictions of mistreatment and understood the importance of this content (Theme 3). Notably, while caregivers appreciated the convenience of participating in an asynchronous web-based intervention, several expressed a desire for more opportunities to speak with other caregivers (Theme 4). Technology challenges, such as a lack of clarity about automated intervention activities, deterred completion.

CONCLUSIONS

Findings from this study suggest an asynchronous web-based intervention covering sensitive topics such as mistreatment is acceptable for at least some AD/ADRD caregivers. Caregivers' comments that materials felt authentic may suggest that the integration of caregiver voices before intervention development enhanced the relevance of content. To make KINDER easier to deliver and participate in, the investigators plan to reduce the use of automation and integrate more group-based programming, as recommended by participants. Further, given the higher-than-expected dropout rate, in future studies, the investigators will collect data to determine the reasons for participants not completing study activities.

A Community Initiative to Engage Employers to Support Caregiving Employees and Build an Advocacy Alliance

Family caregivers to persons living with a chronic or disabling condition often report disruption to their employment. Employment disruption can cause long-term financial difficulty and psychological distress for caregivers, high costs for employers, and exacerbates social inequities. In this commentary, we describe a community initiative to better support employees who are caregivers conducted with nonprofit employers in San Antonio, located in the central Texas region of the United States. This initiative aimed to raise awareness among local employers about the challenges employees face in balancing employment and caregiving. This led to the co-development of a pledge to guide employer efforts to support employees who are caregivers. This initiative represents a first step to mobilize employers as stakeholder allies to improve workplace support for family caregivers. The authors draw on the Shilton Model of Policy Advocacy to make the case that the mobilization of employers as advocacy stakeholders can hasten the advancement of policies that enable family caregivers to balance both roles. Further, the implementation of organization-level changes, in addition to state and federal policy changes, to support employed caregivers by employers is consistent with recommendations of the recently published National Strategy to Support Family Caregivers.

LATINO FAMILY CAREGIVERS’ EXPERIENCES COVERING OUT-OF-POCKET COSTS WHEN CARING FOR SOMEONE LIVING WITH DEMENTIA

Family caregivers to persons living with dementia spend an average of $11,293 annually out-of-pocket on caregiving costs. Costs include home modifications, medications, and other daily expenses. Financial strain from caregiving affects caregiver mental and physical health and is unequally distributed across race/ethnicity groups. While other caregivers spend approximately one-quarter of their income on caregiving, the cost for Latinos family caregivers comprises nearly half of annual income. To gain insight into this disparity, eleven 1-hour in-depth qualitative interviews were conducted with Latino caregivers of persons living with dementia living in California and Texas. Interview transcripts were thematically coded, guided by the Tucker-Seeley Material–Psychosocial–Behavioral Model of financial strain. We identified four themes: 1) caregivers were concerned with meeting the daily needs of care recipients and would incur additional costs, such as credit card interest, to address immediate needs; 2) high levels of psychological distress were expressed regarding caregivers paying for the care of loved ones and themselves in the future; 3) caregivers wanted to use community resources that help older adults and their families but described stressful barriers accessing support. Further, Latino culture affected spending. For example, caregivers incurred shared living costs given reluctance to place loved ones in a nursing facility, exemplifying the concept of familismo. By understanding the factors contributing to high caregiving costs for Latino caregivers and the challenges met when addressing these costs, we can build approaches at both the individual- and policy-levels and develop culturally relevant interventions to help Latino families to lower care costs.

STICK TO THE THEORY: FINDINGS FROM A COMPLEX CARE INTERVENTION FOLLOWING TRANSITION TO DIGITAL DELIVERY

Two thirds of family caregivers to persons living with dementia provide complex care tasks, including medical/nursing tasks, and nearly half worry about making a mistake. Learning Skills Together (LST) was designed to prepare caregivers to provide complex care through hands-on instruction (e.g., practice using a gait belt). Consistent with self-efficacy theory, the in-person intervention integrated behavioral modeling, strengths-based feedback, and knowledge-building. COVID-19 prompted a transition to digital delivery of LST over Zoom. Intervention content was modified to accommodate a digital approach while continuing to adhere to self-efficacy theory. Results from a pre- and post-test pilot study (N=35) indicate improvement in self-efficacy on (mean difference (MD)=1.0, SD= 1.6, p-value=0.004). Caregiver comments during qualitative interviews affirm intervention objectives were met. For example, caregivers described the importance of peer learning (modeling) during discussion. Results indicate that complex care intervention can be digitally delivered to family caregivers to improve self-efficacy surrounding complex care.

THE IMPACT OF THE COVID-19 PANDEMIC ON DEMENTIA CARE: A MULTISTAKEHOLDER PERSPECTIVE

Persons living with dementia (PLWD) and family caregivers are particularly vulnerable to the effects of the COVID-19 pandemic. A multi-methods study was conducted to describe the impact of the pandemic on dementia care from the perspectives of stakeholders, including PLWD, family caregivers, and health and social care professionals (HCPs).The study was conducted using a community engaged approach. Cross-sectional surveys were conducted with PLWD (n=27), family caregivers (n=161), and HCPs (n=77), followed by focus groups and interviews with a sub-sample of survey participants (n=55). Participants reported declines in health and quality of life for PLWD and family caregivers. Participants experienced delayed or cancelled dementia care attributed to the pandemic. Most reported telehealth and tele-support were effective alternative models to care. The pandemic impacted the quality and accessibility of dementia care. Results highlight opportunities to improve quality of care through addressing inequities and identifying approaches to address isolation and virtual care.

Glycated haemoglobin and the association with long-term survival among patients evaluated for stable angina – a prospective Norwegian cohort

Background and methods

Recent guidelines have included glycated haemoglobin (HbA1c) ≥48 mmol/L as a diagnostic criterion for diabetes mellitus (DM) in addition to plasma glucose (PG) concentrations, mainly based on the relationship between hyperglycemia and microvascular disease [1]. However, increased HbA1c may stem not only from hyperglycemia, and the risk association between HbA1c and long-term survival in patients with stable coronary heart disease and HbA1c ≥48 mmol/L but no previous DM according to PG is uncertain. We explored the relationship between HbA1c and survival among patients with and without DM who were evaluated for stable angina in the period 2000–2004. Endpoints were obtained from the Norwegian Cause of Death Registry.

Results

In total, 4164 patients were evaluated by cardiac cathetherization, of whom 576 patients (13.8%) had DM (median HbA1c 55 mmol/L) according to self-report and/or baseline PG concentrations. Of the remaining 3588 patients 1026 had HbA1c ≥48 mmol/L; however, HbA1c did not correlate with the HOMA2 insulin resistance index or fasting PG in these patients. During median (25–75 percentile) follow-up time of 14.0 (12.1–15.4) years a total of 1328 patients (31.9%) died, of whom 582 from cardiovascular causes. In patients with DM according to PG, HbA1c trended towards positive associations with all-cause and CVD mortality when adjusted for age and gender (HRs (95% CIs) 1.13 (0.99–1.28) and 1.16 (0.98–1.39) per 1SD, respectively). However, HbA1c was not associated with survival in either the group of patients without DM and HbA1c <48 mmol/L (median HbA1c 38 mmol/L) (HRs (95% CIs) 0.99 (0.92–1.06) and 0.96 (0.86–1.08) for all-cause and CVD mortality, respectively) or patients without DM but having HbA1c ≥48 mmol/L (median HbA1c 53 mmol/L) (HRs (95% CIs) 0.99 (0.88–1.12) and 1.04 (0.88–1.22)).

Conclusion

In patients evaluated for stable angina pectoris about two decades ago, almost a third of patients with no history of DM according to PG still had HbA1c concentrations indicating DM according to current guidelines. Including these patients in the DM category yielded similar percentages of patients with DM as observed in recent populations with stable coronary disease [2]. However, as opposed to what we observed in patients with DM, HbA1c did not show any association with very long-term survival among patients without DM. Our findings therefore question the use of HbA1c in the diagnosis of DM, especially in terms of risk assessment for longevity among patients with chronic coronary syndrome.

Funding Acknowledgement

Type of funding sources: None.

Inflammation and cardiorespiratory fitness in overweight women and men: the FATCOR study

Background

Women have more body fat compared to men, and adipose tissue is associated with chronic inflammation. Cardiorespiratory fitness has on the other hand been postulated to lower chronic inflammation. However, sex-specific associations of inflammation with cardiorespiratory fitness is less studied.

Purpose

To assess inflammatory markers in overweight and obese women and men according to cardiorespiratory fitness in the FAT associated CardiOvasculaR dysfunction (FATCOR) study.

Methods

Cardiorespiratory fitness was assessed by maximal oxygen uptake (VO2max) by cardiopulmonary exercise testing in 566 subjects (mean age was 48±9 years, 60% women) with body mass index (BMI) >27.0 kg/m2. Participants were grouped according to sex, and fitness status identified from sex and age specific VO2max thresholds. C-reactive protein (CRP) and serum amyloid A (SAA) were analysed using Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry. Serum levels of the kynurenine:tryptophan ratio (KTR) and pyriodoxic acid ratio (PAr) were measured by liquid chromatography tandem mass spectrometry. All inflammatory markers were log transformed before inclusion in linear regression analyses.

Results

In the total study population, 63% had obesity and 74% were cardiorespiratory unfit. Unfit women had the highest fat percentage and the highest serum levels of CRP and SAA compared to the other groups (p<0.05), while serum levels of KTR and PAr were higher only compared to fit men (p<0.05). In multivariable linear regression analyses in women, higher CRP (β −0.15, p=0.001), SAA (β −0.10, p=0.03) and PAr (β −0.09, p=0.03) were associated with lower VO2max after adjusting for age, fat percentage, hypertension and metabolic syndrome. In men, only higher PAr (β −0.14, p=0.02) was associated with lower VO2max in multivariable analyses adjusted for age, fat percentage and metabolic syndrome. In multivariable analyses in obese women only (n=213), higher CRP (β −0.15, p=0.01) and PAr (β −0.13, p=0.03) remained associated with lower VO2max, while in obese men (n=144) there was no significant associations between inflammatory markers and VO2max.

Conclusion

Among overweight subjects participating in the FATCOR study, cardiorespiratory unfit women had the highest serum levels of inflammatory markers. The association of inflammation with reduced cardiorespiratory fitness was more pronounced in women than men, in particular when obesity was present.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Western Regional Health Authority of Norway

A Multiple Stakeholder Perspective on the Impact of COVID-19 on Dementia Care

The aim of this study was to describe the impact of the COVID-19 pandemic on dementia care from a multiple stakeholder perspective. We used a multi-method design, with a cross-sectional survey followed by focus groups/interviews. Surveys were completed by people living with dementia (n  =  27), family caregivers (n  =  161), and health and social care professionals (n  =  77). A sub-sample (n  =  55) participated in an interview or one of 9 focus groups. Surveys were analyzed with descriptive statistics and focus group/interview data were analyzed using a thematic approach. Participants reported an impact of COVID-19 on dementia care, including less access to care and resources for care. Telehealth and tele-support/education were reported to be effective alternatives to support care. Themes from the qualitative data about dementia care were: (1) planning and providing care, (2) making choices around risk and safety, (3) experiences of loss, and (4) technology and dementia care. The results of this study present opportunities to improve the quality of care through addressing inequities and identifying improved and innovative approaches to address social isolation and virtual care for this vulnerable population.

The Differential Effects of Caregiving Intensity on Overnight Hospitalization

This study aims to examine how caregiving for a spouse affects caregivers' likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers (OR = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization (OR = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.

Family caregivers' perceptions and experiences of participating in the learning skills together intervention to build self-efficacy for providing complex care

The purpose of this study was to describe how an intervention to teach family caregivers of persons living with dementia to provide complex care tasks contributes to their self-efficacy. This qualitative study was embedded in a pilot study evaluating the intervention. Semi-structured interviews were conducted with 15 caregivers who had completed the intervention. Content analysis was used to analyze the data. Themes identified from the interviews were: "helpfulness of the content", "if they can do it, so can I", and "applying what I have learned". Caregivers described the helpfulness of learning from expert healthcare professionals in a supportive environment. They valued the group setting, including interacting with and learning from their peers. Caregivers demonstrated mastery of the content by applying it to their caregiving situations and sharing information with other family members. These findings provide insights into successful elements in a complex care intervention that contributed to building caregiver self-efficacy.

Caregiver self-efficacy improves following complex care training: Results from the Learning Skills Together pilot study

Family caregivers to persons living with dementia increasingly provide complex care tasks, though most (53%) do so without any training. "Complex care" includes medical/nursing tasks, as well as personal care tasks that require disease knowledge. Of the 67% of dementia caregivers who provide complex care, nearly half worry about making a mistake. To help caregivers feel more confident when providing complex care tasks, we developed and conducted a pilot study of the 4-week Learning Skills Together psychoeducation program (LST; N=35). Participants in LST reported high satisfaction with the program and found the information shared about complex care was easy to understand. Pre- and post-test data demonstrated improvements in mean caregiver self-efficacy at both 4-weeks and 8-weeks post-intervention (mean difference (MD)=1.0, SD= 1.6, p-value=0.004 and MD= 1.0, SD=2.2, p-value=0.038, respectively). Results demonstrate the potential for a brief psychoeducational program to prepare caregivers to provide complex care to persons living with dementia.

Simulation learning to train healthcare students in person-centered dementia care

In coming decades, healthcare providers will treat a greater number of individuals living with Alzheimer's Disease and related dementias than ever. Simulation-based learning provides experiential learning opportunities to enhance clinical training, but little is known about how dementia simulation training improves understanding of dementia or how it changes in participants' ability to deliver high-quality healthcare to individuals living with dementia. In this study, we examine how a simulation training program may prepare healthcare trainees to treat individuals living with dementia. We conducted eight in-depth, one-on-one interviews with healthcare trainees who participated in the Virtual Dementia Tour (VDT) program and faculty who added VDT to their curricula, and also examined 20 reflection papers from students following participation in VDT. A thematic analysis of qualitative data led us to three themes: 1) dementia simulation complements and enhances traditional teaching methods, 2) dementia simulation helps students to understand the experiences of people living with dementia, and 3) experiential learning inspired students to reflect on actions they would take as clinicians and leaders to support individuals living with dementia and their families. Based on these findings, we propose a modified transformative learning process for dementia simulation training with healthcare students.

An Interprofessional Skills Workshop to Teach Family Caregivers of People Living with Dementia to Provide Complex Care

The purpose of this study was to evaluate the acceptability of and satisfaction with an interprofessional educational workshop to teach family caregivers of persons living with dementia to provide complex care. The workshop was developed by a team that included nursing, occupational therapy, speech-language pathology, nutrition and dental hygiene. Caregivers who attended the workshop completed an evaluation to describe their satisfaction and acceptability using a Likert-type scale, as well as open ended comments about their learning needs and feedback about the workshop. Semi-structured interviews were conducted with family caregivers and members of the interprofessional team to analyze and evaluate how the workshop may have improved their confidence in performing complex tasks and to obtain their perspectives on offering this program as a virtual workshop in the future. Family caregivers (n=171) reported high satisfaction with the workshop and strongly agreed that the workshop provided them with useful information to support their caregiving roles. Themes identified from the content of the interviews were: i) building understanding; ii) mastering new skills; and iii) learning skills together. Our results suggest and emphasize the importance and the benefits of an interprofessional team approach to support family caregivers and build confidence with complex care.

Perceived Appreciation for Care Associates with Higher Quality Caregiving Day-to-Day

Family members are critical to dementia care and the U.S. long-term services system. Yet, little is known about how to support the quality of care provided by family members, who often receive little training. We hypothesize that on days when caregivers feel more appreciated, they report providing a higher quality of care. To test this hypothesis, we asked spousal dementia caregivers (N=21) to complete 14 daily surveys that asked about their daily caregiving experiences. Our measure for “quality of care” was based on the Exemplary Caregiving Scale, and included 3-items pertaining to provision of care (e.g., “You considered your spouse's wishes and opinions when providing assistance”). Response options included “Most of the time,” “Some of the time,” and “Never”; scores were summed (range 0 to 6). Caregivers were also asked to what extent their spouse appreciated the care provided (“Not at all,” “Some,” or “A lot”). We applied multi-level mixed models to the data, and controlled for age, gender, Hispanic ethnicity, number of behavioral symptoms of dementia each day and months since diagnosis. In adjusted models, we found that on days when caregivers believed care recipients appreciated care provided “Some” or “A lot,” they reported providing higher quality care (B=0.52, p=0.010 and B=0.79, p<0.001, respectively) compared with days when caregivers believed care recipients appreciated care provided “Not at all”. Preliminary results may inform programs to support caregivers’ ability to provide high quality care (e.g., by helping caregivers to perceive rewards) and to identify caregivers at risk of providing low-quality care.

Technology-based interventions for nursing home residents: a systematic review protocol

INTRODUCTION

A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19.

METHODS AND ANALYSIS

Databases including the PubMed, PsycINFO, CINAHL and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between 1 January 2010 to 30 September 2021. Titles, abstracts and full-text papers will be reviewed against the eligibility criteria. The Cochrane Collaboration evaluation framework will be adopted to examine the risk of bias of the included study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process and implications for existing interventions and research evaluated by a multidisciplinary research team.

ETHICS AND DISSEMINATION

As the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

CRD 42020191880.

A comparison of negative financial events experienced by carers and non-carers following onset of the Great Recession

This study compares carers and non-carers on experiences of harmful financial events during and immediately after the Great Recession. Carer status was associated with experiencing more negative financial events since the Great Recession began, even after controlling for covariates in a negative binomial regression. Carers had a higher odds of reporting: job loss, moving in with family and friends to save money, and selling possessions to make ends meet. Compared to non-carers, carers were more likely to experience adverse financial events during and following the Great Recession.

The relationship between perceived support and depression in spousal care partners: a dyadic approach

OBJECTIVES

Caregiving within a spousal partnership marks a novel relationship stage for couples. Caregiving introduces new stressors and affects couples' ability to cope, and potentially alters perceptions of emotional support. Prior research on older married couples illustrates how perceived support not only affects an individual's mental health, but also that of their partner. To date, the dyadic relationship between emotional support and mental health is largely unexamined among caregiving partners, where support expectations may differ.

METHOD

Actor partner interdependence models using linear mixed modeling were applied to data from spouses where one partner received caregiving within the 2014 and 2016 waves of the Health and Retirement Study. We examined the cross-sectional and lagged associations between perceived emotional support and strain from a spouse on actor and partner depression scores, as well as whether one was the caregiver or the care recipient moderated associations.

RESULTS

More positive perceptions of support were associated with lower depression scores for oneself (b= -0.55, p < 0.001) and one's partner (b= -0.24, p < 0.001). Actor effects-how one's own perceptions of support associate with one's own depressive symptomology-were stronger for care recipients than for caregivers (b= -0.83, p < 0.001 v. b= -0.26, p < 0.05). Higher perceptions of strain were also associated with higher depression scores for oneself (b = 0.57, p < 0.001) and one's partner (b = 0.39, p < 0.001), associations that remained even in lagged models.

CONCLUSIONS

The observation of both actor and partner effects in this study suggests opportunities to improve care recipient outcomes through intervention with caregivers or both members of the care dyad.

Onasemnogene abeparvovec-xioi: a gene replacement strategy for the treatment of infants diagnosed with spinal muscular atrophy

In May of 2019, the adeno-associated virus (AAV)-based gene therapy onasemnogene abeparvovec-xioi (Zolgensma) became the second Food and Drug Administration (FDA)-approved gene therapy with designated use for infants diagnosed with spinal muscular atrophy (SMA). The decision came nearly 10 years after results of the first preclinical models were initially reported. While the journey was an arduous one, the approval was an indication of the remarkable success of the first in-human clinical trials. According to the traditional classification system of autosomal recessive SMA, of which there are multiple types with phenotypic variability, SMA type 1 is the most common and most severe and represents 45% of the SMA patient population. Children with SMA type 1 cannot lift their heads without assistance and do not live past their second birthday. With Zolgensma, the first treated children with SMA type 1 have reached 5 years of age and some of them achieved the ability to sit unassisted or even walk. In this article, we review the work that led to FDA approval with emphasis on the development of preclinical and clinical studies.

Engaging multi-stakeholder perspectives to identify dementia care research priorities

OBJECTIVES

The purpose of this study was to partner with stakeholders to identify gaps in care for persons living with dementia and their family caregivers and from this list, identify priorities for dementia care research.

METHODS

Using a community-engaged research approach, a Stakeholder Advisory Council (SAC) consisting of diverse membership including persons living with dementia and family caregivers was convened. Through our work with the SAC, along with input from the wider network through a symposium, webinars, and an online learning community, gaps in dementia care and a list of topics for dementia care research was generated. This list was reduced to 46 topics for dementia care research and sent to stakeholders (persons living with dementia, family caregivers, and health/social care professionals in dementia care) to be prioritized by rating each of the 46 topics as "Not so important," "Important," or "Very important." Priorities for dementia care were summarized by frequencies and proportions.

RESULTS

A total of 186 participants completed the survey from August through October 2020, including 23 (12.4%) persons living with dementia, 101 (54.3%) family caregivers, and 62 (33.3%) health/social care professionals. Consistent across stakeholder groups was the focus on research on how best to support families following a diagnosis of dementia. Among persons living with dementia, research focused on support for continuing to live in their own homes was ranked as the highest priority, rated by 91.3% as "Very Important". High priority research areas for family caregivers included interventions to slow cognitive decline (76.3%) as well as non-pharmacological approaches to manage behavioral symptoms (74.7%). The highest priority research topics for health/social care professionals were focused on the diagnosis including benefits of an early diagnosis (71.4%), how best to deliver the diagnosis (70.9%), and supports needed following a diagnosis (78.6%).

CONCLUSIONS

This project draws on the strengths of its multi-stakeholder perspective to support patient-centered outcomes research. Findings are intended to inform those who conduct research and those who fund research about which research topics stakeholders believe are most important and thus have greatest potential to improve the quality of life among people living with dementia and their families.

Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study

Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit ®) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.

A Conceptual Model to Improve Care for Individuals with Alzheimer's Disease and Related Dementias and Their Caregivers: Qualitative Findings in an Online Caregiver Forum

BACKGROUND

As the population rapidly ages, a growing number of families are engaging in care for individuals living with Alzheimer's disease and related dementias (ADRD). The perceived challenges and burdens that face informal caregivers are enormous.

OBJECTIVE

The objective of this study was to 1) explore from the family caregivers' perspective, the daily lives of individuals living with ADRD, and the challenges family caregivers encounter when caring for a family member with ADRD; and 2) to develop a comprehensive model with the endeavor to improve care for individuals with ADRD and their family caregivers.

METHODS

Posts were extracted from the ALZConnected online caregiving forum in May 2019. Guided by a triangular model focused on Caregiver, Individual with ADRD, and Context of Care, two researchers independently analyzed 654 posts with a combination of deductive and inductive thematic analysis approach. Researchers all agreed on finalized codes and themes.

RESULTS

Thematic analysis resulted in four themes: Individual with ADRD, Caregiver, Dynamic between Caregiver and Individual with ADRD, and Context of Care. The most frequently discussed topics among caregivers were informational and emotional support for caregivers, and the capabilities and functioning of individuals with ADRD.

CONCLUSION

Online forums provide a valuable platform for caregivers to support each other informationally and emotionally, share care strategies, and navigate caregiving burdens. An expanded model was derived to support a comprehensive and dynamic approach to improve care for both caregivers and individuals with ADRD. The unique nature of the caregiver forum data is worthy of further data mining using a novel analysis approach.

The Dyadic Effects of Perceived Support on Depression in Spousal Care Partners

Relationship quality is an important factor affecting care partners’ health and wellbeing. Supportive marital relationships are associated with better physical and subjective health, whereas strain is associated with poorer health. Recent studies now indicate a dyadic effect of relationship quality on health outcomes, such that an individual’s perceptions of their relationship also affects their partner’s outcomes. Few studies have examined the dyadic effects of relationship quality on mental health among older cognitively intact caregiving couples. To address the lack of dyadic research about how perceived support from one’s spouse related to experiences of depression for individuals and their care partners, we apply cross-sectional actor partner interdependence models (APIMs) to data from the Health and Retirement Study (HRS) (N=490 dyads). APIM regression models controlled for participant demographic characteristics, relationship length, and care recipient functional ability. Findings showed that positive perceived support from a spouse had a stronger negative association with one’s own depression for care recipients than for caregivers. Similarly, greater negative perceived support from a partner was associated with higher levels of depression; whether the partner was the caregiver or care recipient did not make a difference in this model. Although there are hundreds of caregiver interventions to address caregivers’ mental health, few have demonstrated improvement in care recipient outcomes. Observation of both actor and partner effects in this study suggests there may be opportunities to improve care recipient and caregiver mental health by targeting interventions to promote high quality relationships with caregivers or both members of the care dyad.

The Differential Effects of Caregiving Intensity on Overnight Hospitalization in the Previous 2 Years

Caregiving for a spouse is considered a major stressor many Americans will encounter during their lifetimes. Although most studies indicate caregiving is associated with experiencing diminished health outcomes, little is known about how this role affects caregivers’ use of acute health services. To understand how spousal caregiving affects the use of acute health services, we use data from the Health and Retirement Study. We apply fixed effects (FE) logistic regression models to examine odds of experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and changes in caregiving status and intensity. Models controlled for caregiver gender, age, race, ethnicity, educational attainment, health insurance status, the number of household residents, and self-assessed health. Overall, caregivers were no more likely to experience an overnight hospitalization compared to non-caregivers (OR 0.92; CI 0.84 to 1.00; p-value=0.057). However, effects varied according to the intensity of caregiving and the time spent in this role. Compared to non-caregivers, for example, spouses who provided care to someone with no need for assistance with activities of daily living had lower odds of experiencing a hospitalization (OR 0.77; CI 0.66 to 0.89). In contrast, caregivers who provided care to someone with dementia for 4 to <6 years had 3.29 times the odds of experiencing an overnight hospitalization (CI 1.04 to 10.38; p-value=0.042). Findings indicate that, although caregivers overall appear to use acute health services about as much as non-caregivers, large differences exist between caregivers. Results emphasize the importance of recognizing diversity within caregiving experiences.

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

Background

A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19.

Methods

Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1^st, 2010 to December 4^th, 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team.

Results

NA-protocol study.

Conclusions

Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19.

Systematic Review Registrations

PROSPERO CRD 42020191880.

Fitness is associated with lower inflammatory markers in obesity: the FATCOR study

Background

Obesity is associated with chronic low-grade inflammation, but exercise has anti-inflammatory properties. It is unknown whether the anti-inflammatory effects of fitness may influence the obesity-associated inflammation.

Purpose

To assess levels of inflammatory markers in fit vs. unfit overweight and obese subjects without known cardiovascular disease.

Methods

Peak oxygen uptake (VO2max) was measured by treadmill cardiopulmonary exercise testing in 566 subjects (mean age 48±9 years, 60% women) with body mass index &gt;27.0 kg/m2 in the FAT associated CardiOvasculaR dysfunction (FATCOR) study. Fitness was defined from age- and sex adjusted reference levels of VO2max. Serum levels of C-reactive protein (CRP), serum amyloid A (SAA) and calprotectin were assessed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF) mass spectrometry and log transformed before inclusion in analyses.

Results

Fit subjects (n=147) were older and had less metabolic syndrome, obesity and hypertension compared to unfit subjects (n=419) (all p&lt;0.05). Serum levels of CRP and SAA were lower in fit subjects vs. unfit (p&lt;0.01), while serum calprotectin showed no difference (p=0.06). In multivariable logistic regression analyses, lower CRP (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.61–0.87, p&lt;0.001) and SAA (OR 0.61, 95% CI 0.40–0.93, p=0.02) remained associated with being fit after adjusting for age, sex, obesity, metabolic syndrome and hypertension. When looking at obese (n=357, fit n=53) and overweight subjects (n=209, fit n=94) separately, lower CRP (OR 0.60, 95% CI 0.46–0.78, p&lt;0.001) and SAA (OR 0.44, 95% CI 0.24–0.83, p=0.01) remained associated with being fit in obese, but not in overweight subjects after adjustment for age, sex and metabolic syndrome.

Conclusion

Fitness was associated with lower circulatory inflammatory markers in obesity independent of cardiometabolic risk factors. Our results suggest that fitness may promote cardiovascular benefit through the anti-inflammatory properties of exercise also in obesity.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Western Norway Regional Health Authority

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

Background: A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19. Methods: Databases including PubMed, PsycINFO, CINAHL, and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between January 1 st , 2020 to July 7 th , 2020. Titles, abstracts, and full-texts papers will be reviewed against the eligibility criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process, and implications for existing interventions and research evaluated by a multidisciplinary research team. Results: NAâ€"protocol study Conclusions: Our study will fill critical gaps in the literature by providing a review of technology-based interventions tested in the nursing home setting. As the older adult population grows, there is an urgent need to identify effective technology-based interventions that can address the distinctive characteristics and preferences of nursing home residents. Clear and comprehensive understanding of how available technology-based health solutions facilitate healthcare for nursing home residents will shed light on the approaches open to residents to fend off the negative health consequences amid and beyond the influence of COVID-19. Systematic Review Registrations: PROSPERO CRD 42020191880.

In vitro activity of oritavancin alone or in combination against vancomycin-susceptible and -resistant enterococci

OBJECTIVES

The optimal treatment for serious infections due to Enterococcus spp. is unknown although combination antimicrobial therapy is often recommended for invasive infections to achieve bactericidal activity and improve clinical outcomes. Oritavancin is a novel lipoglycopeptide agent with in vitro activity against enterococci, including vancomycin-resistant VanA-type Enterococcus faecium. Data on its activity in combination with other antibacterials are limited. The objective of this study was to evaluate the activity of oritavancin alone and in combination with ceftriaxone, daptomycin, gentamicin, linezolid and rifampicin against vancomycin-susceptible and -resistant enterococci in in vitro time-kill analyses.

METHODS

Five enterococcal strains were used for all experiments: three vancomycin-resistant VanA-type E. faecium clinical bloodstream isolates, vancomycin-resistant VanA-type E. faecium ATCC 700221 and vancomycin-susceptible Enterococcus faecalis ATCC 29212. Individual drugs were tested at ¼, ½, 1, 2 and 4× MIC. Oritavancin combination experiments were performed with each agent at ¼× MIC.

RESULTS

Daptomycin was the most active single agent and was bactericidal against all strains at 4× MIC, followed by oritavancin, which was bactericidal against all three clinical VRE strains at ≥2× MIC. In combination experiments at ¼× MIC, oritavancin was synergistic with gentamicin against strains not displaying high-level aminoglycoside resistance. No other synergy against VRE strains was observed in any experiment. Strain- and drug-dependent antagonism was observed for many combinations.

CONCLUSIONS

These in vitro data do not support the routine use of combination therapy with oritavancin in the treatment of infections due to VRE.

Determination of Fumonisins B1 and B2 in Corn and Corn Flakes by Liquid Chromatography with Immunoaffinity Column Cleanup: Collaborative Study

A liquid chromatographic (LC) method for the determination of fumonisins B1 (FB1) and B2 (FB2) in corn and corn flakes was collaboratively studied by 23 laboratories, which analyzed 5 blind duplicate pairs of each matrix to establish the accuracy, repeatability, and reproducibility characteristics of the method. Fumonisin levels in the corn ranged from &lt;0.05 (blank) to 1.41 μg/g for FB1 and from &lt;0.05 to 0.56 μg/g for FB2, whereas in the corn flakes they ranged from &lt;0.05 to 1.05 μg/g for FB1 and from &lt;0.05 to 0.46 μg/g for FB2. The method involved double extraction with acetonitrile–methanol–water (25 + 25 + 50), cleanup through an immunoaffinity column, and LC determination of the fumonisins after derivatization with o-phthaldialdehyde. Relative standard deviations for the within-laboratory repeatability (RSDr) of the corn analyses ranged from 19 to 24% for FB1 and from 19 to 27% for FB2; for the corn flakes analyses, RSDr ranged from 9 to 21% for FB1 and from 8 to 22% for FB2. Relative standard deviations for the between-laboratories reproducibility (RSDR) of the corn analyses ranged from 22 to 28% for FB1 and from 22 to 30% for the FB2; for corn flakes analyses, RSDR ranged from 27 to 32% for FB1 and from 26 to 35% for FB2. Mean recoveries of FB1 and FB2 from corn spiked with FB1 at 0.80 μg/g and with FB2 at 0.40 μg/g were 76 and 72%, respectively; for corn flakes spiked at the same levels recoveries were 110 and 97% for FB1 and FB2, respectively. HORRAT ratios for the analyses of corn ranged from 1.44 to 1.53 for FB1 and from 0.96 to 1.48 for FB2, whereas for corn flakes they ranged from 1.60 to 1.82 for FB1 and from 1.39 to 1.68 for FB2.

STRESS, DEPRESSION, AND COGNITIVE FUNCTION IN ADRD FAMILY CAREGIVERS

The rapidly growing number of individuals over the age of 55 stresses the need to identify unique factors to decrease older adults’ vulnerability to psychiatric and neurodegenerative disorders, especially among high-risk groups such as family caregivers to persons with Alzheimer’s disease or related dementias (ADRD). In this project, we investigated physiological stress responses, depression, and cognitive functioning. Using data from the Midlife in the United States database, we examined differences in physiological stress responses, depressive symptoms, and cognitive function (including working memory, episodic memory, verbal ability, processing speed, and executive functioning) between ADRD and non-ADRD caregivers. Results from the secondary analysis revealed a decrease in cognitive function, an increase in depressive symptoms and disrupted physiological responses in ADRD caregivers. These data suggest that the unique aspects of ADRD caregiving are a risk factor for the onset of psychiatric and neurodegenerative disorders. The results of this study support the development of targeted interventions to reduce the risk of depression and cognitive decline among ADRD caregivers. The specific focus on older adult ADRD caregivers, physiological processes, mental health, and dementia is unique in the field of aging and provides a critically needed new paradigm for identifying strategies to support ADRD caregivers and understanding the development of ADRD.

THE EFFECT OF PERCEIVED APPRECIATION ON CAREGIVER WELL-BEING: A TEST OF EQUITY THEORY

Equity theory suggests that equal (reciprocal) exchange of support in social relationships leads to better outcomes for members. However, in caregiving, exchange of support may become unbalanced due to heightened instrumental support from caregivers (CG). Imbalance may be exacerbated in dyads where the care recipient (CR) has dementia, since cognitive changes can attenuate expression of social support. One way social support is demonstrated in through show of appreciation. We used data from National Study on Caregiving (NSOC) to test whether CGs who did not feel appreciated by CRs were more likely to experience depression in the future. To accomplish this, we applied lagged dependent variable (LDV) models to the 2011 and 2015 NSOC waves (N=150). CGs who felt appreciated by the CR in the 2011 wave had 0.22 times the odds of being depressed in 2015 as those who did not feel appreciated by the CR (CI 0.07 to 0.68). This effect appears to exist primarily among CGs to people with dementia. In stratified models, we found CGs to people with dementia in 2015 had 0.04 times the odds of being depressed in 2015 if they previously felt appreciated by the CR (CI 0.003 to 0.40). A statistically significant effect was not observed among those assisting someone without depression (OR=0.65, CI 0.22 to 1.91). Results suggest that CGs to people with dementia who feel appreciated have less risk of experiencing depression. Findings have applications for future interventions for caregiver wellbeing, such as enhancing perceived appreciation (e.g., cognitive restructuring, communication training).

SUPPORTING FAMILY CAREGIVERS: HOW DOES RELATIONSHIP STRAIN OCCUR IN CAREGIVING DYADS? A QUALITATIVE STUDY

Family members and spouses are usually the primary caregivers for older adults. Providing direct care can be stressful, strenuous, and time-consuming for caregivers, potentially leading to frustration and anger towards care recipients. This can be detrimental to the relationship quality of the caregiving dyad. Though caregiver strain and burden have been extensively studied, there is limited information on the development of relationship strain. To explore how relationship strain occurs between caregivers and care recipients, 8 focus groups (N=62) and 8 semi-structured telephone interviews were conducted with caregivers in Los Angeles, inquiring about relationship quality with their care recipients and when frustration and anger occurs. Inductive coding was used to create coding schemas. Findings showed that most caregivers reported relationship strain occurring after taking on the caregiving role, and frustration and anger arose when providing ADLs, especially during bathing and toileting. Although these caregivers had initially experienced strain in their relationships, a recurring theme that emerged was that they developed strategies to decrease frustration and anger and improve the quality of their relationships with their care recipients. Direct communication with caregivers is important in designing a structured and effective intervention. These findings help inform an intervention for new caregivers to help them identify what can lead to relationship strain, as well as teach them reliable strategies to manage frustration and anger towards their care recipients.

CONTEXTS SURROUNDING PSYCHOLOGICAL MISTREATMENT AND NEGLECT BY CAREGIVERS TO PEOPLE WITH DEMENTIA

This presentation examines the individual experiences of caregivers using psychological mistreatment and neglect. When a caregiver indicated psychological mistreatment (e.g., yelling) or neglect (e.g., skipping necessary care) occurred on their daily diary, they were asked what they were doing and how they felt when the event occurred. Text responses were analyzed using content analysis. When psychological mistreatment occurred, there was often a triggering event. For example, 43.8% of caregivers reported they were responding to a behavioral symptom, and 28% indicated something inconvenient occurred. Caregivers were mostly frustrated/angry (68.8%) and annoyed (21.9%) when they used psychological mistreatment. When the caregiver neglected the recipient, 43.5% of caregivers reported the recipient refused to receive care and 30% reported prioritizing other care activities. In cases of neglect, caregivers were frustrated/angry (39.1%) and worried/anxious (30.4%). Findings indicate psychological mistreatment and neglect occur in unique contexts; prevention of these behaviors likely will require distinct intervention strategies.

SUPPORTING FAMILY CAREGIVERS: HOW DO CAREGIVERS OF OLDER ADULTS COPE WITH ROLE STRAIN? A QUALITATIVE STUDY

Qualitative research on positive coping approaches actually used by caregivers can inform interventions that can be feasibly implemented. Absent from previous qualitative research is how caregivers respond to strain in the relationship, specifically. Eight focus groups were conducted with a purposeful sample of racially and ethnically diverse family caregivers in Los Angeles (n=75). An additional 8 in-depth follow-up interviews were conducted. Content analysis was used to understand the mechanisms employed by caregivers to cope with strain and tension in the caregiving relationship. Preliminary results revealed twenty-two individual themes, which were subsequently grouped into four main superordinate themes: 1) Self-care; 2) Adaptation of behaviors and feelings; 3) Seeking and utilizing assistance and respite; and 4) Education and support groups. This work can help inform the design of programs to support caregivers and prevent potentially harmful behaviors, through understanding the experiences of caregivers in their own words.

P6373Serum amyloid A and left ventricular mass in psoriasis patients treated with infliximab

Background

Serum amyloid A (SAA) is an acute phase reactant associated with amyloid tissue deposition. Chronic skin inflammation in psoriasis could cause increased production of SAA in the liver and subsequent deposition in cardiac tissue.

Purpose

To assess if higher SAA is associated with higher left ventricular (LV) mass in psoriasis patients treated with infliximab

Methods

Data from 47 psoriasis patients treated with the tumour necrosis factor-α blocker infliximab (mean age 47±14 years, 66% men) was compared to 106 age and sex-matched control subjects (mean age 47±11 years, 70% men). LV mass was assessed by echocardiography and index to height m2.7. SAA was analysed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry.

Results

Psoriasis patients were more likely to be smokers than controls (38% vs. 16%, p=0.005), while other cardiovascular risk factors and SAA levels were similar. Psoriasis patients had lower LV mass index than controls (35.6±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.008). In the total study population, higher SAA level (β=0.23, p=0.003) was associated with higher LV mass index independent of presence of psoriasis (Table). In psoriasis patients, higher SAA level (β=0.48, p<0.001) was associated with higher LV mass index after adjustment for age and body mass index in multivariable analysis (Table). No association between SAA and LV mass index was found in controls.

Table 1. Multivariable associations of LV mass index in the total study population and in psoriasis patients Total study population Psoriasis LV mass index LV mass index R2=0.33, p<0.001 R2=0.43, p<0.001 β P β P Psoriasis −0.21 0.006 na na SAA, μg/ml 0.23 0.003 0.48 <0.001 BMI, kg/m2 0.39 <0.001 0.50 <0.001 Age, years 0.18 0.03 0.11 0.35 Female gender −0.11 0.15 – – Hypertension 0.08 0.35 – – Smoking 0.03 0.75 – – BMI, body mass index; LV, left ventricular; SAA, serum amyloid A; na, not applicable.

Conclusion

In psoriasis patients on infliximab treatment, higher SAA level was associated with greater LV mass index, pointing to a potential role of chronic inflammation and SAA production in the development of subclinical cardiac disease in psoriasis.

Acknowledgement/Funding

Western Regional Health Authority of Norway, Hjertefondet

Looking Back to Move Forward: The Value of Reflexive Journaling for Novice Researchers

For novice qualitative researchers, each encounter in the field yields a ream of questions and uncertainties. While fieldwork has inherent ambiguities for all researchers, novice researchers have less experience on which to draw to assess their interactions with participants. Adding to this uncertainty, gerontological fieldwork is frequently imbued by age-and cohort-related nuances, characteristics which new researchers often do not share with participants. It is also not uncommon for new researchers to work primarily alone on projects, such as dissertations and theses. Mentors and academic advisors can help examine research encounters, however advice may be most constructive following engagement in reflexive exercises. We discuss the benefits of using reflexive journaling to assist with answering the many questions generated while conducting qualitative interviews during a study with family carers. Advisors should consider encouraging the use of reflexive journaling to help novices grow as researchers.