scholarly journals Perceptions of Treatment Burden Among Elders With Diabetes and Comorbid Alzheimer’s Disease and Related Dementias

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-276
Author(s):  
Victoria Vaughan Dickson ◽  
Halia Melnyk ◽  
Rosie Ferris ◽  
Joshua Chodosh ◽  
Caroline Blaum
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Qualitative Study ◽  
Financial Burden ◽  
Controlled Trial ◽  
Healthcare Providers ◽  
Patient Treatment ◽  
Treatment Burden ◽  
Treatment Plans

Abstract Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.

Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer’s Disease and Related Dementias: A Qualitative Study

2022 ◽  
pp. 105477382110678
Author(s):  
Victoria Vaughan Dickson ◽  
Halia Melnyk ◽  
Rosie Ferris ◽  
Alejandra Leon ◽  
Mauricio Arcila-Mesa ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Qualitative Study ◽  
Systems Of Care ◽  
Cognitive Status ◽  
Self Management ◽  
Patient Treatment ◽  
Treatment Burden ◽  
Complex Treatment ◽  
Caregiver Role

Many older adults with diabetes (DM) have co-occurring Alzheimer’s Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers ( n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient’s cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.

scholarly journals Cognitive Effects of Aerobic Exercise in Alzheimer’s Disease: A Pilot Randomized Controlled Trial

2021 ◽  
pp. 1-12
Author(s):  
Fang Yu ◽  
David M. Vock ◽  
Lin Zhang ◽  
Dereck Salisbury ◽  
Nathaniel W. Nelson ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Aerobic Exercise ◽  
Controlled Trial ◽  
Moderate Intensity ◽  
Cognitive Effects ◽  
Data Set ◽  
Randomized Controlled

Background: Aerobic exercise has shown inconsistent cognitive effects in older adults with Alzheimer’s disease (AD) dementia. Objective: To examine the immediate and longitudinal effects of 6-month cycling on cognition in older adults with AD dementia. Methods: This randomized controlled trial randomized 96 participants (64 to cycling and 32 to stretching for six months) and followed them for another six months. The intervention was supervised, moderate-intensity cycling for 20–50 minutes, 3 times a week for six months. The control was light-intensity stretching. Cognition was assessed at baseline, 3, 6, 9, and 12 months using the AD Assessment Scale-Cognition (ADAS-Cog). Discrete cognitive domains were measured using the AD Uniform Data Set battery. Results: The participants were 77.4±6.8 years old with 15.6±2.9 years of education, and 55%were male. The 6-month change in ADAS-Cog was 1.0±4.6 (cycling) and 0.1±4.1 (stretching), which were both significantly less than the natural 3.2±6.3-point increase observed naturally with disease progression. The 12-month change was 2.4±5.2 (cycling) and 2.2±5.7 (control). ADAS-Cog did not differ between groups at 6 (p = 0.386) and 12 months (p = 0.856). There were no differences in the 12-month rate of change in ADAS-Cog (0.192 versus 0.197, p = 0.967), memory (–0.012 versus –0.019, p = 0.373), executive function (–0.020 versus –0.012, p = 0.383), attention (–0.035 versus –0.033, p = 0.908), or language (–0.028 versus –0.026, p = 0.756). Conclusion: Exercise may reduce decline in global cognition in older adults with mild-to-moderate AD dementia. Aerobic exercise did not show superior cognitive effects to stretching in our pilot trial, possibly due to the lack of power.

scholarly journals Examining the benefits and harms of Alzheimer’s disease screening for family members of older adults: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Nicole Fowler ◽  
Katherine J. Head ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Christopher M. Callahan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Early Detection ◽  
Controlled Trial ◽  
Diagnostic Evaluation ◽  
Randomized Controlled

Abstract Background Multiple national expert panels have identified early detection of Alzheimer’s disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. Methods The Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1,800 dyads, who will be randomized into three groups (n=600/group): Screening Only group will receive ADRD screening at baseline with disclosure of the screening results and a list of local resources for diagnostic follow-up; Screening Plus, ADRD screening at baseline coupled with disclosure of the screening results, with positive screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and Control, no screening. The COADS trial will measure the family member quality of life (primary outcome) and family member mood, anxiety, preparedness, and self-efficacy (secondary outcomes) at baseline, 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). Discussion We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer’s Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies.

scholarly journals Examining the benefits and harms of Alzheimer’s disease screening for family members of older adults: study protocol for a randomized controlled trial

2019 ◽  
Author(s):  
Nicole Fowler ◽  
Katherine J. Head ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Christopher M. Callahan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Diagnostic Evaluation ◽  
Positive Screen ◽  
Randomized Controlled

Abstract Background: Multiple national expert panels have identified early detection of Alzheimer’s disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. Methods: The Caregiver Outcomes of Alzheimer’s Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1,800 dyads, who will be randomized into three groups (n=600/group): Screening Only group will receive ADRD screening at baseline and disclosure of the screening results, with positive screen participants receiving a list of local resources for diagnostic follow-up; Screening Plus, ADRD screening at baseline coupled with disclosure of the screening results, with positive screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and Control, no screening. The COADS trial will measure the family member quality of life (primary outcome) and family member mood, anxiety, preparedness, and self-efficacy (secondary outcomes) at baseline, 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). Discussion: We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer’s Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies.

scholarly journals Physical Exercise with Multicomponent Cognitive Intervention for Older Adults with Alzheimer's Disease: A 6-Month Randomized Controlled Trial

2016 ◽  
Vol 6 (2) ◽  
pp. 222-232 ◽  
Author(s):  
Min-Ji Kim ◽  
Chang-Wan Han ◽  
Kyoung-Youn Min ◽  
Chae-Yoon Cho ◽  
Chae-Won Lee ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Randomized Controlled Trial ◽  
Physical Exercise ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cognitive Intervention ◽  
Total Load ◽  
Randomized Controlled

Aims: This study aimed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program (MCP) on the cognitive function of older adults with moderate to severe Alzheimer's disease (AD). Methods: We included 33 participants with AD in a 6-month randomized controlled trial. The intervention group participated in physical exercise and received a MCP. The control group received only the MCP. Before and after the intervention, cognitive outcomes were assessed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination, and the Clock Drawing Test. Physical performance was evaluated by exercise time, the number of pedal rotation, total load, grip strength, and the Berg Balance Scale (BBS). Results: In all cognitive measures, there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis. However, the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value, age, sex, and education years. All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements. Conclusion: This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention.

scholarly journals Exercise interventions for older adults with Alzheimer’s disease: a systematic review and meta-analysis protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Julie M. Faieta ◽  
Hannes Devos ◽  
Prasanna Vaduvathiriyan ◽  
Michele K. York ◽  
Kirk I. Erickson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Financial Burden ◽  
Meta Analysis ◽  
Well Being ◽  
Pharmacological Intervention ◽  
Exercise Interventions ◽  
Ovid Medline

Abstract Background The growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial burden associated with drug therapies. Various forms and regiments of exercise (i.e., strength, aerobic, multicomponent) have been reported in the literature; however, conflicting evidence obscures clear interpretation of the value and impact of exercise as an intervention for older adults with AD. The primary objective of this review will be to evaluate the effects of exercise interventions for older adults with AD. In addition, this review will evaluate the evidence quality and synthesize the exercise training prescriptions for proper clinical practice guidelines and recommendations. Methods This systematic review and meta-analysis will be carried out by an interdisciplinary collective representing clinical and research stakeholders with diverse expertise related to neurodegenerative diseases and rehabilitation medicine. Literature sources will include the following: Embase, PsychINFO, OVID Medline, and Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily. Inclusion criteria are participants with late onset AD and structured exercise interventions with prescribed duration, frequency, and intensity. The primary outcome of this study will center on improved or sustained cognitive functioning. Secondary outcomes will include institutionalization-related outcomes, ability in activities of daily living, mood and emotional well-being, quality of life, morbidity, and mortality. Analysis procedures to include measurement of bias, data synthesis, sensitivity analysis, and assessment of heterogeneity are described in this protocol. Discussion This review is anticipated to yield clinically meaningful insight on the specific value of exercise for older adults with AD. Improved understanding of diverse exercise intervention approaches and their specific impact on various health- and function-related outcomes is expected to guide clinicians to more frequently and accurately prescribe meaningful interventions for those affected by AD. Systematic review registration PROSPERO CRD42020175016.

scholarly journals Recruiting and Screening Older Adults With Alzheimer’s Disease for the FIT-AD Trial

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 459-460
Author(s):  
Fang Yu ◽  
Jean Wyman ◽  
Susan Greimel ◽  
Lin Zhang
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Sample Size ◽  
Controlled Trial ◽  
Community Outreach ◽  
Hippocampal Volume ◽  
Recruitment Rate ◽  
Community Dwelling ◽  
Screening Process

Abstract Recruiting older adults with Alzheimer’s disease (AD) into clinical trials has been very challenging even for resource-rich trials. This presentation will discuss the recruitment rate, screening ratio, and recruitment yield and costs in the FIT-AD Trial. The FIT-AD Trial was a single-site, pilot randomized controlled trial testing the effects of 6-month aerobic exercise on cognition and hippocampal volume in community-dwelling older adults with mild-to-moderate AD dementia. Ten recruitment strategies and a 4-step screening process were used to ensure a homogenous sample and exercise safety. The target sample size was 90. During the 48-month recruitment period, 396 individuals responded to our recruitment, 301 were reached, and 103 were tentatively qualified at step 4. Of these 103, 67 (69.8%) completed the optional magnetic resonance imaging (MRI) component of the trial and 7 were excluded due to abnormal MRIs. In year 4, our sample size was increased to allow individuals in the screening process a chance to enroll, resulting in a final sample size of 96. Per enrolled participant, the recruitment rate was 2.15, the screen ratio was 2.92, and the recruitment yield was 31.9%. Over 49% of the enrolled participants were yielded through referrals (28.1%) and Alzheimer’s Association events/services (21.9%). The total recruitment cost was $38,246 ($398 per randomized participant). The results indicate that a multi-prong, extensive community outreach-based approach is essential in recruiting older adults with AD dementia into an exercise trial. Referral was the most cost-effective strategy. Two individuals needed to be screened to enroll one participant.

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