scholarly journals The Effects of Remote Activity Monitoring on Family Caregivers of People Living With Dementia Over an 18-Month Period

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 3-3
Author(s):  
Joseph Gaugler ◽  
Rachel Zmora ◽  
Lauren Mitchell ◽  
Jessica Finlay ◽  
Christina Rosebush ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Family Caregivers ◽  
Older Persons ◽  
Controlled Trial ◽  
Activity Monitoring ◽  
Community Dwelling ◽  
Individual Growth ◽  
Time Data ◽  
Dementia Caregivers ◽  
Term Care

Abstract Technology interventions for older persons and long-term care are generally utilized as real-time data capture tools to complement clinical or family care for older persons or as interventions themselves designed to improve important dementia care outcomes. Although research on novel technological interventions for people with Alzheimer's disease and related dementias (ADRD) and their family caregivers has grown considerably in the past two decades, much of this work continues to focus on design, feasibility, and acceptability (with a need for conceptual refinement in these areas) and less on controlled outcome studies. The objective of this experimental mixed methods demonstration was to determine the 18-month effectiveness of remote activity monitoring (RAM) technology in improving outcomes among family caregivers of community-dwelling persons with dementia. We used an embedded experimental mixed methods design, collecting qualitative data within the structure of a traditional randomized controlled trial ([QUAN+qual]→QUAN) over an 18-month period for 171 dementia caregivers. Change in caregiver self-efficacy, sense of competence, and caregiver distress served as the main quantitative outcomes of interest. Individual growth curve models indicated that the RAM technology did not have direct effects on caregiving outcomes, and although the qualitative findings indicated several potential moderators of RAM effectiveness on caregiving outcomes, the inclusion of these qualitatively-identified moderators did not result in statistically significant (p < .05) effects. Ensuring effective human care management alongside RAM technology may help to overcome the barriers reported by dementia caregivers in this demonstration study.

scholarly journals Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol (Preprint)

2017 ◽  
Author(s):  
Elizabeth M. Wallack ◽  
Chelsea Harris ◽  
Michelle Ploughman ◽  
Roger Butler
Keyword(s):  
Family Caregivers ◽  
Controlled Trial ◽  
Dementia Care ◽  
Community Dwelling ◽  
Feasibility Trial ◽  
Post Intervention ◽  
Community Based ◽  
Term Care ◽  
People With Dementia ◽  
Novel Approach

BACKGROUND Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. OBJECTIVE Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to “age in place.” METHODS This is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to “intervention” and 2 to “control”). The study population includes 22 “dementia triads” that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden. RESULTS Results will be available in March of 2018. CONCLUSIONS Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care.

Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Phoebe Ullrich ◽  
Christian Werner ◽  
Martin Bongartz ◽  
Tobias Eckert ◽  
Bastian Abel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older Persons ◽  
Controlled Trial ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Life Space ◽  
Home Based ◽  
Independent Life

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

scholarly journals Emotional Experiences of Dementia Caregiving Transitions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 72-72
Author(s):  
Emily Ihara ◽  
Catherine Tompkins ◽  
William Kennedy ◽  
Rhea Vance-Cheng ◽  
Bianca Kwan ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Well Being ◽  
Emotional Experiences ◽  
Dementia Caregivers ◽  
Nursing Facility ◽  
Term Care ◽  
Group Interviews ◽  
Symptom Progression ◽  
Feeling Overwhelmed

Abstract Research indicates that family caregivers of individuals living with dementia are at risk for high levels of stress, depression, physical health declines, and illness. The health and well-being of family caregivers is critically important to a long-term care system that is dependent on them to continue their caregiving role. In-depth individual and focus group interviews of 16 dementia caregivers were conducted to explore the emotional experiences of caregiving stress during transitions of individuals living with dementia to a higher level of care. Data were transcribed verbatim, checked for accuracy, and analyzed by at least two members of the research team. Line-by-line coding, memo writing, and constant comparative analyses were conducted until redundancy, when no new themes were discovered. Caregivers described various levels of feeling overwhelmed and symptom progression leading to the move to a nursing facility. Social isolation featured prominently, with caregivers describing a gradual erosion of their social network and socializing opportunities because of their caregiving responsibilities and the care recipient’s deteriorating symptoms. Caregivers described feeling isolated and stigmatized. One caregiver said, “…you’re being less invited, you’re being less involved. People don’t know how to deal with you…I don’t know if they become the pariah or I become the pariah.” At the same time, maintaining social connections and having help with caregiving featured prominently in the coping mechanisms described. The health of caregivers is equally as important as the person living with dementia, and programs, interventions, and resources should be a priority for supporting families through transitions.

scholarly journals Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial

2020 ◽  
Vol 9 (3) ◽  
pp. 885
Author(s):  
Ted Kheng Siang Ng ◽  
David Bruce Matchar ◽  
Rehena Sultana ◽  
Angelique Chan
Keyword(s):  
Older Adults ◽  
Older Persons ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Self Care ◽  
Community Dwelling ◽  
Physiological Measures ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
Community Dwelling Older Adults

Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting. Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures. Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B12 levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period. Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities.

scholarly journals Psychometric validation of the Carers of Older People in Europe Index among family caregivers of older persons with dementia

2018 ◽  
Vol 6 ◽  
pp. 205031211879281
Author(s):  
Jill-Marit Moholt ◽  
Oddgeir Friborg ◽  
Mari Wolff Skaalvik ◽  
Nils Henriksen
Keyword(s):  
Factor Analysis ◽  
Older People ◽  
Family Caregivers ◽  
Older Persons ◽  
Negative Impact ◽  
Model Fit ◽  
Dementia Caregivers ◽  
Confirmatory Factor ◽  
Test Retest Reliability

Objectives: The Carers of Older People in Europe Index is a first-stage assessment tool to detect family caregivers in need of support. This instrument assesses caregivers’ subjective perceptions of their caregiving circumstances. The present study examines the psychometric properties of the Norwegian version of the Carers of Older People in Europe Index among family caregivers for older persons with dementia living at home. Methods: Cross-sectional survey data were collected from 430 dementia caregivers. The sample was randomly split as follows: the first half of the sample was used to identify the measurement model using an exploratory factor analysis, and the second half of the sample was used to cross-validate the model using a confirmatory factor analysis. The criterion validity and reliability (internal consistency and test–retest reliability) of the Carers of Older People in Europe Index were also examined. Results: Using an exploratory factor analysis, we extracted three factors that were consistent with previous findings: negative impact of caregiving, positive values of caregiving and quality of support. This model fit the data well using a confirmatory factor analysis. Moreover, a second-order model could replace the three-factor correlated model without sacrificing the model fit, supporting the use of a global impact of caregiving score. The three factors and the global factor correlated with the criteria measures in the expected directions. The internal consistency was assessed using Cronbach’s alpha and was good for the negative impact ( α = 0.86) and the quality of support ( α = 0.76) factors. The positive values factor was less consistent ( α = 0.64). The test–retest reliability was examined using Spearman’s rank order correlation and was good for all three factors. Conclusion: The psychometric properties of the Norwegian version of the Carers of Older People in Europe Index are good. The instrument assesses dementia caregivers’ situations across three primary factors or alternatively validly summarizes the factors in a global impact of caregiving score.

The effects of a multi-component dyadic intervention on the psychological distress of family caregivers providing care to people with dementia: a randomized controlled trial

2015 ◽  
Vol 27 (12) ◽  
pp. 2031-2044 ◽  
Author(s):  
Anna-Eva Prick ◽  
Jacomine de Lange ◽  
Jos Twisk ◽  
Anne Margriet Pot
Keyword(s):  
Randomized Controlled Trial ◽  
Physical Exercise ◽  
Family Caregivers ◽  
Controlled Trial ◽  
Skills Training ◽  
Community Dwelling ◽  
Randomized Controlled ◽  
People With Dementia ◽  
The Us ◽  
Person With Dementia

ABSTRACTBackground:Earlier research showed that multi-component dyadic interventions – including a combination of intervention strategies and addressing both the person with dementia and caregiver – have a beneficial impact on the mental and physical health of people with dementia and their family caregivers. A randomized controlled trial (RCT) of a multi-component dyadic intervention, which is a translated and adapted version of an intervention that has been shown to be effective in the US by Teri et al. (2003), was performed. The effects on caregivers’ mood (primary outcome), burden, general health, and salivary cortisol levels (secondary outcomes) were studied.Methods:Community-dwelling people with dementia and their family caregivers (N = 111 dyads) were randomly assigned. The experimental group received eight home visits during three months, combining physical exercise and support (psycho-education, communication skills training, and planning of pleasant activities). Both the physical exercise and support component were directed at both the person with dementia and the caregiver. The comparison group received monthly information bulletins and phone calls. There were three measurements at baseline (prior to the intervention), at three months, and at six months into the intervention. Data were analyzed with Generalized Estimating Equations (GEE) based on an intention-to-treat analysis of all available data.Results:All analyses showed no benefits of the intervention over time on any of the outcomes.Conclusion:The negative results might be explained by the translation and adaptation of the intervention that has been shown to be effective in the US: the intervention was shortened and did not include cognitive reframing. However, only the health effects on people with dementia and not on caregivers were studied in the US. Several other factors might also have played a role, which are important for future studies to take into account. These are: the usual health care in the country or region of implementation; the wishes and needs of participants for specific intervention components; the room for improvement regarding these components; the inclusion of positive outcome measures, such as pleasure, and the quality of the relationship.

scholarly journals Research Participation among Community Dwelling Dementia Caregivers: Reflections and Suggestions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 799-799
Author(s):  
Kiana Cruz ◽  
Sama Joshi ◽  
Taeyoung Park ◽  
M Carrington Reid ◽  
Keela Herr ◽  
...  
Keyword(s):  
Support Groups ◽  
Ecological Model ◽  
Controlled Trial ◽  
Small Sample ◽  
Lessons Learned ◽  
Community Dwelling ◽  
Central Research ◽  
Research Strategies ◽  
Dementia Caregivers ◽  
Diverse Range

Abstract Clinical trials for dementia caregivers have suffered from small sample sizes that lack adequate power to detect treatment benefits. Addressing these methodological shortcomings is contingent upon successful recruitment and enrollment of caregiver participants, but major barriers impede their participation in research. This presentation describes the lessons learned from recruiting and enrolling dementia caregivers into a pilot randomized controlled trial designed to help caregivers recognize and communicate about pain in dementia care recipients. Using Bronfenbrenner’s ecological model, we organize our discussion of challenges and opportunities into three levels: community (ecosystem), institution (microsystem), and individual. A key challenge at the community level was gatekeeping by organization leaders, including those from support groups, senior centers, and congregate living facilities. At the institutional-level, challenges included an absence of administrative mechanisms for identifying caregivers and a lack of caregiver research expertise on the Institutional Review Board. At the individual-level, challenges included time constraints and varying motivations for participating in research. Strategies for overcoming these challenges spanned the three levels and included establishing trust and rapport with various constituencies; adapting our recruitment approaches to meet the specific motivations of prospective participants; and refining recruitment scripts to allow for greater personalization. Employing these strategies, which can be generalized to recruit other hard-to-reach populations, helped to overcome recruitment challenges and expedite enrollment of caregivers from a diverse range of sociodemographic backgrounds. Further improvement will require coordinated changes at the institutional and community levels, including the development of central research registries and administrative mechanisms for identifying caregivers.

scholarly journals Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025614 ◽  
Author(s):  
Jonas Czwikla ◽  
Maike Schulz ◽  
Franziska Heinze ◽  
Thomas Kalwitzki ◽  
Daniel Gand ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Medical Care ◽  
Delphi Study ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Care Needs ◽  
Term Care

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.

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