Transforming Dementia Care: Implementation Challenges Moving Evidence-Based Programs to Health Care

Abstract Although evidence for dementia care programs continues to grow, families and health providers do not have ready access to programs, nor have they been widely disseminated and routinized in healthcare. Understanding implementation considerations when embedding evidence-based programs in healthcare systems can inform ways to effectively transform dementia care. This symposium will examine similarities and differences in implementation challenges encountered and strategies used when implementing four evidence-based programs being tested in different healthcare environments using distinct study designs. Dr. Gaugler et al., will discuss implementation challenges encountered with a staff-delivered intervention (ADS Plus) to support caregivers in adult day services that is being tested using a mixed methods hybrid trial design in >50 sites nationally. Dr. Hodgson et al., will discuss adaptions and their measurement to COPE, a home-based dyadic support program being embedded in 10 PACEs of a large healthcare system using a noninferiority trial testing staff training strategies. Dr. Forester et al., will examine implementation of the Care Ecosystem for dementia patients in a high-risk, integrated care management program using a pilot embedded pragmatic trial. Dr. Hepburn et al., will explore tactical challenges of implementing Tele-Savvy, an online caregiver psychoeducation program, within the context of a pilot pragmatic clinical trial. Drawing upon implementation science, themes discussed include balancing adaptations and fidelity, measurement of implementation outcomes and organizational readiness, and staff training implications. Also highlighted are research design considerations. Dr. Czaja, an expert in the design and implementation of dementia care interventions from in-person to technology-based will be the discussant.

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Partnering With Hospices to Develop, Test, and Implement Aliviado Dementia Care in a 25-Site Pragmatic Trial

Innovation in Aging ◽

10.1093/geroni/igaa057.2852 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 787-788

Author(s):

Abraham Brody ◽

Tina Sadarangani ◽

Alycia Bristol ◽

Tessa Jones ◽

Kimberly Convery ◽

...

Keyword(s):

Pragmatic Trial ◽

Limited Resource ◽

Dementia Care ◽

Quality Improvement Intervention ◽

Hospice Patients ◽

Diagnosis Of Dementia ◽

Important Input ◽

Barriers To Implementation ◽

Competing Priorities ◽

Evidence Based Programs

Abstract Almost half of hospice patients currently have a diagnosis of dementia. However, few pragmatic, evidence-based, programs have been developed and tested in this setting overall, and targeting persons living with dementia and their caregivers specifically. Furthermore, limited academic-hospice research partnership exist. We thus undertook efforts to develop and test Aliviado Dementia Care-Hospice Edition, a complex multi-modal quality improvement intervention, as part of the HAS-QOL Trial, a 2-phase, 25 site embedded pragmatic clinical trial, through partnership and engagement with hospice and caregiver stakeholders. We discuss methods for engagement and barriers to implementation. Stakeholders assisted with alignment of the intervention to their needs and how to flexibly implement, substantially strengthening the intervention. They also provided important input regarding how to sustain the intervention through technological, mentorship and communication support mechanisms. Barriers found include the nature of implementing in limited resource settings with multiple competing priorities and little research infrastructure.

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Evidence-based programs for older persons in the Americas

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2021.91 ◽

2021 ◽

Vol 45 ◽

pp. 1

Author(s):

Patricia Morsch ◽

Martha Pelaez ◽

Enrique Vega ◽

Carolina Hommes ◽

Kate Lorig

Keyword(s):

Older Adults ◽

Healthy Aging ◽

Management Program ◽

Self Management ◽

Multiple Chronic Conditions ◽

Evidence Based ◽

History Of ◽

Current Context ◽

Personal Skills ◽

Evidence Based Programs

In the current context of the aging of populations and the increase in multiple chronic conditions and dependence, it is important that health systems provide opportunities to improve capacities of older adults to enable healthy aging. Opportunities to enhance older adults’ abilities, including self-management, can be offered through evidence-based programs. Such programs have been proven effective in improving individuals’ symptoms and quality of life, often lowering health-care costs. Self-management evidence-based programs can foster the development of personal skills, increase confidence and motivation on self-care, and help individuals to make better decisions about their own health. This special report describes the implementation history of a self-management program in the Region of the Americas, and the barriers to and facilitators of implementation that can serve as examples for evidence-based program dissemination in the Region.

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Respiratory Muscle Training Improves Speech and Pulmonary Function in COPD Patients in a Home Health Setting - a Pilot Study

10.1101/523746 ◽

2019 ◽

Author(s):

N Bausek ◽

L Havenga ◽

S Aldarondo

Keyword(s):

Pilot Study ◽

Respiratory Muscle ◽

Care Home ◽

Standard Of Care ◽

Management Program ◽

Home Health ◽

Respiratory Muscle Training ◽

List Type ◽

Health Providers ◽

Home Based

Clinical Context and Key FindingsHome-based COPD managment, as provided by certified home-health providers, represents a cornerstone of patient care.Resporatory muscle trainig (RMT) reduces symptoms of COPD and improves underlying respiratory muscle weakness, and may be a beneficial adjunct of standard of care treatment plans.This 4 Week pilot study shows that RMT in combination with a standard of care home-based COPD management program can improve pulmonary and speech functions.

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Training needs for dementia care in China from the perspectives of mental health providers: who, what, and how

International Psychogeriatrics ◽

10.1017/s1041610217002654 ◽

2017 ◽

Vol 30 (7) ◽

pp. 929-940 ◽

Cited By ~ 7

Author(s):

Ling Xu ◽

Hsin-Yi Hsiao ◽

Wenchen Denq ◽

Iris Chi

Keyword(s):

Mental Health ◽

Informal Caregivers ◽

Training Needs ◽

Dementia Care ◽

Mental Health Providers ◽

Health Providers ◽

Dementia Caregivers ◽

Home Based ◽

The Government ◽

Increasing Demand

ABSTRACTBackground:Acknowledging increasing demand of dementia care for patients in China, this paper aims to understand the training needs of dementia care from the perspectives of mental health providers by examining who should be the trainees, what should be the contents of training, and how to deliver the training in China.Methods:Using purposive sampling, data were gathered via four focus group discussions with 40 mental health providers in Beijing, China, in 2011. Data were transcribed by independent investigators and then translated into English. Researchers used content analysis to separately identify themes and codes. Discrepancies were discussed until final agreement achieved.Results:To improve the quality of dementia care, all participants agreed there is a significant need to train both formal or professional (physicians, nurses, hospital administrators, community workers) and informal caregivers (family, friends, or non-kin hired caregivers). For formal or professional caregivers, suggested training content included clinical knowledge of dementia (i.e. pathogenesis, approaches for preventing dementia deterioration) and clinical practice skills (i.e. diagnostic, treatment, caregiving, counseling, communicating skills). For informal caregivers, basic dementia knowledge and home-based caregiving skills such as safety, restorative, stress management, and communication were identified as key training contents. Multilevel support from the government and community centers were considered crucial factors to delivering the training and educating the public to enhance awareness of dementia.Conclusions:Culturally, sensitive education and specific trainings for formal and informal dementia caregivers are urgently needed in China. Policy and program implications are discussed.

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