Study Protocol: Partners at Meals Telehealth Intervention for Caregivers of Persons With Dementia

Background: As the aging population continues to increase, it is estimated that persons with dementias (PWDs) will reach 13 million by 2050. Lack of caregiver skills related to mealtime planning and the ability to cope with dysfunctional behaviors are well-documented factors that influence nutritional outcomes for PWDs, leading to social isolation, and negatively impacting their home stay. The aim of this study protocol is to test the effectiveness of a train-the-trainer program in which non-paid volunteers in respite care centers deliver a telehealth mealtime intervention for caregivers of PWDs, Partners at Meals. The program is based on the C3P Model of Changing the Place, People and Person. Methods: A cluster-randomized controlled trial with parallel mixed methods evaluation processes is being conducted. Caregivers and PWD dyads, receiving respite services are randomized to receive Partners at Meals or enhanced-usual-care for six months. Within the intervention group, dyads are partnered with a C3P-trained volunteer who works with caregivers to devise monthly mealtime plans. Under enhanced-usual-care, dyads receive standardized educational materials modified from The Savvy Caregiver Program for Alzheimer’s caregiving. Primary outcomes include weight, calorie, protein and fluid intake of the PWDs and quality of life of the caregiver. Respite center administrators, program directors, volunteers and caregivers are evaluated for intervention fidelity, acceptability and sustainability. Implications: In this trial, we lay the groundwork to examine effectiveness and sustainability of a train-the-trainer telehealth program that could be widely disseminated for managing mealtimes in-the-home, while promoting quality of life of both the caregiver and PWDs.

Ecological Momentary Assessments and Interventions in Alzheimer’s Caregiving

Background: Caregivers of persons with Alzheimer’s Disease (AD) often experience feelings of lack of support and information from specialists when operating in real scenarios, inclusive of old-age psychiatric wards, care homes, community, and patient’s home. Objective: AD caregivers can provide narrative about what issues need to be addressed in Ecological Momentary Assessment (EMA) to capture real-time and real-scenario needs in AD caregiving, and Ecological Momentary Interventions (EMI) as online e-learning to assist in areas of concerns. Method: Twelve focus group discussions took place with AD caregivers for a total of 62 people interviewed. Once major themes in surveys and learning were identified by using discourse analysis, AD caregivers expressed the likelihood that these themes (where 0 meant “nil” and 1 meant “completely”) would address their focal needs in caregiving and topics in learning. Z scores for proportions and Cohen’s d effect size were calculated for each item reporting the averaged scores. Results: AD caregivers indicated that the major areas of concern that could benefit from an EMA/EMI online platform were: support (d=3.08), collaboration (d=1.85), medication review (d=1.21), dealing with grief and mourning, and time (d=0.97). Moreover, they identified personal resources available to provide help to colleagues: support (d=1.34), information (d=0.97), collaboration (d=2.06), hospital admission (d=3.08), and hospital discharge (d=5.50). Conclusion: Focus groups and narratives can be the initial stage in creating a dedicated AD app supporting EMA/EMI in AD care.