A Nurse as a Member of a Multidisciplinary Team Preventing Elder Abuse Nursing involved to prevent elder abuse can be viewed as a health promotion intervention in that it addresses conditions that increase the risk of an unhealthy situation from deteriorating into abuse. Although the roles of nurses in addressing risks have been discussed throughout this book, this chapter focuses on keeping one step ahead of abuse by addressing conditions that have a high probability of developing into an abusive situation. These risks can be identified in both the older adult and the potential perpetrator by using the Benjamin Rose Institutes on Aging’s (BRIA) Risk of Abuse Tool to identify vulnerabilities associated with increased risk. Using information based on this tool, professionals can implement interventions in a timely manner with the intent of preventing abuse from occurring. The case example in this chapter describes ways in which a nurse and other members of a multidisciplinary team use the tool to identify and address risks to prevent a potentially abusive situation from escalating. For nurses, the case illustrates the importance of using nursing interventions not only to address usual health-related goals but also to achieve the additional goal of preventing elder abuse. In addition, it illustrates how a nurse functions within a multidisciplinary team to address multifaceted needs of both the older adult and the caregiver. Content of this chapter was developed by the BRIA in Cleveland, Ohio, for this book. In addition to engaging in applied research and public policy advocacy, BRIA provides a wide range of home and community-based services and programs, including home health care and affordable, independent housing geared toward promoting the safety, health, and independent functioning of older adults in their homes (BRIA, n.d.). The BRIA’s Risk of Abuse Tool and the Recognizing Abuse Tool described in Chapter 7 are examples of research-based tools that this agency developed for clinical practice. The fictitious case in this chapter illustrates how a multidisciplinary team, including a nurse, uses the Risk of Abuse Tool to develop interventions that are directed toward preventing abuse from occurring. The chapter first provides an overview of the Risk of Abuse Tool and then describes the application of this tool in a community-based clinical setting. The information is applicable to nurses in all settings because it illustrates how usual nursing interventions can be effective in reducing risks and preventing the occurrence of elder abuse. Nurses do not always know if their interventions are successful in preventing abuse from occurring in the long term; however, they can experience satisfaction from knowing that their interventions addressed immediate risks. In addition, interventions directed toward the prevention of abuse are likely to improve the health and functioning of the older adults, which are goals by themselves. Read more
Promoting Heart Health and Behavior Change in a Vulnerable Older Adult Population Background: Older minority populations in low socioeconomic classes are at high risk for cardiovascular disease, stroke, type 2 diabetes, and a host of other heart-related health conditions. Engaging in unhealthy behaviors such as poor diet, sedentary lifestyle, and poor use of health services is a major contributor to these health disparities. The Heart Health Program was developed to improve health outcomes by encouraging behavior change in a group of low-income older African Americans attending two urban senior centers. Using the Health Belief Model as a guiding framework, group sessions were conducted bi-weekly over the course of a three-month period. Session leaders engaged participants in educational activities and helped to develop individual ‘action steps’, or actionable goals for each participant to strive toward as a means of improving heart health. Methods: Twenty-five low-income, African American seniors participated in the Heart Health Program. A prepost design was used to evaluate the acceptability and feasibility of the program. Results: Participants reported high levels of satisfaction with the program as a whole and successful accomplishment of action steps. Results indicate limited long-term behavior change at the program’s conclusion. Conclusions: Lessons were learned about implementing this type of behavior change program in a senior center focused on: preparation, logistics, and relationships between the project team, senior center staff, and participants. Based on the initial experience of the Heart Health Program, plans are underway to refine the program and broaden its delivery to more older adults. Read more
Religiosity and Quality of Life A Dyadic Perspective of Individuals With Dementia and Their Caregivers Objectives: Dyadic coping theory purports the benefit of joint coping strategies within a couple, or dyad, when one dyad member is faced with illness or stress. We examine the effect of religiosity on well-being for individuals with dementia (IWDs). In particular, we look at the effect of both dyad members’ religiosity on perceptions of IWDs’ quality of life (QoL). Neither of these issues has been extensively explored. Method: One hundred eleven individuals with mild-to-moderate dementia and their family caregivers were interviewed to evaluate IWDs’ everyday-care values and preferences, including religious preferences. Using an actor_partner multi-level model to account for the interdependent relationship of dyads, we examined how IWD and caregiver ratings of religiosity (attendance, prayer, and subjective ratings of religiosity) influence perceptions of IWDs’ QoL. Results: After accounting for care-related stress, one’s own religiosity is not significantly related to IWDs’ or caregivers’ perceptions of IWD QoL. However, when modeling both actor and partner effects of religiosity on perceptions of IWDs’ QoL, caregivers’ religiosity is positively related to IWDs’ self-reports of QoL, and IWDs’ religiosity is negatively associated with caregivers’ perceptions of IWDs’ QoL. Conclusion: These findings suggest that religiosity of both the caregiver and the IWD affect perception of the IWD’s QoL. It is important that caregivers understand IWDs’ values concerning religion as it may serve as a coping mechanism for dealing with dementia. Read more
Characteristics of Depressed Caregivers of Veterans With Dementia This study examined the characteristics of caregivers and persons with dementia (PWD) to determine their association with caregiver depression. Participants included 508 PWD (veterans) and 486 caregivers from Boston, Houston, Providence, Beaumont (Texas), and Oklahoma City, identified from diagnoses from medical records and recruited from February 2007 to July 2009, for a larger study evaluating Partners in Dementia Care, a care-coordination intervention. Characteristics evaluated for PWD included activities of daily living, instrumental activities of daily living, cognitive impairment, and disruptive behavior. Caregiver characteristics evaluated included caregiver unmet needs, support-service use, and number of informal helpers. Caregiver depression was measured using the Iowa form 11-item Center for Epidemiologic Studies Depression Scale. Depressed caregivers reported significantly more unmet needs than the nondepressed caregivers. Depressed caregivers also reported a high frequency of disruptive behavior in their PWD. Caregiver perceptions of unmet needs may be an important target for intervention. Read more
Reflections on implementing the evidence-based BRI Care Consultation with RCI in Georgia This evidence-based caregiver support program demonstrated multiple successes and responded effectively to implementation challenges. Read more
Impact of the Care Coordination Program Partners in Dementia Care on Veterans’ Hospital Admissions and Emergency Department Visits Introduction: “Partners in Dementia Care” (PDC) tested a care-coordination program based on partnerships between Veterans Affairs (VA) medical centers and Alzheimer’s Association chapters. The hypothesis posited PDC would reduce the likelihood and number of veterans’ hospital admissions and emergency department (ED) visits, particularly for those with more cognitive impairment or behavioral symptoms. Methods: The sample included 328 veterans with dementia and their primary family or friend caregivers from five matched sites (two randomly selected treatment sites). Data came from VA records; supplemented by caregiver research interviews. Regression analyses using the likelihood and number of hospital and ED visits as outcomes tested for overall treatment-comparison group differences and statistical interactions with cognitive impairment and behavioral symptoms. Results: Consistent with the hypothesis, three significant interactions showed treatment-group veterans, with more cognitive impairment and behavioral symptoms, had fewer hospital admissions and ED visits than comparison-group veterans. There were no differences in the likelihood of hospital or ED use. Discussion: PDC, a low-cost program for veterans and caregivers, was effective in reducing the number, but not the likelihood, of hospital admissions and ED visits. Reductions in service use were greater when caregivers reported more difficulties with veterans’ symptoms, which in the absence of PDC would place veterans at risk of being high-volume, high-cost service users. Read more
A Break-Even Analysis for Dementia Care Collaboration Partners in Dementia Care Background: Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the “Partners in Dementia Care” (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. Objective: We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. Design: This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. Participants: Study subjects were veterans (N=434) 50 years of age and older with dementia and their caregivers at two interventions (N=269) and three comparison sites (N=165). Interventions: PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer’s Association chapters. Main Measures: We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans’ cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. Key Results: Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p≤0.001), baseline cognitive impairment (p≤0.05), number of personal care dependencies (p≤0.01), and VA service priority (p≤0.01) all predicted change in log total cost. Conclusions: These analyses show that PDC meets veterans’ needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer’s Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination Read more
Understanding and Enhancing the Relationship Between People With Dementia and Their Family Families provide the majority of care and support to the millions of people with dementia worldwide (see Chapter 1). Family members assist with instrumental and personal care tasks such as finances, housework, transportation, bathing, feeding, dressing, and toileting. This chapter looks at the experience of dementia for both the person and carer, how interactions, communication, and relationship quality of people with dementia and their carers are affected by changes in memory during the earliest stages of dementia, and the experience of recognizing and accepting symptoms of dementia. Interventions that can improve communication between people with dementia and their care partners and help them develop a plan of care are described. Read more
Time for living and caring A tailored intervention to make respite more effective for caregivers This article presents the rationale for and description of a promising intervention, Time for Living and Caring (TLC), designed to enhance the effectiveness of respite services for family caregivers. It is guided by the theoretical principles of the Selective Optimization with Compensation (SOC) model, which individually coaches caregivers on how to assess their personal circumstances, identify their greatest needs and preferences, and engage in goal setting and attainment strategies to make better use of their respite time. Focusing on respite activities that match caregivers’ unique needs is likely to result in improved well-being. We report on a pilot study examining TLC’s feasibility and potential benefits and how caregivers viewed their participation. While additional research is needed to test and refine the intervention, we need to find more creative ways to enhance respite services. Read more
Statewide Implementation of Reducing Disability of Alzheimer’s Disease Impact of Family Caregiver Outcomes There have been few replications of efficacious evidence-based programs for dementia caregivers offered in community settings. This study highlights the replication of the evidence-based Reducing Disability in Alzheimer's Disease program and explores the changes in outcomes for participating caregivers and whether those changes are related to level of program utilization. With data from 219 caregivers, regression results indicate that more exercise sessions are associated with a decrease in caregiver strain and more behavior management sessions are associated with a decrease in unmet needs after 3 months. Findings demonstrate how a multicomponent program can have positive benefits for family caregivers. Read more
