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
Functional Decline Predicts Emergency Department Use in Veterans With Dementia Background: We examined emergency room (ER) utilization by persons with dementia (PWDs) using caregiver and patient characteristics as predictors. Methods: A secondary analysis of 296 veteran–caregiver dyads. Caregivers recorded PWD baseline characteristics and noted ER visits over the next year. Two sets of regression models analyzed categorical ER use and repeat ER use. Results: In the univariate analysis, categorical use of the ER was predicted by patients’ functional status (P _ .008) and Veterans Affairs priority grouping (P _ .02). Repeat ER admissions were predicted by functional status (P _ .04), number of chronic conditions (P _ .01), and caregiver-reported relationship strain (P _ .04). In multivariate analysis, categorical ER use was predicted by functional status (P _ .02), priority grouping (P _ .03), and number of chronic conditions (P _ .06). Conclusions: Functional status most strongly predicted ER use, highlighting the promise of home-based interventions to improve activities of daily living. Number of chronic conditions and caregiver-reported relationship strain are potential targets of intervention during discharge process. Read more
Activity and Well-Being of Older Adults Does Cognitive Impairment Play a Role This analysis assesses the activity level of 324 older adults and the relationship of activity to quality of life with a specific emphasis on the role of cognitive ability. Although the number of older adults with cognitive impairment continues to grow, few studies have examined the variation in activity and quality of life based on the older adults’ cognitive status. Results indicated that cognitively impaired older adults were less active than their nonimpaired peers; however, correlations revealed that regardless of impairment status, more activity was related to a higher quality of life. There was no support for the hypothesis that impaired older adults who have more cognitive ability will have a higher rated quality of life. These results should be considered in the development of programs for older adults. Regardless of impairment level, activity is paramount to maintaining quality of life. Read more
