Does an Intervention Designed to Improve Self-Management, Social Support and Awareness of Palliative-Care Address Needs of Persons With Heart Failure, Aims and Objectives: To conduct a formative evaluation of the iPad-Enhanced Shared Care Intervention for Partners (iSCIP) among persons with heart failure (HF), family caregivers and clinicians. Together, persons with HF and family caregivers are referred to as partners. Background: There is growing awareness of the caregiver’s contributions to HF self-management, social support and reciprocal benefits of interventions that involve both partners. The iSCIP engages both partners in a six-session psychosocial intervention to address three preventable causes of poor outcomes in a HF population: poor self-management skills, inadequate social support and underutilization of palliative care. An iPad app is used to organize the intervention. The goals of the iSCIP are to engage partners in HF self-management, communication about the HF patient’s care values and preferences, and future planning. Design: A qualitative focus group design was used. Methods: Seven clinicians and eight partners participated in focus groups to explore their experiences, needs and reaction to the iSCIP content and technologies employed. Open-ended questions and closed-ended surveys were used to collect data. Deductive content analysis was used to analyze the qualitative data. NVivo software was used for qualitative data analysis. Bayesian statistical models were used to analyze numeric data. Results: The iSCIP met partners’ and clinicians’ needs to improve self-management, communicate about care values and preferences and plan for the future. Quantitative analysis of numeric data supported our qualitative findings, in that both groups rated the intervention components useful to very useful. Implications for practice: These findings add to the growing evidence of the feasibility and acceptability of programs that address care values and preferences, and care planning. The iSCIP can be used as a guide for developing interventions and software applications, which involve both partners in care and palliative-care discussions. Read more
Development and Implementation of Online Training Modules on Abuse, Neglect, and Exploitation Online training for care managers to identify, report, and prevent abuse, neglect, and exploitation was developed for a demonstration involving the dually eligible Medicare and Medicaid population. It was composed of three modules covering background, screening, and reporting abuse. Of 453 enrollees, 273 completed at least one module and 212 completed all three. Pre- and post-training surveys for each module were used to examine changes in the proportion of correct answers for each question, using the related-samples Cochran’s Q statistic. Improvements in knowledge from pre- to post-training were evident in modules covering background on abuse and reporting abuse, but not in the module about communication principles and screening for abuse. Its content may have already been familiar to the trainees, who were primarily social workers and nurses. Lessons learned are being used to adapt the training for a wider audience to increase public awareness of abuse. Read more
Can Interpreting Nonsignificant Findings Inform the Lessons Learned From an Intervention Reducing Disability in Alzheimer’s Disease (RDAD) is an evidenced-based intervention for individuals with dementia and their caregivers aimed at reducing the psychosocial strain of the caregiver and improving functional ability of the individual with dementia. Overall efficacy, acceptability, and feasibility outcomes have been published regarding RDAD; however, no specific outcome information has been published on the objective physical performance measures (PPM) of gait speed, functional reach, and balance. Data from the Replication of RDAD (n = 508) was utilized to test the hypothesis that each PPM would show change for participants who completed the program. No significant changes were identified in 3 PPM: gait speed (t =.24, P =.81), balance (t = .23, P =.82), and functional reach (t = −.55, P = .58). To strengthen the research about exercise interventions for individuals with dementia, discussion and interpretation of nonfindings is important for improving intervention designs and methodologies. In the case of RDAD, the intervention protocol may require a sufficient dosage of exercise with respect to fundamental exercise science principles, or there may be misalignment between the intervention and outcome measures. Read more
The SHARE Program for Dementia Implementation of An Early-Stage Dyadic Care-Planning Intervention This article describes the implementation of SHARE (Support, Health, Activities, Resources, and Education), a counseling-based care-planning intervention for persons living with early-stage dementia and their family caregivers (CGs). The foundation of SHARE is built upon assessing and documenting the person living with dementia’s care values and preferences for future care. Using the SHARE approach, CGs are given an opportunity to achieve an understanding of their loved one’s desires before the onset of disease progression when the demand for making care decisions is high. Through working together with a SHARE Counselor, the care dyad begins to identify other sources of support, such as family and friends and service providers, in order to build a more balanced and realistic plan of care for the future. Data were collected from 40 early-stage dementia care dyads to determine the acceptability of having structured discussions about future care in the early stages of dementia. Findings from this study demonstrate the importance of planning in the early stages when persons with dementia can voice their care values and preferences for future care. Finally, this paper illustrates the use of supportive strategies such as rapport building, establishing buy-in, and communication to initiate care-related discussions with care dyads in the early stages that will help lead to more effective decision making in the future. Read more
Recruitment Challenges and Strategies Lessons Learned From an Early-Stage Dyadic Intervention An increasing number of family caregivers are seeking services and support due in large part to the dramatic increase in the number of older adults obtaining dementia diagnoses. This paper describes barriers and challenges experienced by our research team in recruiting early-stage dementia caregiving dyads into research studies. Effective recruitment and screening strategies to address these barriers are also discussed. Recruitment and enrollment success depends on these strategies as well as having well-trained recruitment staff who are knowledgeable about the study and have experience working with older adults, and more specifically, persons with dementia. 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
Improving Policies for Caregiver Respite Services This paper provides a template for the decade ahead regarding the delivery, supply, and funding of caregiver respite services. Policy changes are needed to address these issues as concerns about our country’s ability to meet future caregiving needs are growing along with our aging population. Federal initiatives and state-level policies and programs affecting respite are reviewed and directions for policy advancement are highlighted. Much more work is needed to educate caregivers and the general public about the necessity for respite beginning early in the caregiving career to prevent burnout and other adverse effects. Because it is unlikely that there will be a sufficient number of direct-care workers to replace unpaid caregivers, improved policies are needed to ensure that their situation is sustainable through increased availability of high-quality respite and other services vital to caregiver health and well-being. Among the 2015 White House Conference on Aging’s priorities in the next decade, policies on long-term services and supports will require focused attention on family caregivers and the direct-care workforce to strengthen their ability to give care now and support their own physical, emotional, and financial needs in the future. 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
Evidence-Based Program Replication Translational Activities, Experiences, and Challenges With a growing number of evidence-based programs, it is necessary to understand the translation activities, experiences, and challenges of program replication in a community setting. This article reviews the implementation tasks necessary for agencies to implement the Reducing Disability in Alzheimer’s Disease (RDAD) intervention. It presents the importance of using original evidence-based program protocols and enhancing them to best fit service settings by reviewing the translation and implementation activities of (a) selecting and training program and supervisory staff; (b) recruiting, screening, and consenting participants to enroll in the program; and (c) developing a manual to guide community-based program replication. Furthermore, the process revealed that the replication of an evidence-based program can take place within the realities of a community setting with input from program oversight, implementation, and evaluation staff and the original researcher. 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
