ABSTRACT
OBJECTIVE: The current study translated the Resources for Enhancing Alzheimer's Caregiver Health: Offering Useful Treatments (REACH OUT), a skills-building stress and burden intervention, for the primary care setting and pilot the resulting intervention. METHODS: The 16-week intervention consisted of a combination of clinic-based group and one-on-one sessions offered within a medical home, geriatrics clinic. A quasi-experimental pre- and post-test study design without a control group tested the resulting intervention. Semi-structured qualitative exit interviews evaluated program satisfaction. RESULTS: Twenty-five caregivers participated in one of four intervention groups; 21 caregivers completed the intervention (attended at least five of six group sessions). Caregiver burden on standardized assessments was significantly reduced between pre- and post-intervention, specifically for physical/emotional strain and caregiving uncertainty. Significant reductions were found in the frequency of reported disruptive behaviors; increased caregiver confidence in handling behavior problem frequency, depressive symptoms, disruptive behaviors, and memory-related problems; and decreased bother with respect to behavioral problem frequency and care recipient depression. Program satisfaction was high. CONCLUSION: This work suggests that the REACH OUT program can be successfully modified for use within a primary-care medical home setting.
Subject(s)
Alzheimer Disease , Caregivers , Alzheimer Disease/therapy , Humans , Pilot Projects , Primary Health Care , Program EvaluationABSTRACT
OBJECTIVES: Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. METHOD: Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. RESULTS: Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. CONCLUSION: Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.
Subject(s)
Anti-Anxiety Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Caregivers/statistics & numerical data , Dementia/drug therapy , Drug Prescriptions/statistics & numerical data , Independent Living/statistics & numerical data , Adult , Aged , Aged, 80 and over , Dementia/epidemiology , Female , Health Services Research , Humans , Male , Middle Aged , United States/epidemiologyABSTRACT
INTRODUCTION: Under the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3). METHODS: The Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system. RESULTS: The workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3. DISCUSSION: To advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan.
Subject(s)
Alzheimer Disease/epidemiology , Alzheimer Disease/therapy , Long-Term Care/methods , Biomedical Research , Humans , National Institutes of Health (U.S.)/standards , National Institutes of Health (U.S.)/trends , Public Policy , United States/epidemiologyABSTRACT
PURPOSE OF THE STUDY: To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. DESIGN AND METHODS: A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. RESULTS: Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. IMPLICATIONS: RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning.
Subject(s)
Caregivers/psychology , Community-Based Participatory Research , Memory , Palliative Care/psychology , Qualitative Research , Quality of Life , Volunteers/psychology , Aged , Female , Humans , Male , Motivation , Retrospective StudiesABSTRACT
OBJECTIVES: The current practice of prescribing psychotropic medication for the management of dementia-related behavioral disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. We hypothesized that caregiving burden and patient characteristics, particularly behavior disturbances and pain, would be positively associated with psychotropic medication use. METHODS: Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N = 598). Caregiver characteristics, such as confidence managing problematic behaviors, and care recipient characteristics including pain, problem behaviors, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. RESULTS: Contrary to our hypothesis, behavioral disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. CONCLUSION: These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community.
Subject(s)
Caregivers , Dementia/drug therapy , Independent Living , Psychotropic Drugs/therapeutic use , Aged , Caregivers/psychology , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
CONTEXT: Palliative care patients and their family caregivers may have a foreshortened perspective of the time left to live, or the expectation of the patient's death in the near future. Patients and caregivers may report distress in physical, psychological, or existential/spiritual realms. OBJECTIVES: To conduct a randomized controlled trial examining the effectiveness of retired senior volunteers (RSVs) in delivering a reminiscence and creative activity intervention aimed at alleviating palliative care patient and caregiver distress. METHODS: Of the 45 dyads that completed baseline assessments, 28 completed postintervention and 24 completed follow-up assessments. The intervention group received three home visits by RSVs; control group families received three supportive telephone calls by the research staff. Measures included symptom assessment and associated burden, depression, religiousness/spirituality, and meaning in life. RESULTS: Patients in the intervention group reported a significantly greater reduction in frequency of emotional symptoms (P=0.02) and emotional symptom bother (P=0.04) than the control group, as well as improved spiritual functioning. Family caregivers in the intervention group were more likely than control caregivers to endorse items on the Meaning of Life Scale (P=0.02). Only improvement in intervention patients' emotional symptom bother maintained at follow-up after discontinuing RSV contact (P=0.024). CONCLUSION: Delivery of the intervention by RSVs had a positive impact on palliative care patients' emotional symptoms and burden and caregivers' meaning in life. Meaningful prolonged engagement with palliative care patients and caregivers, possibly through alternative modes of treatment delivery such as continued RSV contact, may be necessary for maintenance of therapeutic effects.
Subject(s)
Caregivers/psychology , Occupational Diseases/prevention & control , Palliative Care/psychology , Psychotherapy, Group/methods , Social Support , Stress, Psychological/prevention & control , Volunteers , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Occupational Diseases/psychology , Stress, Psychological/psychology , Treatment OutcomeABSTRACT
OBJECTIVES: The purpose of this pilot study was to conduct limited-efficacy testing of the newly developed Preserving Identity and Planning for Advance Care (PIPAC) intervention on self-reported and proxy-reported emotional and health-related outcomes of individuals in the early stages of dementia. METHOD: A two-group comparison design was implemented. Blocked randomization was used to assign individuals with mild dementia and a family contact to either (1) the four-session, multi-component intervention group focused on reminiscence and future planning or (2) the minimal support phone contact comparison group. Of the 19 enrolled dyads, 18completed post-treatment assessments (i.e. 10 intervention and 8 comparison group). Individuals with dementia were M=82.8 (SD=6.46) years old; 31.6% were men and 68.4% were women. Participants were predominantly white/Caucasian (n=18, 94.7%) with one black/African-American (5.3%). RESULTS: Analyses of covariance controlling for baseline differences revealed clinically meaningful differences (with medium to large effect sizes) between groups at post-treatment for depressive symptoms, quality of life, health-related quality of life indicators, and decisional conflict. Individuals in the intervention group were also observed to exhibit higher levels of coping. Feasibility data collected from participants and interventionists were encouraging. CONCLUSION: Emotion-focused, patient-centered interventions like PIPAC hold promise for advancing treatment options in the early and mild stages of dementia. A full-scale, randomized clinical trial of this intervention is warranted to determine both short-term and long-term impacts on clinical outcomes including improved depressive symptomatology, quality of life, and health-related factors that impact daily functioning in social environments.
Subject(s)
Advance Care Planning , Dementia/psychology , Patient-Centered Care/methods , Psychotherapy/methods , Adaptation, Psychological/physiology , Aged , Aged, 80 and over , Dementia/therapy , Depression/psychology , Depression/therapy , Feasibility Studies , Female , Humans , Male , Pilot Projects , Quality of Life/psychology , Self Concept , Severity of Illness Index , Social Identification , Social Support , Stress, Psychological/psychology , Stress, Psychological/therapy , Treatment OutcomeABSTRACT
PURPOSE: Literature on institutionalization of patients with dementia has not considered the role of caregivers' quality of care, which encompasses caregivers' exemplary care (EC) behaviors and caregivers' potentially harmful behaviors (PHBs) toward care recipients. This study sought to understand the role of quality of care in mediating between caregiving stressors and caregiver desire to institutionalize (DTI) a patient with dementia. DESIGN AND METHODS: A sample of 612 family caregivers from diverse racial/ethnic backgrounds was drawn from the baseline data of the Resources for Enhancing Alzheimer's Caregiver Heath (REACH II) project. Multiple mediator models were run using Preacher and Hayes asymptotic and resampling strategies to assess direct and indirect effects of caregiver stressors (daily care bother, behavioral bother, and burden) on caregiver desire to institutionalize a patient with dementia. RESULTS: Overall, PHB was positively related to caregiver desire to institutionalize their care recipients. Specifically, PHB was found to mediate the relationship between caregiving stressors and DTI in the Caucasian and Latino groups, whereas only the mediation effect of EC was significant in the African American group. IMPLICATIONS: Caregivers' perceptions of quality of care helped explain their desire to institutionalize their care recipients with dementia. Including assessment of EC and PHB in clinical and social service settings is recommended for all ethnic groups. Interventions should facilitate EC behaviors among African American caregivers and address concerns of PHBs in Caucasian and Latino caregivers.
Subject(s)
Caregivers/psychology , Dementia/nursing , Family/psychology , Institutionalization , Quality of Health Care , Aged , Aged, 80 and over , Dementia/psychology , Ethnicity , Family/ethnology , Female , Forecasting , Health Services Needs and Demand , Homes for the Aged , Humans , Male , Middle Aged , Multivariate Analysis , Nursing Homes , Prohibitins , Stress, Psychological , ViolenceABSTRACT
PURPOSE: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs. DESIGN AND METHODS: We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes. RESULTS: Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity. IMPLICATIONS: Overall, CGs' perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care.
Subject(s)
Caregivers/psychology , Dementia/psychology , Ethnicity/psychology , Stress, Psychological/psychology , Activities of Daily Living/psychology , Adult , Aged , Aged, 80 and over , Depression/psychology , Factor Analysis, Statistical , Female , Health Status , Humans , Interviews as Topic , Male , Middle Aged , Psychological Tests , Stress, Psychological/ethnology , Young AdultABSTRACT
OBJECTIVE: The objectives of this study were to assess the dimensionality and reliability of a frequently used scale for predicting the desire to institutionalize among White, African American, and Hispanic caregivers of persons with dementia. METHOD: Exploratory factor analysis (EFA) and reliability analyses were performed on a slightly modified version of Morycz's (1985) Desire to Institutionalize (DTI) scale separately for each racial group using data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II study (Belle et al., 2006). RESULTS: The EFA revealed a one-factor structure that was equivalent across all racial groups. The scale demonstrated moderate reliability with KR-20 alpha of .694 for Whites, .742 for African Americans, and .767 for Hispanics. DISCUSSION: Findings suggest that Morycz's DTI scale is a consistently reliable measure for assessing the desire to institutionalize across White, African American, and Hispanic dementia caregivers.
Subject(s)
Black or African American/psychology , Ethnicity/psychology , Hispanic or Latino/psychology , Institutionalization/statistics & numerical data , White People/psychology , Adaptation, Psychological , Black or African American/statistics & numerical data , Aged , Aged, 80 and over , Dementia/epidemiology , Dementia/psychology , Depression/epidemiology , Depression/psychology , Factor Analysis, Statistical , Female , Health Status Indicators , Hispanic or Latino/statistics & numerical data , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Spain/epidemiology , Stress, Psychological , White People/statistics & numerical data , Young AdultABSTRACT
OBJECTIVE: We examined predictors of staff-reported need-driven behaviors and resistiveness to care in nursing home residents with dementia and predictors of certified nursing assistant (CNA) burden related to both constructs. Background and proximal factors from the need-driven dementia-compromised behavior model [Algase, D.L., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., et al. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer's Disease, 5, 10-19] were examined as potential predictors of need-driven behaviors (NDBs) and resistiveness to care and CNA burden. METHOD: We used secondary data analysis of prospective data from 10 nursing homes in Birmingham, Alabama. One-hundred and sixty-one residents (83.43 +/- 8.56 years) with mini mental state examination (MMSE) score = 6.41 (+/- 6.66) were assessed via chart review, resident surveys, and surveys of CNAs. RESULTS: Multiple regression models revealed that cognitive functioning, activities of daily living functioning, race, gender, and CNA-reported weekly resident pain intensity were associated with resident NDBs. Regression models also revealed that weekly pain intensity and medical comorbidity were associated with CNA burden associated with the resident NDBs. However, we were unable to explain a significant amount of variance in the resistiveness to care or CNA burden associated with resistiveness to care. DISCUSSION: Results underscore the role of pain in both resident NDBs and associated CNA burden. Future research should focus on predictors of resident resistiveness to care and the relation of pain assessment and management practices to CNA burden. Moreover, interventions to improve resident care should seek to include CNAs in institutional pain assessment and management processes.
Subject(s)
Allied Health Personnel , Dementia/psychology , Dementia/therapy , Nursing Homes , Patient Acceptance of Health Care/psychology , Activities of Daily Living , Aged , Aged, 80 and over , Alabama , Cognition , Cost of Illness , Female , Goals , Humans , Male , Mental Status Schedule , Nursing Staff , Pain , Prospective Studies , Psychomotor Agitation , Social Behavior Disorders , WorkforceABSTRACT
In this article the author first attempts to disentangle a number of issues in translational science from a social science perspective. As expected in a fledgling field of study being approached from various disciplines, there are marked differences in the research literature on terminology, definition of terms, and conceptualization of staging of clinical research from the pilot phase to widespread dissemination in the community. The author asserts that translational efforts in the social sciences are at a crossroads, and its greatest challenge involves the movement of interventions gleaned from clinical trials to community settings. Four strategies for reaching this goal are discussed: the use of methods derived from health services research, a yet-to-be-developed strategy where decisions to modify aspects of an intervention derived from a clinical trial are triggered by data-based criteria, community based participatory action research (CBPR), and a hybrid system wherein methods from CBPR and traditional experimental procedures are combined to achieve translation. The author ends on an optimistic note, emphasizing the impressive advances in the area over the existing barriers and calling for a unified interdisciplinary science of translation.
Subject(s)
Clinical Trials as Topic , Community-Based Participatory Research , Interdisciplinary Communication , Social Sciences , Translational Research, Biomedical , Humans , Terminology as TopicABSTRACT
OBJECTIVES: To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN: Randomized, multisite clinical trial. SETTING: CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS: Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION: CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period. MEASUREMENTS: The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS: After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION: A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.
Subject(s)
Alzheimer Disease/therapy , Caregivers , Family Health , Aged , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: It is currently estimated that the resident population of individuals over the age of 65 living in nursing homes will double by 2020. Nearly one-third of all nursing home residents have difficulty seeing or hearing, 46% have some form of dementia, and 30-84% of those with dementia in nursing homes show some form of agitation. Nursing home residents who do not receive appropriate audiological services may experience social isolation, cognitive decline and decreased mobility. PURPOSE: To examine the effectiveness of standard audiological testing procedures for nursing home residents and to discuss the purpose of adapting assessment procedures that can lead to more effective audiological assessments for this population. RESEARCH DESIGN: A retrospective chart analyses. A 33-item coding form was used to complete descriptive analysis of original audiological data and demographic data for 307 nursing home residents for a study to examine the effects of auditory stimulation on dementia-related behavior problems exhibited by nursing home residents through audiotape exposure to environmental sounds or soothing voice. RESULTS: Although 77% (n = 235) of the 307 residents were considered compliant for the testing process and 74% (n = 288) tolerated putting on headphones, audiological assessment using air conduction testing could be completed in both ears on 32% (n = 100) of the residents. In fact, only 5% (n = 16) of the 307 residents were able to complete a full traditional audiometric assessment protocol. CONCLUSIONS: Proper identification of hearing impairment through effective and appropriate audiological assessment is crucial for preserving and enhancing quality-of-life in nursing home residents. This study served as an introduction to the problem of using traditional behavioral testing for hearing assessment of nursing home residents. Much work needs to be done to establish best practices for audiometric assessment in this population.
Subject(s)
Dementia/epidemiology , Geriatric Assessment/methods , Hearing Loss/epidemiology , Hearing Tests/methods , Nursing Homes/statistics & numerical data , Aged , Aged, 80 and over , Comorbidity , Dementia/diagnosis , Female , Hearing Loss/diagnosis , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Retrospective StudiesABSTRACT
OBJECTIVES: To develop and validate a brief screening measure for use in research, healthcare, and community settings to systematically assess well-being and identify needed areas of support for caregivers of patients with dementia. DESIGN: This study used data from Resources for Enhancing Alzheimer's Caregiver Health (REACH II), a multisite randomized clinical trial of a behavioral intervention designed to improve the quality of life of caregivers in multiple domains. SETTING: REACH II. PARTICIPANTS: Two hundred twelve Hispanic, 211 black, and 219 white family caregivers providing in-home care to patients with dementia. MEASUREMENT: Based on conceptual and psychometric analyses, a 16-item measure was developed that assesses six domains linked to caregiver risk and amenable to intervention: depression, burden, self-care and health behaviors, social support, safety, and patient problem behaviors. The reliability and validity of the instrument was evaluated with 642 dementia caregiver dyads from the REACH II program. RESULTS: The measure was found to have acceptable internal consistency for a multidimensional scale and similar measurement properties for each of the racial and ethnic groups. Concurrent validity was also demonstrated for the measure. CONCLUSION: The REACH Risk Appraisal Measure developed in this study shows promise as an assessment tool that can be used in research, clinical, and community settings to guide, prioritize, and target needed areas of support for caregivers of patients with dementia.
Subject(s)
Alzheimer Disease/nursing , Caregivers/psychology , Social Support , Aged , Female , Health Status Indicators , Humans , Male , Middle Aged , Quality of Life , Risk FactorsABSTRACT
PURPOSE: The aim of this study was to translate the evidence-based Resources for Enhancing Alzheimer's Caregiver Health (REACH) II intervention for use in 4 Area Agencies on Aging (AAAs). A secondary aim was to examine possible moderators of treatment outcome. DESIGN AND METHODS: We used a quasi-experimental pre-post treatment design with no control group. A partnership was formed between the Alabama Department of Senior Services and the University of Alabama. The partnership trimmed the REACH II intervention used in the clinical trial for feasible use in a social service agency. The condensed REACH intervention, termed REACH OUT, was delivered to 272 dementia caregivers during 4 home visits and 3 phone calls for a period of 4 months. The assessment examined pre-post treatment effects on a number of outcomes, including care recipient risk, mood, memory, and behavior problems; caregiver stress and emotional well-being; caregiver health; and program satisfaction. All aspects of the program except for training, periodic consultation, and data analysis were controlled by the AAA staff. RESULTS: Analyses were conducted on the 236 dyads that completed at least 3 of the 4 planned sessions. Significant positive pre-post effects were found on caregiver subjective burden, social support, caregiver frustration, depression, caregiver health, care recipient behavior problems and mood, and 2 of 4 care recipient risk behaviors. Site of intervention and certain participant characteristics (e.g., caregiver relationship) moderated several pre-post differences. A caregiver survey and interventionist focus group reported high acceptability of the program IMPLICATIONS: This project suggests that the REACH II intervention can be modified for feasible and effective use in AAAs. The next step is to integrate the intervention into usual service delivery to achieve sustainability.
Subject(s)
Caregivers , Community-Institutional Relations , Diffusion of Innovation , Social Support , Adult , Aged , Aged, 80 and over , Alabama , Caregivers/psychology , Dementia , Evidence-Based Practice , Female , Focus Groups , Humans , Male , Middle Aged , Surveys and Questionnaires , Universities , Young AdultABSTRACT
PURPOSE: The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990) in a racially diverse sample of Alzheimer's caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. SAMPLE: Participants included White or Caucasian (n = 212), Black or African American (n = 201), and Hispanic or Latino (n = 196) Alzheimer's CGs from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial. RESULTS: SEM revealed that the Pearlin model obtains a satisfactory fit across race or ethnicity in the REACH II data, despite significant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. IMPLICATIONS: Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefit for individuals of different cultural or ethnic backgrounds.
Subject(s)
Alzheimer Disease/psychology , Caregivers/psychology , Models, Theoretical , Stress, Psychological/ethnology , Alzheimer Disease/ethnology , Female , Humans , Male , Racial Groups , Stress, Psychological/etiologyABSTRACT
The authors examined perceived income inadequacy as a predictor of self-reported depressive symptomatology and anxiety in the original sites of the Resources for Enhancing Alzheimer's Caregiver Health I project. Perceived income inadequacy, self-reported household income, and control factors (e.g., subjective health) were entered into hierarchical regression analyses predicting psychological distress. Findings suggest that perceived income inadequacy and not household income significantly predicted more self-reported depressive symptomatology and greater self-reported anxiety. This supports previous findings that objective income measures alone are not adequate indicators of socioeconomic status in older adults.
Subject(s)
Alzheimer Disease/psychology , Anxiety Disorders/psychology , Caregivers/psychology , Cost of Illness , Depressive Disorder/psychology , Income , Poverty/psychology , Activities of Daily Living/psychology , Adaptation, Psychological , Aged , Anxiety Disorders/diagnosis , Depressive Disorder/diagnosis , Female , Humans , Male , Mental Status Schedule , Middle Aged , Quality of Life/psychology , Socioeconomic FactorsABSTRACT
Objective. This study explored how male and female family caregivers of Alzheimer's disease (AD) patients differ in their use of formal services and informal support and how religiousness may affect such differences. Methods. Data were from a sample of 720 family caregivers of AD patients who participated in the Resources for Enhancing Alzheimer's Caregiver Heath (REACH I) study sites in Birmingham, Boston, Memphis, and Philadelphia. Results. Female caregivers were less likely to use in-home services than males (M = 0.83 vs. M = 1.06, p < .01) but reported more use of transportation services (21.6% vs. 12.7%, p < .01) and more use of informal support (M = 13.9 vs. M = 10.7, p < .01). Mediation tests suggested that three measures of religiousness helped explain the relationship between gender and use of formal services and informal support. Discussion. These findings highlight the necessity to assess AD caregivers' religiousness to better understand their circumstances.
Subject(s)
Alzheimer Disease , Caregivers , Home Care Services/statistics & numerical data , Religion , Social Support , Female , Humans , Male , Sex Factors , SocializationABSTRACT
Previous studies have suggested that 4 latent constructs (depressed affect, well-being, interpersonal problems, somatic symptoms) underlie the item responses on the Center for Epidemiological Studies Depression (CES-D) Scale. This instrument has been widely used in dementia caregiving research, but the fit of this multifactor model and the explanatory contributions of multifactor models have not been sufficiently examined for caregiving samples. The authors subjected CES-D data (N = 1,183) from the initial Resources for Enhancing Alzheimer's Caregiver Health Study to confirmatory factor analysis methods and found that the 4-factor model provided excellent fit to the observed data. Invariance analyses suggested only minimal item-loading differences across race subgroups and supported the validity of race comparisons on the latent factors. Significant race differences were found on 3 of the 4 latent factors both before and after controlling for demographic covariates. African Americans reported less depressed affect and better well-being than White caregivers, who reported better well-being and fewer interpersonal problems than Hispanic caregivers. These findings clarify and extend previous studies of race differences in depression among diverse samples of dementia caregivers.