The Savvy Caregiver program: the demonstrated effectiveness of a transportable dementia caregiver psychoeducation program.

This article is about the trial of a transportable psychoeducation program for family caregivers of older adults with Alzheimer's disease and other dementias that was based on a program developed and previously tested in an academic setting. Family caregivers were recruited by agencies in three states and invited to participate in a randomized trial of this six-session program. Questionnaires were administered prior to randomization and again 5 to 6 months later to assess program effect. A total of 52 caregivers completed both questionnaires (22 were in the wait-list control group). Experimental participants' scores on measures of mastery and distress were significantly better than control participants' scores at follow-up (Time 2 Results for this transported program showed benefits to caregivers com parable to those in the previous trials. The program demonstrated that it could be offered in a variety of settings and that it had benefit for caregivers.

Self-administered screening for mild cognitive impairment: initial validation of a computerized test battery.

The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI), a computer administered, scored, and interpreted touch screen battery was evaluated for its ability to detect mild cognitive impairment. Subjects were three hundred ten community-dwelling elders who enrolled in an National Institute on Aging (NIA)-funded study. One-month test-retest reliability correlations were all significant (p<0.05-p<0.001). Concurrent validity correlations were all significant (p<0.001). A high level of diagnostic validity was attained relative to the Weschler Memory Scale-Revised (WMS-R) LMS-II test (p<0.001). Confirmatory factor analysis supported a three-factor model indicating the tests measure the intended cognitive dimensions of memory, language/spatial fluency, and executive function/mental control. Goodness-of-fit indicators were strong (Bentler Comparative Fit Index=0.99; Root Mean Square Error of Approximation=0.055). Initial validation analyses indicate that the CANS-MCI shows promise of being a reliable, valid screening tool in determining whether more intensive testing for early cognitive impairment is warranted.

Family caregiver satisfaction with the nursing home after placement of a relative with dementia.

OBJECTIVE: This article examines family caregiver satisfaction after nursing home placement of a relative with Alzheimer disease or a related dementia. Determining what contributes to family caregiver satisfaction is a critical step toward implementing effective quality improvement strategies. METHODS: A stress process model is used to study caregiver satisfaction among 285 family caregivers in relation to primary objective stressors (stage of dementia, length of stay, length of time in caregiving role, visitation frequency, involvement in nursing home, and involvement in hands-on care), subjective stressors (expectations for care), caregiver characteristics (education, marital status, familial relationship, workforce participation, distance from nursing home, and age), and organizational resources (rural/urban location, profit/nonprofit ownership, special care unit [SCU] designation, and custodial unit designation). SAS PROC MIXED is used in a multilevel analysis. RESULTS: Higher satisfaction is associated with earlier stage of dementia, greater length of time involved in caregiving prior to institutionalization, higher visitation frequency, less involvement in hands-on care, greater expectations for care, and less workforce participation. DISCUSSION: Multilevel analysis showed that primary stressors are the strongest predictors of satisfaction. Only one caregiver characteristic (work participation) and one organizational resource (rural/urban location) predict satisfaction. SCU designation was unrelated to satisfaction, perhaps because SCUs have less to offer residents in more advanced as opposed to earlier stages of Alzheimer disease. If family satisfaction is to be achieved, family presence in a nursing home needs to give caregivers a sense of positive involvement and influence over the care of their relative.

Community residential care: comparison of cognitively impaired and noncognitively impaired residents.

Community residential care (CRC) is growing, with cognitive impairment the most common reason for CRC placement. We enrolled cognitively impaired and noncognitively impaired residents, informal caregivers, and providers in 219 CRC facilities for this study. Residents with cognitive impairment were older (p < .001), needed more activities of daily living (ADL) assistance (p < .001), and had a higher frequency of behavior problems (p < .001) than noncognitively impaired residents. Cognitively impaired and noncognitively impaired residents did not significantly differ in the facility-related factors they perceived as important or in the amount of control they felt they had over the decision to move. Including residents with cognitive impairment in future research and separately analyzing residents by cognitive status will give a more accurate picture of the needs of CRC residents.

Resident outcomes of Medicaid-funded community residential care.

PURPOSE: Washington State's initiatives to increase the availability and quality of community residential care presented an opportunity to describe clients entering adult family homes, adult residential care, and assisted living and to identify outcomes of care. DESIGN AND METHODS: We enrolled 349 residents, 243 informal caregivers, and 299 providers in 219 settings. We conducted interviews at enrollment and 12 months later, and we collected data from state databases. RESULTS: The average resident was a 78 year old woman reporting dependence in two of six activities of daily living. Residents in adult family homes demonstrated significantly more disability. Seventy-eight percent of residents survived at the 12-month follow-up. In analyses that controlled for differences at enrollment, residents in the three types of settings were very similar in health outcomes at follow-up. IMPLICATIONS: State policies should reflect the wide range of needs of residents seeking care in these settings. Choices among type of setting can be based on the match of needs to individual preferences.

Potentially inappropriate medication use in community residential care facilities.

OBJECTIVE: To describe the prevalence of potentially inappropriate medication use in community residential care (CRC) facilities at baseline, describe exposure to potentially inappropriate drugs during the 1-year follow-up, and examine characteristics associated with potentially inappropriate use. DESIGN: A cohort study was conducted using 282 individuals aged >/=65 years entering a CRC facility in a 3-county area in the Puget Sound region of Washington State between April 1998 and December 1998 on Medicaid funding. MAIN OUTCOME MEASURE: Use of potentially inappropriate medications as defined by explicit criteria (e.g., drugs that should generally be avoided in the elderly because potential risks outweigh any potential benefits). RESULTS: Sixty-two (22%) residents took a total of 75 potentially inappropriate medications at baseline. The most common agents used at baseline were oxybutynin (3.5%) and amitriptyline (3.5%). The incidence of new use of potentially inappropriate medications was 0.1/100 person-days during the follow-up period. Potentially inappropriate use was related to self-reported fair or poor health (adjusted OR 1.42; 95% CI 1.05 to 1.92) and number of prescription drugs (adjusted OR 1.12; 95% CI 1.05 to 1.19). In the Cox proportional hazard model, no characteristics predicted new potentially inappropriate medication use during the follow-up. CONCLUSIONS: Potentially inappropriate medication use is common among residents in CRC facilities. A comprehensive periodic review may be beneficial for reducing potentially inappropriate use, especially for patients taking multiple drugs.

The savvy caregiver program: developing and testing a transportable dementia family caregiver training program.

PURPOSE: This article reports on the development and field testing of the Savvy Caregiver Program, the transformation of a successful, academic-based caregiver psychoeducational program into a self-contained program that can be adopted in other locations. DESIGN AND METHODS: Program development began with a prototype of a 12-hr course with the aims of introducing family caregivers to the caregiving role, providing them with the knowledge, skills, and attitudes needed to carry out that role, and alerting them to self-care issues. Results from initial field trials dictated a substantial revision of the workshop materials. The next version was field tested in multiple sites in southern rural Minnesota, Colorado, and Alaska. In this expanded testing, participants evaluated the program, and cross-group comparisons were conducted by use of well-established caregiver well-being scales. RESULTS: Virtually all respondents reported increased skill, knowledge, and confidence, and all would recommend the program to others. A preintervention versus postintervention analysis indicates that caregivers' reaction to the overall behavior of the persons for whom they provide care (i.e., "total reaction"), their self-reported burden, and their beliefs about caregiving (emotional enmeshment) changed significantly in directions indicating better caregiver well-being. IMPLICATIONS: Results suggest that it is feasible to translate a research-based caregiver intervention into a packaged program that can be adopted in other settings without the direct involvement of the program initiators.

Discourse-derived perspectives: differentiating among spouses' experiences of caregiving.

A method of constant comparative analysis was used to code open-ended interviews with 132 spouse caregivers regarding their experiences in caregiving. Results of this analysis yielded 69 qualitative code categories. We used these categories to compare the caregivers on several groupings that the literature has identified as providing meaningful ways to differentiate among caregivers. We used the qualitative responses to compare the caregivers by caregiver gender care-recipient dementia severity, and duration of caregiving. Results partly confirmed previous findings that wife caregivers are more distressed than husbands, but the results also indicated these caregivers were more similar than dissimilar The other analyses likewise indicated greater similarities than dissimilarities in the caregiving experience. We next continued the analysis and, using the coding categories as a springboard, identified four distinct patterns for construction of the meaning of the caregiving experience in the caregivers' discourse. These discourse-derived framing categories, applicable in about three-quarters of the caregivers, offered other ways to distinguish among caregivers. Further analysis of these robust groupings' showed important differences among the groups. These framing categories suggest ways to differentiate among caregivers, based on their perception of their role in the caregiving situation, ways that might point the way to intervention strategies for each of the groupings.

Burden among family caregivers of persons with Alzheimer's disease in nursing homes.

PURPOSE: This article examines family caregiver burden after placement of a relative with Alzheimer's disease or a related dementia in a nursing home. DESIGN AND METHODS: A systems-oriented contextual approach was used to study burden in 276 family caregivers. RESULTS: SAS PROC MIXED analysis showed burden to be associated with caregiver age, length of time involved in caregiving, custodial units, involvement in hands-on care, and expectations for care. IMPLICATIONS: The findings suggest that more services aimed at relieving caregiver burden after nursing home placement may be warranted, particularly so for caregivers who are older and for those who had a shorter length of involvement in direct caregiving before institutionalization.