Technology and Caregiving: Emerging Interventions and Directions for Research.

An array of technology-based interventions has increasingly become available to support family caregivers, primarily focusing on health and well-being, social isolation, financial, and psychological support. More recently the emergence of new technologies such as mobile and cloud, robotics, connected sensors, virtual/augmented/mixed reality, voice, and the evermore ubiquitous tools supported by advanced data analytics, coupled with the integration of multiple technologies through platform solutions, have opened a new era of technology-enabled interventions that can empower and support family caregivers. This paper proposes a conceptual framework for identifying and addressing the challenges that may need to be overcome to effectively apply technology-enabled solutions for family caregivers. The paper identifies a number of challenges that either moderate or mediate the full use of technologies for the benefit of caregivers. The challenges include issues related to equity, inclusion, and access; ethical concerns related to privacy and security; political and regulatory factors affecting interoperability and lack of standards; inclusive/human-centric design and issues; and inherent economic and distribution channel difficulties. The paper concludes with a summary of research questions and issues that form a framework for global research priorities.

Efficacy of behavioral interventions for dementia caregivers.

Behavioral symptoms of Alzheimer's disease, particularly agitation, appear to be a major contributing factor to the emotional distress exhibited by family caregivers. Psychosocial interventions have been shown to reduce caregiver emotional distress, but few studies have examined the efficacy of these interventions with caregivers exposed to high levels of dementia-related behavioral symptoms. The purpose of this study is to test the efficacy of a caregiver skill building intervention in reducing emotional distress to agitated behaviors of care recipients. This study analyzed data from a subgroup of caregivers who participated in a larger randomized clinical trial (N = 295). Data from 143 caregivers of family members with baseline agitated behaviors indicate that the skill building intervention was more effective than an information and support oriented comparison condition in reducing emotional distress over an 18-month period. These findings indicate that dementia caregivers exposed to agitated behaviors can benefit from psychosocial interventions, particularly those aimed at building behavioral management skills.

Caring for self while caring for others: the two-track life of coping with Alzheimer's disease.

Relationships between depressive symptoms and altered immune function have been documented in the literature; however, the links between depressive symptoms, altered immune function, and changes in physical health are less clear. Although a number of caregiver descriptive studies have examined immunological outcomes, only one intervention study with caregivers of individuals with Alzheimer's disease, known to the authors, has included immunological outcomes. The purpose of this pilot study was to assess the effectiveness of a caregiver skill-building intervention to decrease caregiver depressive symptomatology and care-receiver behavioral symptoms; and to assess the feasibility and stability of the delayed type hypersensitivity (DTH) skin test with this population. Caregiver depressive symptoms decreased, while care-receiver behaviors did not. Findings suggested that the DTH skin test could be successfully administered to caregivers of individuals with Alzheimer's disease and that this skin test had short-term stability. There were no significant relationships between caregiver depressive symptoms and immune function. Study findings suggest that nurses can play a pivotal role in intervening with family caregivers and potentially decreasing their depressive symptoms.

Promoting a good death for persons with dementia in nursing facilities: family caregivers' perspectives.

The experience of dying from Alzheimer's disease (AD) in a nursing home setting is a poorly understood phenomenon. Fifty-seven family member caregivers of persons with Alzheimer's disease, who had died as a resident in a national nursing home chain, participated in a structured telephone interview. Despite the belief that their loved one had died with dignity, 16 out of 57 (28%) family member caregivers believed that their loved one had not experienced a good death. This article reviews the definition of a good death and the six themes of a good death found in the literature: pain and symptom management; clear decision making; preparation for death; completion; contributing to others; and affirmation of the whole person. Five standards for evaluating the quality of an anticipated death are discussed in relation to the experiences of the persons with AD. Finally, recommendations for how nurse administrators and other members of the healthcare team can promote a positive death experience for a person with AD are proposed.