The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation

iSupport for rare dementias: a mixed-methods non-randomised feasibility study of an online self-help programme for carers

BACKGROUND

iSupport for dementia carers is an online education and self-care programme developed by the World Health Organisation for carers of people with the most common forms of dementia (Alzheimer's disease and vascular dementia). iSupport for rare dementias (RDC) is the first adaptation designed specifically to address the challenges faced by carers of individuals with rare dementias (frontotemporal dementia, posterior cortical atrophy, primary progressive aphasia or Lewy body dementia).

METHODS

A 12-week mixed-methods non-randomised feasibility study assessed the feasibility of recruitment and participant retention, the feasibility of outcome measures and the acceptability of iSupport RDC. Participants were recruited through the Rare Dementia Support Network (target N = 30). Data were collected through online interviews and self-report, including pre and post-intervention measures of depression, anxiety, burden and resilience. A modified version of the NoMAD questionnaire evaluated acceptability of implementation. Scores range from 0 to 4 with > / = 2.5 indicating acceptability. Usability was assessed through self-report and data from Blackboard.

RESULTS

Thirty-four (13 males and 21 females) carers of people with frontotemporal dementia, posterior cortical atrophy, primary progressive aphasia or Lewy body dementia consented to the study and given access to iSupport RDC, hosted online by Blackboard Learn. Their ethnicity was reported as white and their mean age was 64.2 (range 35-86). N = 24 completed pre and post outcome measures, N = 10 completed pre-intervention and then withdrew, n = 4 reporting technical difficulties (70.6% completion rate). There were no missing responses. N = 20 completed 3 of the 5 iSupport RDC modules; n = 13 completed five. N = 4 could not access due to technical difficulties. Technical difficulties meant the data from Blackboard Learn were not obtained. The NoMAD total score (3.5) indicated iSupport RDC was acceptable. Qualitative analysis from n = 19 participants revealed themes of 'technical difficulties' (n = 10), 'useful and informative' (n = 7), and 'provide at point of diagnosis' (n = 5).

CONCLUSIONS

Recruitment targets were met but there were limitations in sample diversity. The extent of attrition warrants strategies to ensure retention to future studies, including testing online interventions on different internet browsers and operating systems. The favourable response to iSupport RDC from the participants indicates its potential as a valuable resource for supporting carers dealing with rare dementias.

A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias

OBJECTIVES

Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program.

DESIGN

Pre-post interventional mixed methods study.

SETTING

Online videoconference group program for carers across the UK held in 2021.

PARTICIPANTS

Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators.

INTERVENTION

The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions.

MEASUREMENTS

We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2.

RESULTS

Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression.

CONCLUSION

The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.

How Do Care Partners of People with Rare Dementia Use Language in Online Peer Support Groups? A Quantitative Text Analysis Study

We used quantitative text analysis to examine conversations in a series of online support groups attended by care partners of people living with rare dementias (PLWRD). We used transcripts of 14 sessions (>100,000 words) to explore patterns of communication in trained facilitators' (n = 2) and participants' (n = 11) speech and to investigate the impact of session agenda on language use. We investigated the features of their communication via Poisson regression and a clustering algorithm. We also compared their speech with a natural speech corpus. We found that differences to natural speech emerged, notably in emotional tone (d = -3.2, p < 0.001) and cognitive processes (d = 2.8, p < 0.001). We observed further differences between facilitators and participants and between sessions based on agenda. The clustering algorithm categorised participants' contributions into three groups: sharing experience, self-reflection, and group processes. We discuss the findings in the context of Social Comparison Theory. We argue that dedicated online spaces have a positive impact on care partners in combatting isolation and stress via affiliation with peers. We then discuss the linguistic mechanisms by which social support was experienced in the group. The present paper has implications for any services seeking insight into how peer support is designed, delivered, and experienced by participants.

Recent research advances in young-onset dementia

PURPOSE OF REVIEW

Young-onset dementia (YOD) refers to a dementia for which symptom onset occurs below the age of 65. This review summarizes the recent literature in this area, focusing on updates in epidemiology, diagnosis and service provision.

RECENT FINDINGS

In the last year, internationally, the prevalence of YOD was reported as 119 per 100 000, but this may vary according to population types. Although the commonest causes of YOD are Alzheimer's disease (AD) and frontotemporal dementia (FTD), there is increasing recognition that YOD is diagnostically and phenotypically broader than AD and FTD. YOD may be due to many other diseases (e.g. Huntington's disease, vascular dementia) whereas accumulation of the same protein (e.g. amyloid protein) may lead to different phenotypes of Alzheimer's disease (such as posterior cortical atrophy and behavioural-variant/frontal-variant AD). This heterogeneity of phenotypic presentation is also seen in YOD due to known genetic mutations. Biomarkers such as plasma and cerebrospinal fluid proteins, neuroimaging and genetics have shown promise in the early identification of YOD as well as providing further understanding behind the overlap between psychiatric and neurodegenerative conditions occurring in younger people. The management of YOD needs to consider age-specific issues for younger people with dementia and their family networks together with better integration with other health services such as aged, disability and improved access to services and financial assistance.

SUMMARY

These findings emphasize the need for early identification and appropriate age-specific and person-centred management for people with young-onset dementia.