Caregiver Preparedness: A Therapeutic Mechanism and Moderating Factor on Outcomes for the Savvy Caregiver Program

OBJECTIVES

Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits.

METHODS

The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form.

RESULTS

A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F(1) = 6.68, p=.012, partial η2=.10), depressive symptom endorsement, (F(1) = 6.41, p=.014, partial η2=.09, and anticipatory grief, (F(1) = 6.22, p=.02, partial η2=.1), post-treatment.

CONCLUSIONS

Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions.

CLINICAL IMPLICATIONS

Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC.

Relationship Between Cannabis Use and Immediate, Delayed, and Working Memory Performance Among Older Adults

Cannabis is increasingly accessible and use is increasing rapidly among older adults as laws change and cannabis becomes more frequently prescribed in healthcare settings. Past research identified cognitive effects of cannabis use among adolescents and young adults that can persist for several weeks after intoxication, though little is known about how these effects generalize to older adults. Participants (N = 1348) were drawn from the Health and Retirement Study (HRS) and were categorized as current occasional users (up to once/week in the past year, n = 36), current frequent users (once per week or more in the past year, n = 92), past users (n = 334), and non-users (n = 886). Participant ages ranged from 50 to 98 (M = 67.25, SD = 10.68). Uncontrolled, one-way ANOVAs and controlled ANCOVAs were used to examine between-group differences on immediate and delayed wordlist memory and working memory (serial sevens). When controlling for age, gender, education, and minority status, current frequent users demonstrated significantly worse immediate memory performance compared to past and non-users. However, this difference could have been the result of acute, residual effects of past-month cannabis use among current users. In controlled analyses, there were no differences between groups on delayed or working memory. Findings indicate that greater than weekly cannabis use may result in attentional and short-term memory deficits. Further, these effects may be mitigated by sustained abstinence. Limitations including sample size and measures of cannabis use warrant future studies to replicate and build upon these findings.

Loss-of-Control-Eating Mediates the Relationship between Cannabis-Related Problems and Eating Pathology

The prevalence of eating pathology among college students has increased significantly in recent years. This coincides with increases in the use of cannabis, both nationally, but also among college students. Problematic cannabis use has been linked to eating pathology in prior research. Research also shows that cannabis may affect appetitive drives linked to food consumption. The current study tested the hypothesis that the association between problem cannabis use and eating pathology was mediated by greater loss of control eating. Cross-sectional data were collected from a sample of 805 college student cannabis users at a large Southeastern university in the U.S. The sample were primarily Caucasian (76%) and female (65.22%) with an average age of 20.15 (SD = 3.91). Participants completed surveys assessing eating outcomes (loss of control eating and eating pathology), cannabis use, and cannabis-related problems. The analysis used an observed variable path model. After controlling for cannabis use, cannabis-related problems were indirectly linked to eating pathology via loss of control eating (B = 0.109, SE = 0.025, p < .001), supporting the primary hypothesis. The direct relationship between cannabis-related problems and eating pathology was fully accounted for (B = 0.010, SE = 0.028, p = .724) by the indirect effect of loss of control eating. These data suggest that the association between problematic forms of cannabis use and eating pathology may be due to the association between cannabis problems and loss of control eating. While this may be due to changes in appetite and food evaluation as a function of more problematic use patterns, it may also be that individuals with problematic cannabis use have more problematic eating patterns due to deficits in adaptive coping strategies. Future research should seek to parse out these different potential explanations.

Viz.ai Implementation of Stroke Augmented Intelligence and Communications Platform to Improve Indicators and Outcomes for a Comprehensive Stroke Center and Network

BACKGROUND AND PURPOSE

Comprehensive stroke centers continually strive to narrow neurointerventional time metrics. Although process improvements have been put in place to streamline workflows, complex pathways, disparate imaging locations, and fragmented communications all highlight the need for continued improvement.

MATERIALS AND METHODS

This Quality Improvement Initiative (VISIION) was implemented to assess our transition to the Viz.ai platform for immediate image review and centralized communication and their effect on key performance indicators in our comprehensive stroke center. We compared periods before and following deployment. Sequential patients having undergone stroke thrombectomy were included. Both direct arriving large-vessel occlusion and Brain Emergency Management Initiative telemedicine transfer large-vessel occlusion cases were assessed as were subgroups of OnHours and OffHours. Text messaging thread counts were compared between time periods to assess communications. Mann-Whitney U and Student t tests were used.

RESULTS

Eighty-two neurointerventional cases were analyzed pre vs. post time periods: (DALVO-OnHours 7 versus 7, DALVO-OffHours 10 versus 5, BEMI-OnHours 13 versus 6, BEMI-OffHours 17 versus 17). DALVO-OffHours had a 39% door-to-groin reduction (157 versus 95 minutes, P = .009). DALVO-All showed a 32% reduction (127 versus 86 minutes, P = .006). BEMI-All improved 33% (42 versus 28 minutes, P = .036). Text messaging thread counts improved 30% (39 versus 27, P = .04).

CONCLUSIONS

There was an immediate improvement following Viz.ai implementation for both direct arriving and telemedicine transfer thrombectomy cases. In the greatest opportunity subset (direct arriving large-vessel occlusion-OffHours: direct arriving cases requiring team mobilization off-hours), we noted a 39% improvement. With Viz.ai, we noted that immediate access to images and streamlined communications improved door-to-groin time metrics for thrombectomy. These results have implications for future care processes and can be a model for centers striving to optimize workflow and improve thrombectomy timeliness.

AN EXAMINATION OF ADVANCED CARE PLANNING IN BLACK AMERICANS: DIRECTION TO IMPROVE ENGAGEMENT

Past studies have found that older Black Americans are less likely to establish advance care directives (ACDs) than their White age peers, and medical distrust has been identified as one possible cause. Others have suggested the formulaic approach of ACD documentation which may conflict with the spiritual and cultural nature of these decisions. The Five Wishes ACD was developed partially to address this need. This study seeks to 1) replicate past findings regarding race and ACD adoption, and test the hypotheses that 2) Race will differentially predict Advanced Care Planning (ACP) engagement scores between conditions (Five Wishes vs State Directive), and 3) level of trust in physicians will relate to ACP engagement. The sample (N = 186) was recruited from Amazon Mechanical Turk and Prolific. Participants ranged from 50 to 77 years, were predominantly female (56.8%), White (51.61%), married (52.6%), and college-educated (70 .6%). ANCOVA results were a nonsignificant main effect of ACP engagement by race (F(1, 185) = 1.93, p = .166) and nonsignificant interaction of race by condition (F(1, 185) = 0.16, p < .69). Trust in physician scale scores predicted ACP engagement (F(1, 185) = 16.15, p < .001). The lack of an effect of race on ACP utilization may be explained by educational and SES characteristics of the sample by contrast to prior studies. The Five Wishes and State Directive ACD documents resulted in similar ACD engagement. These results suggest that trust in physicians is a primary barrier to ACP utilization.

PERCEIVED FINANCIAL VULNERABILITY, WEALTH, AND WEALTH CHANGE: THE HEALTH AND RETIREMENT STUDY

Financial vulnerability among older adults is an escalating social concern given all too frequent financial exploitation of this population. The 6-item Perceived Financial Vulnerability (PFV) was derived from the 56-item Lichtenberg Financial Decision Rating Scale to examine awareness and psychological vulnerability regarding finances. It was included as an experimental module in the Health and Retirement Study (HRS) in 2018. Prior findings have identified significant associations of PFV with wealth, demographics, and health status. The goals of the current study were to examine the relationship between wealth, changes in wealth, and perceived financial vulnerability. The sample included 1156 respondents to the HRS. Respondents were 57.5% female and 77.2% Caucasian. Average age was 68.28 (SD = 10.74) and average years of education was 13.11 (SD = 2.88). The PFV demonstrated adequate internal consistency (α = .60). Total assets at baseline (2016) and change in total assets over two waves (2016 to 2018) were independently stratified into deciles and used as primary predictors of perceived financial vulnerability in 2018. A multiple linear regression model was conducted to examine these relationships. Consistent with previous findings, demographics (R2=0.04, F(5,1150)=10.07, p < .001) and baseline wealth (B= -0.20, SE=0.02, p < .001) predicted PFV scores. Subsequent addition of wealth change (B=-0.06, SE=0.02, p=.002) significantly contributed to overall variance accounted for (p < .01). Negative wealth change over two years and low baseline wealth related to higher PFV. These findings support the construct and the PFV measure as valid and informative.

WORKING MEMORY MODERATES DEPRESSIVE SYMPTOMS AFTER PARTNER MORTALITY: HEALTH AND RETIREMENT STUDY

Grief is conceptualized as a process after which the individual becomes better adapted to changed living conditions after a loss. The Selection, Optimization, and Compensation with Emotion Regulation (SOC-ER) model posits that working memory may be necessary for mitigation and resolution of grief. This study examined the hypothesis that working memory facilitates successful grieving following the loss of an intimate partner. Participants include 3,599 respondents of the longitudinal Health and Retirement Study (HRS) who experienced spousal mortality between 1994 and 2014. Working memory was measured assessed using Serial 7’s, and depressive symptoms were assessed using the 8-question CES-D. Latent-growth models were used to estimate rate of change in depressive symptoms up to loss-of-spouse (baseline event), and then subsequent to that loss. Missing data were handled using full-information maximum likelihood. Sample participants had an average age 78.04 (SD = 7.32) at the time of their spouse’s death and were disproportionately female (69.10%), White/Caucasian (82.30%), non-Hispanic (92.37%), and completed an average of 11.61 (SD = 3.42) years of education. The hypothesized level 2 model fit the data very well: χ2(56)=61.323, p=.29 RMSEA=0.005 [0.000 0.012]; CFI=0.998, SRMR=0.028. Initial depressive symptom endorsement was significantly related to working memory ability. Working memory also moderated the relationship between depressive symptom endorsement and time, where individuals with better working memory tended to report lower depressive symptoms and demonstrated a lesser increase in depressive symptoms. In conclusion, working memory may be one determinant of successful bereavement. Findings support application of the SOC-ER model to the study of grief.

Quality of relationship between adult children caregivers and parents with dementia