Duet playing in dementia care: a new therapeutic music technology

PURPOSE

Supporting the relational worlds of people living with dementia, especially the spousal dyad, is a growing focus in dementia care as is advancing the therapeutic use of music in dementia care. This paper describes a mixed-methods, multi-phase, iterative research study designed to develop the Music Memory Makers (MMM) Duet System, a novel therapeutic music technology, that allows non-musicians to play a personalized repertoire of songs arranged as duets.

METHODS

Following a pilot phase to iteratively assess and refine the MMM Duet System for recreational and therapeutic purposes, multiple sources of data were used to investigate five older spousal dyads' experiences with the system, two couples living with dementia and three who were not. We assessed perceptions of task difficulty, joint agency, and enjoyment as well as therapeutic benefits associated with enhancing the spousal relationship and sense of couplehood.

RESULTS

Findings suggest playing meaningful songs together is an enjoyable interactive activity that prompts musical reminiscence, involves joint agency, and supports relationship continuity within a relational, positive approach to dementia care. All couples mastered the task, none evaluated it as "very challenging," and positive couple interactions were evoked, commonly before and after playing the duets.

CONCLUSIONS

The MMM Duet System is recommended for further research and development as an innovative way to support couples living with dementia with commercial implications, and as a new music technology suitable for use as a research tool.

The Experiences of Skilled Nursing Staff in Memory Care Units During the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

The novel coronavirus disease 2019 (COVID-19) resulted in the need for multiple mitigation strategies. The impacts of these safety measures were felt more extremely by healthcare providers. This qualitative study focused on the experiences of staff in skilled nursing facilities, specifically in locked memory care units, during the first year of the COVID-19 pandemic.

RESEARCH DESIGN AND METHODS

This study used a basic interpretive methodology. In-depth interviews were conducted with skilled nursing staff members who worked in a locked memory care unit during the 2020 calendar year. Thematic analysis was used to organize and interpret the data.

RESULTS

A total of 11 participants provided data that resulted in themes around reasons for working on a locked memory care unit, experiences working with people who have behavioral and psychological symptoms due to dementia, training, outcomes of shared experiences, outcomes of policy changes, management support, and suggestions for a future pandemic.

DISCUSSION AND IMPLICATIONS

The results of this study may have implications for skilled nursing facilities with locked memory care units that continue to grapple with the realities of providing care during a pandemic. Providing appropriate training, social support, and appropriate protective equipment are among the suggestions.

Improving psychosocial well-being and parenting practices among refugees in Uganda: Results of the journey of life effectiveness trial

Caregivers play a critical role in mediating the impacts of forced displacement on children; however, humanitarian programming remains hampered by a lack of evidence-based programming. We present findings from an evaluation of a group-based curriculum delivered over the course of 12 sessions, journey of life (JoL). A waitlist-control quasi-experimental design was implemented in the Kiryandongo refugee settlement (intervention n = 631, control n = 676). Caregiver mental distress, measured using the Kessler-6, was the primary outcome. Secondary outcomes included (a) functioning, (b) social support and (c) caregiving attitudes and behaviors. Propensity score matching (PSM) and Cohen's d estimates were used to examine the intervention effects. According to our primary PSM analysis, JoL led to significant improvements in mental distress (coef.: 2.33; p < 0.001), social support (coef.: 1.45; p < 0.001), functioning (coef.: 2.64; p < 0.001), parental warmth/affection (coef.: 2.48; p < 0.001), parental undifferentiated rejection (coef.: 0.49; p < 0.001) and attitudes around violence against children (VAC) (coef.: 1.98; p < 0.001). Evidence from Cohen's d analysis underscored the value of the intervention's effect on parental warmth/affection (0.74), mental distress (0.70) and VAC attitudes (0.68). This trial adds to the evidence on holistic parenting programming to improve the mental health and parenting outcomes among refugee caregivers.

Strategies to Alleviate the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Low- and Middle-Income Countries: Scoping Review

BACKGROUND

There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries.

OBJECTIVE

This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries.

METHODS

A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis.

RESULTS

Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions.

CONCLUSIONS

This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/44268.

Comprehensive Older Adult and Caregiver Help (COACH): A person-centered caregiver intervention prevents elder mistreatment

BACKGROUND

Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia.

METHODS

We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points.

RESULTS

The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010).

CONCLUSIONS

In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.

Qualitative Analysis of Implementation Factors of an Embedded Caregiver Support Intervention into Adult Day Services

Background

Adult day services (ADS) are an important and often underutilized support resource for older adults. For persons living with dementia (PLWD), ADS is an optimal access point to not only receive therapeutic and rehabilitative activities, but as a vehicle for respite/relief for dementia caregivers. Yet, there is currently a lack of research on integrating caregiver interventions into home and community-based services such as ADS.

Objective

This paper reports on qualitative findings from the Improving Outcomes for Family Caregivers of Older Adults with Complex Conditions: The Adult Day Plus (ADS Plus) Program Trial.

Methods

Drawing from semi-structured interviews conducted with family caregivers and ADS site staff, we conducted a thematic analysis to examine the implementation process of ADS Plus.

Results

Themes address the relational nature of the intervention, learning, influence of the administrative infrastructure, and receptivity of ADS Plus.

Conclusions

Our analysis determined that implementation of ADS Plus was feasible and accepted by site staff and dementia caregivers but also calls for additional evaluation of embedded caregiver support interventions across different contexts (e.g., staff size, limited technology environments) to further identify and test implementation mechanisms across settings.

Assessment of Quality of Life, Grief, and Psychosocial Need Among Bereaved Caregivers of Children with Cancer

Cancer is the leading disease-related cause of death for children in the United States; however, limited data exists on caregivers' needs and evidence-based bereavement interventions are lacking. This is a cross-sectional study of primary caregivers of children who died from cancer. Participants completed five surveys assessing well-being and an optional semi-structured, in-depth qualitative interview. Caregiver's greatest unmet needs were finding meaning in the death, personal wellness, and social activities. Bereaved caregivers with greater unmet needs reported poorer quality of life in the energy/fatigue (p = .01), role limitations due to emotional problems (p = .01), pain (p = .01), and emotional well-being (p = .02) domains. Interview themes elicited include inadequate bereavement services, support for siblings, desired contact with the medical team, and connections to other bereaved caregivers. Findings support the need for intensive, evidence-based bereavement programs for families of children who died from cancer, to attempt to mitigate poor bereavement-related outcomes.

Navigating Compassion: A Comprehensive Review of Palliative Care in Respiratory Medicine

Palliative care has emerged as a crucial aspect of comprehensive healthcare, particularly in respiratory medicine. This review navigates the intricate landscape of palliative care in the context of respiratory diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. The exploration begins with a comprehensive examination of palliative care's definition, significance, and purpose in respiratory medicine. It progresses to understanding common respiratory diseases, their impact on patients' quality of life, and the nuances of disease progression and prognosis. Delving into the principles of palliative care, the review highlights the importance of a patient- and family-centered approach, emphasizing the multidisciplinary collaboration required for holistic care. Symptom management takes center stage, with a detailed exploration of dyspnea, cough, and pain, covering pharmacological and non-pharmacological interventions. The psychosocial and spiritual dimensions are then unveiled, recognizing the psychological impact of respiratory diseases and the significance of addressing spiritual needs with cultural sensitivity. Communication in palliative care is explored through breaking lousy news, advance care planning, and shared decision-making. The section acknowledges the complex considerations surrounding end-of-life care, including recognizing the end-of-life phase, establishing care goals, and withdrawing life-sustaining therapies. Recognizing the indispensable role of caregivers, the review underscores the importance of caregiver support. It delineates strategies for providing emotional and practical support alongside a crucial focus on self-care for caregivers who shoulder the responsibilities of providing palliative care. As the exploration concludes, the challenges in implementing palliative care in respiratory medicine are outlined, from late referrals to communication barriers. However, the review also envisions a future marked by innovation, with emerging approaches, such as telehealth and personalized medicine, offering promising avenues for improvement. Research gaps and areas for improvement are identified, emphasizing the need for a collaborative effort to enhance the quality of palliative care for individuals facing respiratory diseases. The review culminates in a call to action, urging early palliative care integration, investment in education and training, research initiatives, advocacy for accessible services, and collaboration across disciplines. By heeding this call, healthcare providers, researchers, and policymakers can collectively contribute to the evolution and enhancement of palliative care in the challenging landscape of respiratory medicine.

Family Caregiver Support Interventions' Effectiveness Before and During the COVID-19 Pandemic

The authors aimed to assess the impact of a family caregiver support intervention on caregiver burden and hospital readmission before and during the COVID-19 pandemic. By adopting a quasi-experimental design with no randomization, caregivers (n = 65) received a 90-day home visitation caregiver support intervention before the COVID-19 pandemic and caregivers (n = 41) received a 90-day phone-only visitation caregiver support intervention during the COVID-19 pandemic. Caregiver burden was collected in a survey, and hospital readmission of the care recipient was collected by hospital data. The results of a repeated-measures ANOVA demonstrated that participants of a family caregiver support intervention during the COVID-19 pandemic improved their caregiver burden statistically significantly more than those who received the intervention before the pandemic. There were no significant differences in hospital readmissions before or during the COVID-19 pandemic. The study demonstrates the efficacy of family caregiver support interventions over the phone during a pandemic.

Exploring the role of a facilitator in supporting family carers when embedding the iSupport for Dementia programme in care services: A qualitative study

AIMS

To explore stakeholders' perceptions of a facilitator's role in supporting carers when embedding iSupport for Dementia psychoeducation program, in care services.

METHODS

A qualitative descriptive study design was applied. Data were collected from workshops and interviews with carers of people living with dementia (PLWD)and with health and social care professionals from two tertiary hospitals and two community aged care organisations across three Australian states between October 2021 and March 2022. A thematic analysis was used to analyse data. The COREQ guideline was followed to report our findings.

RESULTS

A total of 30 family carers and 45 health and social care professionals participated in the study. Three main themes and seven subthemes were identified from the data. We described the main themes as (1) the facilitator's role at the time of dementia diagnosis, (2) the facilitator's role throughout the everyday dementia care journey and (3) the facilitator's role during transition moments.

CONCLUSIONS

Caring for family members with dementia is demanding and stressful for carers. Embedding a facilitator-enabled iSupport for Dementia program in hospital and community aged care settings has the potential to mitigate sources of stress associated with care recipient factors, carer factors and care service factors, and improve the health and well-being of carers and those for whom they care.

RELEVANCE TO CLINICAL PRACTICE

Our findings will inform the establishment of iSupport facilitators appointed by dementia care providers in hospital and community care settings and help determine their roles and responsibilities in delivering the iSupport program. Our findings relate to nurse-led and coordinated dementia care in hospital and community aged care settings.

PATIENT OR PUBLIC CONTRIBUTION

This study was co-designed with stakeholders from two aged care organisations and two tertiary hospitals. The study participants were staff employed by these organisations and carers of PLWD who were service users.

Intersection of multiple factors shape Korean American caregiver experience in dementia caregiving

BACKGROUND AND OBJECTIVES

Studies have shown that cultural norms such as filial responsibility and familism operate in the Korean American caregiving context. The purpose of our study is to understand the practice of Korean American caregivers who provide care to a family member living with dementia and their dementia care support needs.

MATERIALS AND METHODS

We conducted 2 focus groups and individual semi-structured interviews with a total of 20 Korean American caregivers. We used inductive thematic analysis to guide coding and generation of themes.

RESULTS

Three themes were identified; 1) intersectionality in the Korean American caregiver experience, 2) complex family dynamics, and 3) dementia care barriers and caregiver support needs. Within the dyadic relationship and the family, cultural identity, generational, acculturational, and language factors shaped the caregiver experience. The need to navigate bicultural norms could lead to tensions but also provide opportunity for caregivers to consider self-care and use external supports to decrease the work of caregiving. Family was the unit of caregiving and caregiving was divided among family members based on acculturation and language fluency. Caregivers desired both medical information combined with knowledge that experienced lay support could provide. Support that reflects their cultural context was valued.

DISCUSSION

Findings suggest the importance of understanding the diversity of response to strong elder care norms among Korean American caregivers and the intersection of multiple factors that influence their caregiving experience. Integrating acculturation and generational assessments may be useful as a way to tailor interventions to optimize engagement in dementia care interventions.

Nature-Based Virtual Reality Feasibility and Acceptability Pilot for Caregiver Respite

Home-based informal caregivers (CGs), such as the family members and friends of cancer patients, often suffer averse emotional symptoms, such as anxiety and depression, due to the burden associated with providing care. The natural environment has been valued as a healing sanctuary for easing emotional pain, promoting calmness, relaxation, and restoration. The use of virtual reality (VR) nature experiences offers an alternative option to CGs to manage emotional symptoms and improve their quality of life. The aim of this mixed-method pilot was to evaluate the feasibility and acceptability of a nature-based VR experience for home-based CGs. Nine informal CGs participated in a 10 min nature-based VR session and completed feasibility, acceptability, and VR symptom measures in the laboratory. Semi-structured interviews with five of the CGs provided qualitative data regarding their experiences with VR. The CGs (mean age 64.78 years) were mostly female (n = 7). Our analysis showed high feasibility (15.11 ± 1.76; range 0-16) and acceptability (15.44 ± 1.33; range 0-16), as well as low VR Symptoms (1.56 ± 1.33; range 0-27). Participants primarily expressed positive perceptions regarding VR feasibility and acceptability during interviews. Our findings show promise for the use of VR nature experiences. In the next phase of the study, the intervention will be tested on home-based informal CGs of patients at end of life.

Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults

The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.

Honoring What We Say We Do: Developing Real-World Tools for Routine Family Caregiver Assessment and Support in Outpatient Palliative Care

Background: Family caregivers are essential to the care of patients with serious illness and supporting caregivers alongside patients is a core tenet of palliative care. While there is increasing recognition of the need to support family caregivers, there are limited resources to assess and support their needs in a systematic way in outpatient palliative care practice. Objectives: The aim of this study is to develop an approach to conducting assessments of routine needs and support of family caregivers in outpatient palliative care practice using a quality improvement framework. Setting: Seven, interdisciplinary, outpatient palliative care teams in California collaborated in this study. Measurements: Family caregivers were surveyed about levels of distress and support using a 10-point scale and asked about specific areas of need for support. Usefulness of a supportive caregiver resource was also measured on a 10-point scale, in addition to qualitative assessment of clinician satisfaction and feasibility of routine caregiver assessment and support. Results: Seven hundred thirty-six caregiver needs assessments were conducted and 44 supportive tool kits were distributed. A majority of family caregivers reported moderate or severe distress related to caregiving (score ≥4 on a 10-point scale). The most common sources of distress included emotional distress, worry caregiving was negatively impacting their own health, and planning for the future. Most caregivers reported feeling moderately or very well supported, most commonly by family, friends, and faith/spirituality. Caregivers rated the supportive tool kit an 8.4 on a 10-point usefulness scale and 92% would recommend it to others. Conclusions: We successfully developed and piloted practical clinical tools for routine family caregiver screening and support.

Supporting Caregivers of Veterans with Dementia

As the number of veterans with dementia continues to increase, support services for those veterans and their caregivers must also increase. Caregivers of veterans with dementia often report high levels of emotional distress in the form of anxiety, exhaustion, and burden that negatively impacts their health and quality of life. This brief descriptive report highlights a Veterans Health Administration (VHA) project in which a social worker trained in palliative care, teaches stress-reduction to caregivers through individual counseling and virtual groups. In two years, 39 caregivers received individual assessment and counseling focused on stress-reduction. Also, five group webinars were held on the topic of self-care that averaged 17 caregivers per group. 24 caregivers completed a survey and results suggested that stress-reduction and self-care may be viable target areas of intervention for caregivers of veterans with dementia in both individual and group formats. More research is needed in this area to improve our knowledge of how stress may be reduced for caregivers and what type of interventions may be effective to help caregivers reduce stress and improve their self-care.

A Novel Instrument for Caregivers in Managing Neuropsychiatric Symptoms of Dementia: Baycrest Quick-Response Caregiver ToolTM

Background

Family caregivers can experience significant stress related to behaviour changes in persons with dementia (PWD). Approaches to support caregivers with stress management when responding to changes in behaviours are needed. The Baycrest Quick-Response Caregiver Tool^TM (BQRCT) was developed to provide caregivers with an online tool that can be used in real time to recognize and manage their emotions when managing neuropsychiatric symptoms of dementia.

Methods

A mixed-methods approach was used to evaluate the feasibility of this new tool. Family caregivers of persons with dementia received education about managing neuropsychiatric symptoms of dementia through the online tool. Caregiver demographic information and feedback about the tool was obtained through telephone and online surveys. Health-care providers accessed the tool and also provided feedback.

Results

The 21 caregivers who completed the study found the tool helpful and reported high feasibility that included being able to access, complete, and implement the strategies presented in the tool. The 18 health-care providers found the tool useful and most would recommend it to peers and clients. Participants also provided specific suggestions for improvement, such as including more examples of complex behaviours.

Conclusions

This tool adds to and complements existing strategies for managing neuropsychiatric symptoms of dementia. Its accessibility through the online platform is especially useful for caregivers who are unable to seek help in person, and for health-care providers and caregivers seeking additional resources.

Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial

Background

Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access.

Objective

We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers.

Methods

SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire.

Results

Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases.

Conclusions

SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy.

Dementia Caregiver Virtual Support-An Implementation Evaluation of Two Pragmatic Models during COVID-19

Caregivers of people with Alzheimer's and related dementias (ADRD) require support. Organizations have pivoted from traditional in-person support groups to virtual care in the face of the COVID-19 pandemic. We describe two model programs and their pragmatic implementation of virtual care platforms for ADRD caregiver support. A mixed methods analysis of quantitative outcomes as well as a thematic analysis from semi-structured interviews of facilitators was performed as part of a pragmatic quality improvement project to enhance delivery of virtual support services for ADRD caregivers. Implementation differed among individual organizations but was well received by facilitators and caregivers. While virtual platforms can present challenges, older adults appreciated the strength of group facilitators and reported enhanced connectedness related to virtual support. Barriers to success include the limitations of virtual programming, including technological issues and distractions from program delivery. Virtual support can extend outreach, addressing access and providing safe care during a pandemic. Implementation differs among organizations; however, some elements of virtual support may be long-lasting.

It Takes a Team to Make It Through: The Role of Social Support for Survival and Self-Care After Allogeneic Hematopoietic Stem Cell Transplant

Background

Social support plays an important role for health outcomes. Support for those living with chronic conditions may be particularly important for their health, and even for their survival. The role of support for the survival of cancer patients after receiving an allogeneic hematopoietic cell transplant (alloHCT) is understudied. To better understand the link between survival and support, as well as different sources and functions of support, we conducted two studies in alloHCT patients. First, we examined whether social support is related to survival (Study 1). Second, we examined who provides which support and which specific support-related functions and tasks are fulfilled by lay caregivers and healthcare professionals (Study 2).

Methods

In Study 1, we conducted a retrospective chart review of alloHCT patients (N = 173, 42.8% female, age: M = 49.88) and registered availability of a dedicated lay caregiver and survival. In Study 2, we prospectively followed patients after alloHCT (N = 28, 46.4% female, age: M = 53.97, 46.4% ethnic minority) from the same hospital, partly overlapping from Study 1, who shared their experiences of support from lay caregivers and healthcare providers in semi-structured in-depth interviews 3 to 6 months after their first hospital discharge.

Results

Patients with a dedicated caregiver had a higher probability of surviving to 100 days (86.7%) than patients without a caregiver (69.6%), OR = 2.84, p = 0.042. Study 2 demonstrated the importance of post-transplant support due to patients’ emotional needs and complex self-care regimen. The role of lay caregivers extended to many areas of patients’ daily lives, including support for attending doctor’s appointments, managing medications and financial tasks, physical distancing, and maintaining strict dietary requirements. Healthcare providers mainly fulfilled medical needs and provided informational support, while lay caregivers were the main source of emotional and practical support.

Conclusion

The findings highlight the importance of studying support from lay caregivers as well as healthcare providers, to better understand how they work together to support patients’ adherence to recommended self-care and survival.

Caregiver identity in care partners of persons living with mild cognitive impairment

Research on caregiver identity in the context of memory impairment has focused primarily on more advanced stages of the cognitive impairment trajectory (e.g., dementia caregivers), failing to capture the complex dynamics of early caregiver identity development (e.g., MCI; mild cognitive impairment caregivers). The aim of this study was to develop a nuanced understanding of how caregiver identity develops in family and friends of persons living with MCI. Using constructivist grounded theory (ConGT), this study explored caregiver identity development from 18 in-depth interviews with spouses (n = 13), children (n = 3), and friends (n = 2) of persons recently diagnosed with MCI. The overarching themes influencing MCI caregiver identity development included MCI changes, care-related experiences, “caregiver” interpretation, and approach/avoidance coping. These themes influenced how participants primarily identified, represented as I am a caregiver, I am not a caregiver, or liminality (i.e., between their previous identity and a caregiver identity). Irrespective of their current self-identification, all conveyed thinking about their “future self,” as providing more intensive care. MCI caregiver identity development in family and friends is a fluid and evolving process. Nearly all participants had taken on care tasks, yet the majority of these individuals did not clearly identify as caregivers. Irrespective of how participants identified, they were engaging in care, and would likely benefit from support with navigating these changes and their new, ambiguous, and evolving roles.

Can Use of Digital Technologies by People with Dementia Improve Self-Management and Social Participation? A Systematic Review of Effect Studies

There is increasing interest in the use of technology to support social health in dementia. The primary objective of this systematic review was to synthesize evidence of effectiveness of digital technologies used by people with dementia to improve self-management and social participation. Records published from 1 January 2007 to 9 April 2020 were identified from Pubmed, PsycInfo, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials. Controlled interventional studies evaluating interventions based on any digital technology were included if: primary users of the technology had dementia or mild cognitive impairment (MCI); and the study reported outcomes relevant to self-management or social participation. Studies were clustered by population, intervention, and outcomes, and narrative synthesis was undertaken. Of 1394 records identified, nine met the inclusion criteria: two were deemed to be of poor methodological quality, six of fair quality, and one of good quality. Three clusters of technologies were identified: virtual reality, wearables, and software applications. We identified weak evidence that digital technologies may provide less benefit to people with dementia than people with MCI. Future research should address the methodological limitations and narrow scope of existing work. In the absence of strong evidence, clinicians and caregivers must use their judgement to appraise available technologies on a case-by-case basis.

Informal Caregiving for People With Life-Limiting Illness: Exploring the Knowledge Gaps

Background: People with life-limiting illness are increasingly having more care provided to them by informal caregivers (ICs) such as family members and friends. Although there is a substantial amount of literature surrounding informal caregiving, there is a paucity of research from a hospice palliative care angle. To address this knowledge gap, this scoping review explored the effects of/challenges to informal caregiving at the end of life in Canada. Methods: Scoping review of the literature following Arksey and O’Malley’s framework. Key healthcare and social sciences databases alongside the gray literature were searched. Relevant scholarly and gray literature sources from 2005 to 2019 were screened for inclusion criteria, and a thematic content analysis employed to summarize findings. Results: Of 2,717 initial search results, 257 distinct full text articles were obtained. Following deduplication and screening, 33 met inclusion criteria. Four major themes were identified: (1) Physical health challenges, (2) Psycho-socio-spiritual health challenges, (3) Financial issues, and (4) Health system issues. Gender of ICs was also found to be an important contributor to the differing effects of providing support. Conclusions: This review raises awareness toward ICs regarding the numerous physical, psycho-socio-spiritual, financial, and health system challenges faced during care for people with life-limiting illness. The knowledge gained will inform and advance future practice, policy, and research. Application to interventions (such as caregiver benefits) will assist to improve informal caregiving experiences and outcomes alongside quality of life. Further research is required to understand these unique experiences and the challenges of minority IC populations.

Development of the final version of the occupational adaptation questionnaire for family caregivers

Background

Given the growing role of family caregivers in meeting the increasing demand for ageing-related care in Japan, the occupational adaptation of family caregivers needs to be evaluated.

Methods

This study developed the Occupational Adaptation Questionnaire for Family Caregivers (OAQC) and evaluated its reliability, validity, and effectiveness. To develop the OAQC item pool, the construct ‘Occupation of nursing care engaged in by family caregivers’ was evaluated. Using the Delphi method, 8 experts evaluated 64 items and confirmed that 41 items adequately represented the domain. The scale was then completed by 216 family caregivers of users of outpatient service establishments affiliated with hospitals in the Chubu region. The validity of the scale items was tested, and statistical analysis was performed. The construct validity and internal consistency of the OAQC were examined using exploratory factor analysis and the ω coefficient, respectively.

Results

The discrimination ability and difficulty level were calculated using the item response theory. The findings showed that the scale’s reliability and validity were satisfactory. Construct validity was acceptable for 16 items with 5 factors. The OAQC also had high internal consistency, reliability, and effectiveness. The item slope parameters and difficulty parameters revealed good item response, indicating that the scale could effectively measure family caregivers’ occupational adaptation.

Conclusion

The scale was compatible with the data obtained from family caregivers. Given its overall effectiveness, data obtained using the OAQC can contribute towards implementing personal care support programs for caregivers and enriching their lives by offering support from an occupational adaptation perspective.

The Experience of a Neurocritical Care Admission and Discharge for Patients and Their Families: A Qualitative Analysis

INTRODUCTION

A qualitative assessment of discharge resource needs is important for developing evidence-based care improvements in neurocritically ill patients.

METHODS

We conducted a quality improvement initiative at an academic hospital and included all patients admitted to the neuroscience intensive care unit (ICU) during an 18-month period. Telephone assessments were made at 3 to 6 months after admission. Patients or caregivers were asked whether they had adequate resources upon discharge and whether they had any unanswered questions. The content of responses was reviewed by a neurointensivist and a neurocritical care nurse practitioner. A structured codebook was developed, organized into themes, and applied to the responses.

RESULTS

Sixty-one patients or caregivers responded regarding access to resources at discharge with 114 individual codable responses. Responses centered around 5 themes with 23 unique codes: satisfied, needs improvement, dissatisfied, poor post-ICU care, and poor health. The most frequently coded responses were that caregivers believed their loved one had experienced an unclear discharge (n = 11) or premature discharge (n = 12). Two hundred four patients or caregivers responded regarding unanswered questions or additional comments at follow-up, with 516 codable responses. These centered around 6 themes with 26 unique codes: positive experience, negative experience, neutral experience, medical questions, ongoing medical care or concern, or remembrance of time spent in the ICU. The most frequent response was that caregivers or patients stated that they received good care (n = 115). Multiple concerns were brought up, including lack of follow-up after hospitalization (n = 15) and dissatisfaction with post-ICU care (n = 15).

CONCLUSIONS

Obtaining qualitative responses after discharge provided insight into the transition from critical care. This could form the basis for an intervention to provide a smoother transition from the ICU to the outpatient setting.

Utilization and Cost Effects of the VHA Caring for Older Adults and Caregivers at Home (COACH) Program

Since 2010, the Veterans Health Administration has initiated a home-based Caring for Older Adults and Caregivers at Home (COACH) program to provide clinical support to dementia patients and family caregivers. But its impact on health care utilization and costs is unknown. We compared 354 COACH care recipients with a propensity score weighted comparison group of 9,857 community-dwelling Veterans during fiscal years 2010-2015. In 1-year follow-up, COACH program was associated with a lower rate of long-term nursing home placement (average treatment effect on the treated [ATT] -3%; p = .01). The program increased utilization of emergency services (ATT 6%; p = .01), hospitals (ATT 10%; p < .001), and personal care services (ATT 31%; p < .001). Health care costs were also significantly increased. Improved access to services may have enabled COACH Veterans to stay at home longer. As one of Veterans Health Administration's top priorities to expand caregiver assistance programs, COACH seems to be a promising model for a nationwide implementation.

Coping strategies of family caregivers in spinal cord injury: a qualitative study

Purpose: To identify the coping strategies used by family caregivers of persons with spinal cord injury (SCI) in Switzerland in order to develop tailored support programs.Materials and methods: Purposive sample of >18 years participants, speaking an official Swiss language fluently, being family caregivers of persons with SCI for at least 4 years, and perceiving either a high or low burden in relation to caregiving. Data were collected through face-to-face semi-structured interviews (N = 22). Thematic analysis was performed.Results: Four main coping strategies were identified: reappraisal, active acceptance, setting limits to the caregiver role, and seeking support. These strategies can be used one at a time or combined, and at different times of a caregiver pathway. Our analysis highlighted that caregivers need skills to implement these strategies (e.g., self-evaluation skills).Conclusions: Caregivers of persons with SCI develop cognitive coping strategies to make sense of the situation and establish a "new normal" and problem-focused coping strategies to deal with their new tasks and role. These strategies do not seem to be typical only of SCI caregivers. Hence, interventions that worked for caregivers in other fields could be adapted. Rehabilitation centers should systematically integrate programs targeted to caregivers into their offerings.IMPLICATIONS FOR REHABILITATIONHealthcare systems need to develop educational and support measures for both persons with a health condition and their caregivers.Caregivers should become long-term partners in rehabilitation and a regular and structured needs assessment should be offered.Interventions that worked for caregivers in other fields can be adapted to support also caregivers in SCI.Educational and support programs dedicated to caregivers should teach not only how to perform caregiving tasks but also how to balance between responding to the care recipient's needs and their own needs.

From Passive Patient to Engaged Partner: My Journey With Parkinson Disease

This patient narrative by Richard Higgins with Maureen Hennessey describes Richard's journey of learning to live with a chronic and progressive illness. It begins with Richard's diagnosis and shares many of the lessons learned along the way. Richard copes daily with this condition, relying on the support and expertise of his wife and the treatment team he has assembled while also encouragingly drawing on the skills and knowledge gained as a longtime running coach. A clinical commentary is provided at the article's conclusion, drafted by Richard's friend, Maureen Hennessey, PhD, CPCC, CPHQ, offering observations about the relevance of Richard's story to participatory medicine and suggesting pertinent resources for patients and health care professionals.

The Effect of National Family Caregiver Support Program Services on Caregiver Burden

Extant evidence on the effectiveness of caregiver programs in alleviating caregiver burden is mixed, underscoring the need for further investigations. This study evaluated the effect of the National Family Caregiver Support Program (NFCSP) educational services and respite care on caregiver burden. We used survey data from caregivers assigned to program (n = 491) or comparison (n = 417) group based on their reported use of NFCSP services. Adjusted difference-in-differences (DiD) analysis found an increase in mean burden scores for both groups from baseline to 6 or 12 months. Among program caregivers receiving ≥4 hr of NFCSP respite care per week (n = 307) and matched comparisons (n = 370), burden scores decreased slightly for program caregivers (-0.095 points), but increased for comparison caregivers (+0.145 points). The DiD (0.239 points) was not statistically significant. More research is needed to determine the minimum amount of respite care needed to positively impact caregiver burden.

A dementia-friendly church: How can the African American church support families affected by dementia?

Dementia, including Alzheimer's disease, is affecting the African American community at alarming rates, as African Americans have a greater risk of dementia than other races. The African American church has traditionally been a safe haven where families go for support and healing. However, many churches are not equipped to support families living with dementia. The purpose of this study was to explore ways African American churches can be dementia-friendly to support families affected by dementia. A qualitative descriptive design was used to collect data from 12 African American community stakeholders. Participants were inclusive of caregivers, church leaders, community members, and service providers. During the semi-structured interviews, participants were asked to share characteristics of a dementia-friendly church. Thematic analysis was performed using data from interviews, researcher's journal, and field notes. Responses described a dementia-friendly church as (a) resourceful; (b) welcoming and friendly; (c) inclusive and comfortable; (d) understanding and accepting; and (e) concerned about personal well-being. This study has wide implications not only for African American churches and families, but also for families living with dementia outside of African American faith communities. These findings allow for faith leaders and churches to begin the process of becoming dementia-friendly, thus enabling congregations, communities, and persons with dementia to continue living in meaningful ways. In conclusion, churches are a source of religious support and provide access to resources for families in difficult times. Thus, it is imperative for African American churches to explore ways to best support and meet the needs of families living with dementia.

Online information and support for carers of people with young-onset dementia: A multi-site randomised controlled pilot study

OBJECTIVES

The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study.

DESIGN

A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial.

RESULTS

Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme.

CONCLUSIONS

Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal.

Skin Self-Examination: Partner Comfort and Support During Examinations as Predictors of Self-Efficacy in Patients At Risk for Melanoma Recurrence

BACKGROUND

Skin self-examination (SSE) is an effective method for melanoma survivors to detect potential cancerous growths sooner.

OBJECTIVES

The purpose of this study was to examine whether the SSE self-efficacy of patients with melanoma and their partners is affected by their partners' comfort and support during skin examinations.

METHODS

100 patient-partner dyads completed a 25-item sociodemographic questionnaire. Fifty-two partners attended an education session with the patient on skin examinations and the early detection of melanoma. All patients attended the education session.

FINDINGS

Having their partners attend the education session, as well as being supportive and comfortable with skin examinations, significantly predicted patients' self-efficacy with SSEs. In addition, male patients were found to be significantly more comfortable with partner-assisted skin examinations and reported feeling more supported by their partner than female patients.

Understanding Male Caregivers' Emotional, Financial, and Physical Burden in the United States

Men caregivers face caregiving burden, have weak support networks and are less likely to seek out programs which increase their caregiving capabilities and help them cope with this burden. Using the 2011 and 2015 National Study of Caregiving (NSOC) database and hierarchical regressions, we studied the emotional, financial, and physical burden of male caregivers as spouses, sons, and other caregivers by assessing the impact of caregiver characteristics, tasks and resources for each subgroup. We highlighted the importance of using a nationally representative database for men caregivers only and emphasized that these caregivers are not a monolithic group. We found that all caregivers experienced these three burden types, particularly elevated emotional stress, with sons reporting the highest emotional and financial strain levels. Assisting with personal care was the most stressful task and caregivers vastly under-utilized support and training. Our results suggest that burden suppressants included having family and friends help with caregiving, having time to decompress, and feeling appreciated by the care recipient. These findings offer insight for devising future policies that intentionally include relationship and burden type to encourage improved and more caregiving from men while supporting their well-being.

Psychological Artificial Intelligence Service, Tess: Delivering On-demand Support to Patients and Their Caregivers: Technical Report

This technical report highlights how one mental health chatbot, or psychological artificial intelligence service named Tess, has been customized to deliver on-demand support for caregiving professionals, patients, and family caregivers at a non-profit organization. This low-cost, user friendly, and highly customizable service allows emotional support to be scaled to thousands of people at a single time. The following report describes the phased approach to implementing Tess in order to reach staff, caregivers, and patients across Canada and the United States.

An Experience Sampling Method Intervention for Dementia Caregivers: Results of a Randomized Controlled Trial

OBJECTIVE

Ecological momentary interventions integrated with real-life assessments using the experience sampling method (ESM) could be promising to effectively support dementia caregivers in daily life. This study reports on the effectiveness of the ESM-based intervention "Partner in Sight."

DESIGN, SETTING, PARTICIPANTS

A randomized controlled trial with 76 dementia caregivers was performed. Participants were randomly assigned to the intervention group ("Partner in Sight": ESM self-monitoring and personalized feedback), the pseudo-intervention group (ESM self-monitoring without feedback), or the control group (usual care).

MEASUREMENTS

Effects were evaluated pre- and postintervention and at 2-month follow-up. Primary outcomes were retrospective measures of caregiver sense of competence and mastery. Secondary outcomes were retrospective measures of depression, anxiety, and perceived stress. Complementary ESM measures of positive and negative affect were collected pre- and postintervention.

RESULTS

Both the experimental and pseudo-experimental groups showed an increase in retrospective sense of competence and a decrease in perceived stress at 2-month follow-up. At postintervention, the experimental group showed a decrease in momentary negative affect compared with the pseudo-experimental and control groups. No effects were found for retrospective mastery, depression, anxiety, and momentary positive affect.

CONCLUSIONS

ESM interventions could be an important asset for increasing caregiver resources and could help caregivers to better adapt and manage difficult situations and to protect against negative emotions.

What Do You Do When Oncology Chooses You?

My journey through nursing school at the University of Hawaii Maui College has been the most challenging but, by far, the most memorable adventure of my life. During this short-lived period, I lost my mom, who was also my best friend, to stage IV non-small cell lung cancer. Almost three years have passed, but the memories and the emotions are still quite vivid.

[Factors related to eating behaviors in early childhood: Relationships between autistic tendency, sensory characteristics, and childcare environment]

Objective　The objective of this study was to examine the influence of environmental factors on eating behaviors of children.Method　The participants were the caregivers of 1,678 children attending nursery schools or kindergartens in two different cities of a prefecture. We distributed several self-administered questionnaires to the caregivers in conjunction with collaborating organizations. The participants returned the questionnaires either to collection boxes placed at the collaborating organizations facilities or by mailing them. The questionnaires included assessment of the child's basic attributes, caregiver assessments of eating behaviors, the Social Responsiveness Scale (SRS) measure of autistic traits, the Japanese Sensory Inventory-Revised (JSI-R), and the Index of Child Care Environment (ICCE). We conducted a chi-square (χ²) test, Fisher's exact test, and a multiple regression analysis.Results　We received responses from 843 participants (response rate=50.4%), and of those, 583 were considered valid (34.7%). The mean number of problematic eating behaviors for each child as perceived by the caregivers was 2.43±2.26. In general, caregivers thought that about 40% of the children had an unbalanced diet and about 30% had a problem of "not being able to sit still." The multiple regression analysis showed that the number of problematic eating behaviors was significantly and positively affected by the SRS T-score total (β=0.188, P<0.001), sense of taste (β=0.319, P<0.001) and auditory sense (β=0.168, P<0.001) in JSI-R. A positive relationship was found between the environmental factors of human stimulation (β=0.096, P=0.010) and social support (β=0.085, P=0.022). A negative relationship was found between sense of smell (β=-0.108, P=0.013), number of siblings (β=-0.100, P=0.005), age (β=-0.077, P=0.029), and sex (β=-0.091, P=0.010).Conclusion　Our study results showed that having an unbalanced diet and "not being able to sit still" were typical features of eating behaviors. The number of problematic eating behaviors was associated with personal factors such as autistic tendency and sensory characteristics, and also with environmental factors, such as human stimulation and social support. Our findings show the importance of evaluating all relevant factors when dietary guidance is provided in the treatment of problematic eating behaviors.

Underreporting of Gender and Race/Ethnicity Differences in NIH-Funded Dementia Caregiver Support Interventions

Women and racial/ethnic minority dementia caregivers have unique caregiving experiences and support needs. To ensure the identification of potentially important differences in outcomes within these groups, the amended National Institutes of Health (NIH) Policy on Inclusion of Women and Minorities mandates reporting by gender and race/ethnicity. The objective of this study was to determine the inclusion and reporting rates among NIH-funded dementia caregiver support interventions. A focused systematic literature review of studies published from 1994 to 2015 located 48 articles meeting inclusion criteria. The majority of studies included women and racial/ethnic minorities; however, 67% did not report results by gender or racial/ethnic group. Acknowledgment of underreporting was more common for race/ethnicity than gender. Our findings suggest limited NIH guideline compliance that may reflect a lack of awareness regarding potential gender disparities in caregiving roles. Ensuring NIH guideline compliance necessitates shared investments from researchers, editors, and reviewers to ensure group differences are systematically identified and reported.

What We Do: Key Activities of an Outpatient Palliative Care Team at an Academic Cancer Center

BACKGROUND

Outpatient palliative care (PC) has been shown to positively impact quality of life and decrease healthcare utilization, but there are limited data describing what activities render these benefits.

OBJECTIVE

Describe the topics addressed by an outpatient PC team during scheduled visits.

DESIGN

Longitudinal cohort study.

SETTING

The Symptom Management Service, an ambulatory PC program at an academic comprehensive cancer center.

MEASUREMENT

Between March 23, 2015 and June 14, 2016, outpatient PC providers completed a checklist after each clinic visit, documenting topics covered during the visit.

RESULTS

During the study period, 1243 visits were conducted for 577 unique patients. Symptom management was the topic most commonly addressed during initial visits (in 92% of visits), followed by an introduction of PC (69%), support for family caregivers (47%), and communication with other clinicians (38%). Providers also supported patients to understand their prognosis (28%), treatment options (36%), and to make care decisions (22%). Formal advance care planning activities occurred infrequently, however, including designation of a Durable Power of Attorney for Healthcare (26%), completion of an advance directive or Provider Orders for Life-Sustaining Treatment form (10%), and discussing hospice (8%). Follow-up visits were dominated by symptom management (93%) and caregiver support (27%).

CONCLUSIONS

Symptom management, support for family and caregivers, and care coordination are the most common activities that occurred during scheduled outpatient PC visits. These findings can guide developing PC practices, as well as clinicians who provide primary PC.

Social support and school outcomes of adolescents orphaned and made vulnerable by HIV/AIDS living in South Western Uganda

The goal of this study is to examine the role of social support from multiple sources, including the extended family, caregivers, classmates, peers and teachers, in improving the school outcomes (grades and attendance) of children orphaned by AIDS in Uganda. Data for this study comes from a 4-year randomized control trial, called Suubi-Maka (Hope for families), conducted in the Southwestern part of Uganda from 2008 to 2012. Using multivariate regression modeling - controlling for several individual-level and school-level characteristics, we find that social support (perceived emotional and information support received from parents, classmates and teachers), caregiver's acceptance and warmth, and family cohesion have positive effects on children's school grades and attendance. This finding underscores the importance of strengthening relationships within the extended family and the school environment to serve as a net of strength that can influence not only family functioning but also vulnerable adolescents' educational trajectories.

The Dementia Care Coordination Program: Engaging Health Systems in Caregiver Supports

This paper reports on a process evaluation using mixed methods to assess a Dementia Care Coordination Program, which is distinctive in using the medical system, rather than direct outreach, to identify and refer families to supports provided by an Alzheimer's Association chapter via dedicated care consultants. One care consultant received referrals from individual physicians, while the other, employed by a health plan, received referrals from health plan case managers. Through key informant interviews, focus groups, and physician and caregiver surveys, we identified key issues, finding high rates of stakeholder satisfaction, but some practical issues around information sharing and data tracking. We further found the health plan model of collaboration to offer significant potential for the systematic and early detection of potential clients, provided investments in minor systems change. The Dementia Care Coordination Program, therefore, represents a minimalist model of dementia-specific support, which could be further supplemented via more focused outreach and education.

Quantifying the relative importance to patients of avoiding symptoms and outcomes of heart failure

OBJECTIVE

To evaluate heart failure (HF) patients' disease knowledge and preferences for avoiding different disease outcomes.

METHODS

An online survey was administered to 400 individuals with a self-reported diagnosis of HF to elicit relative importance weights (RIWs) for avoiding 11 potential HF symptoms and outcomes using best-worst scaling. The survey also included questions about individuals' HF knowledge, and demographic and disease-experience characteristics. Differences in RIWs among sub-groups, defined by HF knowledge, caregiver support, age, recent hospitalization or emergency room visit for HF, health-related quality-of-life, and cardiac device experience were examined.

RESULTS

Relative to limitations in usual activities (RIW 1.00), respondents preferred avoiding severe, infrequent cardiovascular events (e.g. stroke [RIW 8.51], heart transplant [RIW 7.84], or heart attack [RIW 5.3]) most, followed by difficulty breathing (RIW 2.55), inability to enjoy life (RIW 1.84), cardiac device implantation (RIW 1.74), and atrial fibrillation (RIW 1.57). Patients preferred avoiding swelling (RIW 0.47) and fatigue (RIW 0.58) least. RIWs for avoiding severe, infrequent events were higher among those with high disease knowledge, those without caregivers, and those without a recent hospitalization or emergency room visit.

CONCLUSIONS

Patients' preferences for avoiding HF outcomes vary across outcomes and by individuals' knowledge, caregiver status, and age. Healthcare providers should solicit and incorporate insights about patients' knowledge of HF and their preferences for avoiding HF outcomes into HF education and management planning efforts.

Effectiveness of respite care in supporting informal caregivers of persons with dementia: a systematic review

OBJECTIVE

Supporting informal caregivers of persons with dementia is considered to be an effective strategy for improving the well-being of caregivers and care recipients and for delaying nursing home placement. Although considerable research has been conducted to investigate the effectiveness of psychoeducational interventions, cognitive behavioral therapy, and occupational therapy, research into the effectiveness of respite care is rare. This systematic review aims to investigate the effectiveness of different types of respite care in supporting informal caregivers of persons with dementia.

METHODS

A systematic literature search was conducted using Web of Science and PubMed, and the Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality. Randomized controlled trials, quasi-experimental studies, pretest-posttest studies without a control group, and cohort studies were included.

RESULTS

Seventeen papers met the inclusion criteria. Day care services are effective in decreasing caregiver burden and behavioral problems in persons with dementia, but they also accelerate time to nursing home admission. The results of temporary residential admission are rather mixed and show unexpected adverse effects on both caregivers and care recipients. High-quality comparable evidence on community-based respite care is still lacking, although earlier qualitative evidence indicated promising results.

CONCLUSION

Unlike in previous reviews, we were able to draw some conclusions about the effectiveness of some types of respite care. There is nonetheless still a need for new intervention studies measuring the impact of respite care, especially in-home respite care programs, on the caregiver, the care recipient, and health care resource utilization. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of a Health and Social Collaborative Case Management Model on Health Outcomes of Family Caregivers of Frail Older Adults: Preliminary Data from a Pilot Randomized Controlled Trial

Family caregiving is an important form of informal care provided to frail, community-dwelling older adults. This article describes a health and social collaborative case management (HSC-CM) model that aims to optimize the support given to caregivers of frail elderly adults. The model was characterized by a comprehensive assessment to identify the caregiver's needs; a case management approach to provide integrated, coordinated, continued care; and multidisciplinary group-based education customized to the caregiver's individualized needs. A pilot study using a randomized controlled trial study design was conducted to evaluate the effects of the HSC-CM on caregiver burden and health-related quality of life of family caregivers of frail elderly adults. Sixty family caregivers (mean age 61.3 ± 15.5) of frail older adults recruited from a community center for elderly adults in Hong Kong were randomly assigned to receive a 16-week HSC-CM intervention or usual care. Case managers who conducted a comprehensive assessment of the care dyads to identify caregiver needs using a case management approach to optimize care coordination and continuity led the HSC-CM. These case managers served as liaisons for multidisciplinary efforts to provide group-based education according to caregiver needs. Family caregivers who participated in the HSC-CM had significantly greater improvement on the Caregiver Burden Index (p = .03) and on the Medical Outcomes Study 36-item Short-Form Survey subscales, including vitality (p = .049), social role functioning (p = .047), and general well-being (p = .049). This study provides preliminary evidence indicating that client-centered care, a case management approach, and multidisciplinary support are crucial to an effective caregiving support initiative. A full-scale study is required to validate these findings.

Managing Loss and Change: Grief Interventions for Dementia Caregivers in a CBT-Based Trial

Dementia caregivers often experience loss and grief related to general caregiver burden, physical, and mental health problems. Through qualitative content analysis, this study analyzed intervention strategies applied by therapists in a randomized-controlled trial in Germany to assist caregivers in managing losses and associated emotions. Sequences from 61 therapy sessions that included interventions targeting grief, loss, and change were transcribed and analyzed. A category system was developed deductively, and the intercoder reliability was satisfactory. The identified grief intervention strategies were recognition and acceptance of loss and change,addressing future losses,normalization of grief, and redefinition of the relationship Therapists focused on identifying experienced losses, managing associated feelings, and fostering acceptance of these losses. A variety of cognitive-behavioral therapy-based techniques was applied with each strategy. The findings contribute to understanding how dementia caregivers can be supported in their experience of grief and facilitate the development of a manualized grief intervention.

Non-pharmacological management for patients with frontotemporal dementia: a systematic review

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by changes in behavior and language caused by focal degeneration of the frontal and anterior temporal lobes. The behavioral symptoms are distressing to patients and their caregivers. Non-pharmacological management is important as no disease-specific pharmacological treatment for FTD is currently available. The primary objective is to review the literature on non-pharmacological management for FTD and to propose directions for future research, with reference to findings. A search was performed using PubMed, MEDLINE, and EMBASE. Search terms included "frontotemporal dementia", and words related to non-pharmacological management, and it identified a total of 858 articles. Results revealed that very few randomized controlled trials exist on non-pharmacological management interventions for FTD. These interventions have been proposed by literature based on clinical experience. A small number of studies have supported behavioral management techniques that exploit disease-specific behaviors and preserved functions in patients with FTD, along with the management of caregivers' distress. These limitations warrant well-designed large-scale research to examine effects of non-pharmacological interventions on behavioral symptoms of FTD.

Beyond respite: the role of adult day services in supporting dementia caregivers

Adult day services (ADS) are the leading provider of community-based care for persons with dementia and their caregivers. While the provision of caregiver respite is well-documented, little is known about the provision of other forms of dementia caregiver support. Logistic regression analyses of ADS providers (N = 297) in the MetLife Study indicated that the number of hours of social work support was a significant predictor of case management services, while nonprofit status was a significant predictor of caregiver education and support groups. These findings have implications for practice and policy related to this growing provider of dementia services.

[Caregivers of people with neurodegenerative diseases: from help to delegation]

Being a caregiver is difficult, even more so when it comes to helping people with a neurodegenerative disease. These caregivers, either family members or close friends, are confronted with an unexpected delegation which can prove to be highly complex as the pitfalls can indeed be significant. Moreover, the support the caregivers can provide depends on the support they can get for themselves.