Translation of a Dementia Caregiver Support Program in a Health Care System-REACH VA
ABSTRACT Based on the National Institute on Aging/National Institute of Nursing Research Resources for Enhancing Alzheimer's Caregiver Health (REACH) randomized controlled trial (REACH II), REACH VA (Department of Veterans Affairs) was the first national clinical translation of a proven behavioral intervention for dementia caregivers, running from September 2007 through August 2009. This article describes the population and outcomes of the REACH VA translation of REACH II into the VA.
Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia. Like REACH II, the 6-month REACH VA intervention, structured through a protocol and individualized through a risk assessment, targeted education, support, and skills training to address caregiving risk areas of safety, social support, problem behaviors, depression, and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions. Staff members of the Memphis VA Medical Center, Memphis, Tennessee, collected data on burden, depression, health and healthy behaviors, caregiving frustrations, social support, dementia-related behaviors, and time spent providing care and on duty.
From baseline to 6 months, caregivers reported significantly decreased burden, depression, impact of depression on daily life, caregiving frustrations, and number of troubling dementia-related behaviors. A 2-hour decrease in hours per day on duty approached significance. Caregivers (96%) believed that the program should be provided by the VA to caregivers.
This clinical translation achieved outcomes similar to the REACH II randomized controlled trial, providing clinically significant benefits for caregivers of a veteran with a progressive dementing disease. This model of caregiver support can inform public policy in providing assistance to caregivers.
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ABSTRACT: Background Services in specialized day-care units for individuals with dementia are set up to enable these persons to live in their own home. The purpose of this paper is to discern the experiences of families with these services while caring for a close relative with dementia. Method Longitudinal interviews with 8 family members were conducted. In total, 25 interviews were carried out over a period of 5 years. Results The experience of these families of looking after a close person with dementia appeared to be influenced by (a) the multifaceted meaning of ties, (b) the perception of purposeful relief of the day-care services and (c) the progress of the disease. Conclusion All families found the services of specialized day-care units both useful and pleasant. This kind of resource was shown to make everyday life much more manageable for all persons involved, most importantly for the patient with dementia.09/2014; 4(3):344-54. DOI:10.1159/000358823
Geriatrics & Gerontology International 07/2014; 14(3). DOI:10.1111/ggi.12310 · 1.58 Impact Factor
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ABSTRACT: Background: Poor self-management of heart failure (HF) is an essential contributor to poor outcomes. Caregivers are involved in the care of HF patients, but caregiver interventions intended to improve the outcomes of patients have been largely unsuccessful. Improved knowledge of caregivers' desired roles in care may improve future interventions. Methods and Results: This qualitative study of 20 caregivers of BF patients recruited from an academic medical center used a general inductive approach, with insights from role theory, to analyze the data. Caregivers perceived themselves as health care managers and care plan enforcers, advocates for quality of life, and experts in the lived experience of HF at home. However, they encountered role strain (expectations of role exceed ability to perform role) and role conflict (incompatible or contradictory roles) when it seemed that these roles were incompatible with those that they felt the health care system saw them in. This resulted in expressions of anger and distrust towards the health care system. Conclusions: Clinicians caring for patients with BF can seek to better empower and enable this care. Involving caregivers in disease management research and assessing their roles before intervention may hold promise for enabling and empowering caregivers to improve outcomes of HF patients.Journal of Cardiac Failure 07/2014; 20(10). DOI:10.1016/j.cardfail.2014.07.011 · 3.07 Impact Factor