Training Community Consultants to Help Family Members Improve Dementia Care: A Randomized Controlled Trial

School of Nursing, University of Washington, Seattle, 98115-2053, USA.
The Gerontologist (Impact Factor: 3.21). 01/2006; 45(6):802-11. DOI: 10.1093/geront/45.6.802
Source: PubMed


We investigated whether community consultants could be trained to teach family caregivers a systematic behavioral approach for reducing mood and behavior problems in persons with Alzheimer's disease.
This study consisted of a randomized controlled trial; we randomly assigned 95 family caregivers and care recipients with Alzheimer's disease to STAR-caregivers (STAR-C) or control groups. Masked interviewers conducted assessments at baseline, after treatment, and after 6 months. Consultants were master's-level health care professionals who were currently practicing in community settings serving older adults. We assessed the extent to which consultants were able to learn and adhere to the treatment protocol, and the relationship between adherence and measures of caregiver mood, burden, and care recipient mood and behavior.
Community consultants were able to learn and adhere to the behavioral treatment protocol. Caregivers receiving STAR-C training showed significant improvements in depression, burden, and reactivity to behavior problems in the care recipient. There were also significant reductions in the frequency and severity of care recipient behavior problems, and improved quality of life. Results were maintained at 6-month follow-up.
Community-based consultants successfully implemented a behavioral intervention with family caregivers of persons with Alzheimer's disease. Consequently, STAR-C seems to be a practicable and reasonable evidenced-based approach to caregiver training in actual clinical settings.

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    • "In contrast, the other studies (Graff et al., 2007; Teri et al., 2005) first identified the problems experienced by the caregiver, and then used activities as one of a variety of approaches to address the problems. An additional study, which was focused on improving sleep in the person with dementia, involved developing a daily exercise program (McCurry et al., 2005). "
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    ABSTRACT: Aims: Behaviors of concern and psychological symptoms such as depression, apathy, agitation, wandering, and resistance to care are common in people with dementia and can be challenging for the caregiver to manage. This narrative review summarizes details of interventions found to be effective in reducing behaviors of concern and psychological symptoms. Methods: This review is based on an existing meta-analysis. The published meta-analysis included a large number of studies which ranged in efficacy. Studies were only included in this review if a moderate or large positive effect was found (Cohen's d ≥ 0.40). Information regarding the main aims of the intervention, dose, type of health professional providing the intervention, and the components of the intervention program were extracted. Results: Interventions with a positive effect contained multiple components including caregiver education, skills training, and engagement in meaningful occupations. Several of the interventions were delivered by an occupational therapist or were developed with extensive input from occupational therapists. Conclusion: This paper provides a description of effective interventions and can be utilized to guide the implementation of evidence-based practice in dementia care.
    Physical & Occupational Therapy in Geriatrics 07/2014; 32(4). DOI:10.3109/02703181.2014.934944
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    • "These more detailed analyses should also lead to the design of interventions that, as noted by previous studies , are tailored to individual needs [53] [54] [55], call for the active participation of caregivers [56], and are linked to the context in which care is provided [57]. Some homebased personalized interventions have been shown to be effective at reducing burden among caregivers [58] [59]. "
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    ABSTRACT: Although numerous studies have examined caregiver burden in the context of Alzheimer’s disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer’s disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89–13.47), as were sole caregivers (OR 3.51; 95% CI 1.98–6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance.
    Journal of Alzheimer's disease: JAD 06/2014; 42(2):623-633. DOI:10.3233/JAD-140360. · 4.15 Impact Factor
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    • "Some studies16,17 have had well trained staff educate family members either by performing family visits or making telephone contact. Other studies18,19 have directly trained health professionals, such as assisted living residence or care staff in nursing or residential homes, to develop skills in behavioral management. Although these studies resulted in significant clinical improvements in some aspects of either patient or caregiver outcome (eg, depression, perceived changes in well-being, burden), they failed to observe a significant reduction in behavioral problems, such as agitated behaviors, in dementia patients. "
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    ABSTRACT: Agitated behaviors are frequently observed in patients with dementia and can cause severe distress to caregivers. However, little evidence of the efficacy of nonpharmacological interventions for agitated behaviors exists for patients with dementia. The present pilot study aimed to evaluate a behavioral management program developed by the Seattle Protocols for patients with agitated behaviors in Japan. Eighteen patients with dementia (Alzheimer's disease, n = 14; dementia with Lewy bodies, n = 4) participated in an open study testing the effectiveness of a behavioral management program. The intervention consisted of 20 sessions over the course of 3 months. The primary outcomes were severity of agitation in dementia, as measured using the Agitated Behavior in Dementia scale (ABID) and the Cohen-Mansfield Agitation Inventory (CMAI). The behavioral management program resulted in significant reductions in total scores on both the ABID and CMAI. Although both physically agitated and verbally agitated behavior scores on the ABID improved significantly, symptoms of psychosis did not improve after the intervention. The behavioral management technique may be beneficial to distressed caregivers of patients with dementia. In the future, a well designed study to develop the behavioral management program more fully is needed.
    Neuropsychiatric Disease and Treatment 01/2013; 9(1):9-14. DOI:10.2147/NDT.S38943 · 1.74 Impact Factor
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