Article

STAR-Caregivers: A Community-based Approach for Teaching Family Caregivers to Use Behavioral Strategies to Reduce Affective Disturbances in Persons With Dementia

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Abstract

The STAR-Caregivers program is a behavioral intervention to decrease depression and anxiety in individuals with Alzheimer's disease and their family caregivers. It consists of 8 weekly in-home sessions followed by 4 monthly telephone calls. Community-based mental health practitioners were trained to conduct the systematic and standardized STAR-Caregivers program, and deliver it to family members who were caring for a relative with dementia at home. This article describes the STAR-Caregivers program and presents illustrative case studies to demonstrate that master's-level practitioners in a community setting can effectively deliver behavioral interventions.

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... Semi-structured daily diaries have been used as a tool to collect both qualitative and quantitative data relating to individualized use of non-pharmacologic interventions (Logsdon et al., 2005;Lowery et al., 2014;Mausbach et al., 2011;McCurry et al., 1998). ...
... The daily diary was developed by using items generated based on prior research focused on weighted blankets and prior studies testing other interventions that have used a daily diary tool (Champagne et al., 2007;Logsdon et al., 2005;Lowery et al., 2014;Mausbach et al., 2011;McCurry et al., 1998). The family caregiver completed one diary entry at the end of each day to document the use of the weighted blanket by the person with ADRD. ...
Thesis
People living with dementia (PLWD) often experience behavioral and psychological symptoms of dementia (BPSD) which are burdensome to those diagnosed, their families, and society. Many non-pharmacologic interventions have demonstrated efficacy in reducing BPSD in research but have had limited uptake in the community, possibly due to lack of feasibility and limited acceptance by PLWD and their family caregivers. Acutherapy and weighted blankets are non-pharmacologic interventions that have improved outcomes among older adults, but few studies have focused on PLWD and BPSD. The purpose of this research was to explore the potential of acutherapy and weighted blankets as non-pharmacologic interventions to reduce BPSD in PLWD. The research presented in this 3-paper dissertation was guided by 6 specific aims: 1. Identify, examine, and synthesize the state of the science relating to the effects of acutherapy on BPSD. (Paper 1) 2. Explore perspectives of family caregivers of community dwelling older adults with Alzheimer’s disease or related dementias (ADRD) regarding BPSD and use of non-pharmacologic interventions for BPSD management. (Paper 2) 3. Explore perspectives of family caregivers of community dwelling older adult family members with ADRD regarding changes in their caregiving experiences, BPSD displayed by their relatives with ADRD and BPSD management strategies used during the COVID-19 pandemic. (Paper 2) 4. Explore initial perceptions of family caregivers regarding weighted blankets as an in-home care strategy for community dwelling PLWD following a brief description and visual presentation of weighted blankets. (Paper 3) 5. Examine feasibility and acceptability of a virtually delivered, in-home weighted blanket intervention for older adults with ADRD living in the community as perceived by the family caregiver and the person with ADRD. (Paper 3) 6. Examine feasibility of collecting outcome measures of BPSD, cognitive function, and quality of life of care recipients with ADRD, and well-being and self-reported health status of family caregivers. (Paper 3) Aims were addressed using: a scoping review methodology (Aim 1); a qualitative approach using semi-structured interviews with 21 family caregivers living with community dwelling PLWD (Aims 2, 3, and 4); a prospective, within subjects, pre-post design study with 21 community dwelling PLWD and their family caregivers (Aims 5 and 6). This dissertation research had 6 key findings: 1) Acutherapy is a safe non-pharmacologic care strategy for PLWD and a potential treatment for BPSD, but additional research is needed to determine efficacy; 2) The caregiving experience of family caregivers of community dwelling PLWD was described as an interdependent partnership between the caregiver and the PLWD; 3) Family caregivers and PLWD experienced challenges to in-home care prior to the COVID-19 pandemic, many of which were compounded by it; 4) The virtually delivered, in-home weighted blanket intervention was feasible and acceptable to PLWD and their family caregivers; 5) Collecting outcome measures of care recipient cognitive function, caregiver well-being and caregiver self-reported health was feasible; 6) Collecting outcome measures of care recipient BPSD and quality of life was feasible through measures completed by caregiver report, but not by care recipient self-report. The efficacy of feasible and acceptable care strategies for community dwelling PLWD must be determined to promote broader uptake by clinicians, support service providers, and families. As BPSD are overwhelming for PLWD, their families, and society, we are in dire need of evidence-based non-pharmacological interventions to reduce the burden and improve the quality of life of PLWD and their families.
... All the interventions were delivered in person to groups of caregivers. The psychoeducation group [50] followed the STAR-Caregivers model [58] which was a program initially designed and delivered in the USA, where all the other interventions appear to have been independently designed for LMIC populations. All the studies found at least one significant result relating to caregiver mental health or perceived burden. ...
Article
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Objectives: With the increasing prevalence of dementia worldwide, there is a growing need for an integrated approach to dementia care. Little is known at present about the benefits of educational interventions for informal caregivers of people living with dementia (PLWD) in low- and middle-income countries (LMICs). This review aimed to identify and synthesise the current research on these interventions. Method: Four databases (PsycINFO, Medline, Web of Sciences and Scopus) were searched, alongside Google Scholar and reference lists. The Downs and Black checklist was used for quality assessment and data relating to intervention characteristics, outcomes, and educational component features were compared. Results: Eighteen papers detailing 17 studies were included. All studies presented found at least one significant outcome/effect. Study comparison was difficult due to diverse methodologies, intervention structures, and outcomes. Study quality was also variable. Four studies had education as the primary focus, and most interventions utilised multicomponent and group-based designs. Interventions that included group delivery tended to find more significant results than individual approaches. Intervention length did not appear to influence efficacy. Regular delivery and an average intervention dosage of around 12 h appeared most effective. Conclusions: Research into educational interventions for caregivers in LMICs appears to be promising and can help guide future interventions towards clinical implementation. A multicomponent group intervention trialled in Egypt provided particularly favourable findings. Future studies should focus on understanding the active mechanisms within such interventions to optimize their effectiveness. Collaboration between LMICs, high-income countries (HICs), and caregivers is crucial in developing interventions tailored to meet caregiver needs whilst accounting for feasibility and equity for dementia care worldwide.
... Both AAAs had a history of working with academic institutions to test interventions and disseminate evidence-based programs. 26,27 Both AAAs operate ADRCs but implement programs and services differently. ADS serves a population of 2,190,200, of which 18% are aged ≥60 years. ...
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Introduction Programs and services available through the aging services network can help community-dwelling older adults to age in place but are often not discussed in routine primary care. The primary care liaison was developed as a novel integration intervention to address this disconnect. Methods Employed by an Area Agency on Aging, primary care liaisons performed outreach to primary care with the goal of raising awareness of community-based programs, resources, and services available to older adults and their caregivers and facilitating referrals. The evaluation of the primary care liaison model, conducted from December 2015 to February 2019, used the Reach, Effectiveness, Adoption, Implementation, Maintenance framework and assessed reach (number of clinics contacted), adoption (number of referrals to the Area Agency on Aging), implementation (number of follow-up contacts with a practice), and effectiveness (proportion of referrals reached and provided relevant resources). Results The primary care liaisons contacted a median of 18.5 clinics per month (IQR=15−31). Primary care referrals averaged >100 per month, and referrals increased over time. Successful follow-up outreach visits had a median of 3 (IQR=2−10), and follow-up contacts had a median of 3 (IQR=1−7) per practice. Three quarters of caregivers for people with dementia reached by Area Agency on Aging staff were provided with information about relevant resources. Conclusions The primary care liaison model is feasible, fosters ongoing interactions between primary care and Area Agencies on Aging, and connects older adults and their caregivers to relevant programs and services. Adoption of the primary care liaison model by other Area Agencies on Aging across the U.S. may help further the vision of optimized health and well-being of older adults.
... 17 This study is just beginning to pilot test a virtual caregiver-coaching program where PLWD and their familybased caregivers, who live at home, are randomized to an online education training program, based on STAR-C, with remote support from a coach or existing tutorials offered by the Alzheimer's Association. [18][19][20] Participant dyads are identified automatically in real time using medication and diagnosis data in the EHR. Research staff use messaging within the EHR to communicate with delivery system physicians. ...
Article
The current evidence base for testing nonpharmacological interventions for people living with dementia (PLWD) and their caregivers is limited, especially within care settings such as ambulatory care, assisted living communities, nursing homes, hospitals, and hospices. There has been even less attention to translation of effective interventions for PLWD into delivery of care. Thus, there is an urgent need for researchers to partner with these care settings, especially those that follow a learning healthcare systems (LHSs) model, and vice versa to conduct embedded pragmatic clinical trials (ePCTs). These trials are conducted within sites that offer routine care and are designed to answer important, relevant clinical questions and leverage existing electronic health and administrative data. ePCTs set in LHSs create a unique opportunity for researchers, healthcare providers, and PLWD and their families to work and learn together as potentially effective interventions are studied and stress tested in real‐world situations. Healthcare settings that embrace research or quality improvement as part of a culture of continuous learning are ideal settings for ePCTs. In this article, we summarize what we have learned from the National Institutes of Health's Health Care Systems Research Collaboratory–funded ePCTs, discuss challenges of ePCTs within settings that serve PLWD, and describe the work of the Health Care Systems Core within the National Institute on Aging's IMbedded Alzheimer's Disease and Related Dementias Clinical Trials Collaboratory that will occur over the next 5 years. J Am Geriatr Soc 68:S43–S48, 2020 .
... A manual was designed based on recommended interventions [22,30,31,37] and used in order to standardize both the counseling sessions and the group meetings [38]. Local nurses and occupational therapists trained in the structured approach performed the intervention. ...
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Background: Many relatives of close family members suffering from dementia have taken on the caregiver role. While intervention studies have revealed promising results on caregiver burden, distress, and depression, there is a lack of knowledge about how caregivers' perceived relationship with their ill family member influences the burden of care. This study examined whether a psychosocial intervention influenced this perceived relationship from the caregivers' perspective. We also explored whether the caregivers' perception of the care receiver's attitude and behavior changed over time, and whether caregiver stress and mood differed following the intervention. Methods: The participating caregivers and care receivers were randomly assigned to a psychosocial intervention comprising education about dementia, counselling and group sessions, or to treatment as usual. The study investigated caregivers' experience of expressed emotion using the Felt Expressed Emotion Rating Scale (FEERS), a self-report questionnaire that captures caregivers' perception of criticism (CC) and emotional over-involvement (EOI) exhibited by the family members with dementia. Results: A total of 208 dyads were enrolled in the study. There were no significant differences between the intervention and control groups in the studied variables. Caregivers' perception of CC and EOI was low but fluctuated somewhat, whereas their mood and stress level were stable during the follow-up period. Conclusions: According to the FEERS, the intervention did not influence caregivers' perception of CC and EOI, and there was no difference between the intervention and control groups regarding caregivers' perceived relationship. Despite the increased symptoms of dementia, caregivers' level of distress and mood remained stable, and they seemed to maintain a positive perception of the quality of their relationship with the care receiver. Trial registration: Clinical.Trials.gov Sept. 2009, NCT01287767.
... Sixteen studies evaluated education and training programmes targeted specifically at family carers. These included six psychoeducational ((de Rotrou et al., 2011), Gallagher-Thompson, Gray, Dupart, Jimenez, & Thompson, 2008), (Gallagher-Thompson et al., 2010), (Buckwalter, Gerdner, & Kohout, 1999;Gerdner, Buckwalter, & Reed, 2002;Garand, Buckwalter, & Lubaroff, 2002), (Hebert et al., 2003) and (Martin-Carrasco et al., 2009)), six psychosocial ( (Burgio, Stevens, Guy, Roth, & Haley, 2003), (Czaja, Loewenstein, Schulz, Nair, & Perdomo, 2013), (Farran et al., 2004;Farran et al., 2007), (Moniz-Cook et al., 2008), (Tremont et al., 2014;Tremont et al., 2013;Tremont, Davis, Bishop, & Fortinsky, 2008) and (Ulstein, Sandvik, Wyller, & Engedal, 2007)) and four other training programmes ( (Gavrilova et al., 2009;Guerra, Ferri, Fonseca, Banerjee, & Prince, 2011), (Hepburn, Tornatore, Center, & Ostwald, 2001;Ostwald, Hepburn, & Caron, 1999), Logsdon et al., 2005) and (Wright, Litaker, Laraia, & DeAndrade, 2001)). ...
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Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms. This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia. Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant randomised controlled trials. We searched electronic databases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and updated searches in October 2016. We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care settings. This paper presents findings from a narrative synthesis of 48 randomised controlled trials evaluating interventions for people living with dementia alone, family carers alone and patient-carer dyads. Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion. Evidence from 48 randomised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes. Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms, but professional comparisons are lacking and there is no shared language about or understanding of behavioural and psychological symptoms amongst professionals, or between professionals and family carers. Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms. It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms.
... Previous research on outcomes in dementia care interventions has shown promise for the ability to positively effect factors that are found to influence QOL. Cognitive stimulation programs show significantly improved mood, memory, cognitive functioning, and reduced behavioral disturbances when compared to controls [[242], reduces the frequency and duration of nighttime awakening by 32%, significantly increases exercise, and significantly reduces depression [243]. Interventions focusing on exercise and behavior management find that over 80% of caregivers can successfully learn to guide patients in exercise, and the intervention results in significantly more exercise, better general physical functioning, fewer restricted activity days, higher quality of life, and fewer depressive symptoms at 24 months [244]. ...
Thesis
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Given that, by and large, Information and Communication Technologies (ICTs) are aimed at increasing efficacy of workflows, faster and more accurate transfer of information, and decreasing cumbersome procedures, at least some ICTs are directed towards promoting a high quality of life. Particularly, if technologies are used to enhance services, ensure or increase safety and security, promote independence, and/or facilitate social interaction, they impact domains specifically measured in quality of life assessments. As there is no cure for most dementias, the focus of care is largely on the individual’s quality of life, applying technologies to this area of health and social care would seem an appropriate fit. One of the aims of technology solutions to benefit aging adults is to improve quality of life and capability to live independently and healthily; however, improvements in life quality are difficult to measure, and showing the effectiveness of gerontechnology-based solutions is problematic. This research investigated the quantitative data to see if technology use was indeed a facilitator of increased quality of life. The hypothesis was that the older adults and their caregivers would report a positive influence on their quality of life after using the technologies. The end users gave reports via questionnaires on quality of life while metrics, such as frequency of use of a technology and time of use were recorded through the technology system. The work is based on data collected through the clinical intervention trial, and the courses, publications, independent analysis, and interdisciplinary collaboration during the PhD study. The PhD was with the Department of Electronic Systems at Aalborg University in Aalborg, Denmark. The research has been funded through Aalborg University and the European Union Information and Communication Technology Policy Support Program Pilot Type B Project ISISEMD (Intelligent System for Independent living and SElf-care of seniors with cognitive problems or Mild Dementia). Conclusions drawn from the study show that gerontechnology can indeed have a positive influence on quality of life in dementia care; however, significant effects on life quality were confirmed only in the caregivers. There are still knowledge gaps in evaluating quality of life outcomes from using technology in dementia care, and more homogenous, rigorous studies need to be done in this field. Without careful operationalization of the concept, it will be difficult for researchers to interpret the (clinical) outcomes into meaningful results that can be used by other researchers, caregivers, and medical professionals. Objective: Intervention analysis on the efficacy of telecare services in home-based dementia care after 15 months. Design: Multinational, non-blinded, quasi-experimental, clinical intervention trial (nonpharmacological) Setting: Homes of individuals with dementia in North Ireland, Denmark, Finland, and Greece Participants: From 63 individuals with dementia and their caregivers, 31 intervention dyads are compared to 22 control dyads. Intervention: A telecare system consisting of domotics with a centralized architecture aimed to support safety, independence, and quality of life, and to reduce caregiver burden through the transfer of tasks and care support. Main outcome measures: Physical functioning (ADL and IADL), quality of life (QOL-AD and SQLC), caregiver burden (ZBI) are comparative outcomes, and global responses provide exploratory outcomes in the intervention group. The statistical analysis applies t-tests to verify significant differences in means and Pearson correlations to test for linear relationships within the data, all using 95% Confidence Interval. Results: There is a highly significant difference in caregiver burden between the technology intervention and control groups (p=0,02**). The intervention group showed a non-significant reduction in caregiver burden (p=0,51) while the control group showed a highly significant increase in caregiver burden (p=0,01**). The intervention group shows improvement in home safety (80,6%), a high level of user satisfaction (88,7%), and the majority expresses desire to continue using (90,3%) the telecare services and a willingness to pay for such services (53,2%). Conclusion: This study showed that the use of telecare intervention to support dementia care has protective and positive effects for the informal caregivers, but overall does not measure as performing significantly different than usual care. The evidence suggests telecare can be beneficial but methodology limitations prevent definitive conclusions. Trial registration: The Phase I clinical intervention trial did not require registration. The trial was funded by the European Commission Competitiveness and Innovation Programme - Information and Communication Technology - Policy Support Programme. The pilot type B.2008.1.4 project ISISEMD was executed from 01/03/2009 to 31/08/2011. Reference: CIP-ICT-PSP-2-238914. Trial information can be found at the project website http://www.isisemd.eu/. Full text can be accessed via Aalborg University at http://vbn.aau.dk/en/publications/gerontechnology-outcomes-technology-intervention-on-quality-of-life-in-dementia-care(79f9afd3-eb57-4997-a5ee-a2dacf5990ab).html
... 16 For example, one component of the intervention set out in the Seattle carer training protocols (STAR-C) focused on 'increasing pleasant events'. 51 This has the potential to help adjustment to the changed circumstances and thus moderate the sense of 'feeling bereft' (see Appendix). An adaptation of this multicomponent programme to a UK setting also reduced BPSD and carer responses to behaviour, and improved carer mood. ...
Article
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Background: Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes. Aims: To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered. Method: A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012. Results: We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in 'feeling bereft'; and perceptions of transgressions against social norms associated with 'misunderstandings about behaviour' in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging. Conclusions: Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their 'personhood'. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.
... Pese a que en los últimos años se han realizado grandes avances en el estudio de diferentes tratamientos farmacológicos y no farmacológicos (Arango-Lasprilla & Fernández, 2003;Moreno, Valero & Fernández, 2003), en la actualidad no existe ningún tratamiento que pueda curar esta enfermedad. Debido a su carácter progresivo, en la gran mayoría de los casos los pacientes con demencia suelen recibir tratamientos paliativos mientras que su cuidado y supervisión constante recae principalmente en la familia de estas personas (Andrén & Elmstahl, 2005;Edelman, Kuhn, Fulton & Kyrouac, 2006;George & Gwither, 1986;Lavretzky, 2005;Logsdon, McCurry & Teri, 2005;Mahoney, Regan, Katona & Livingston, 2005;Neundorfer y cols., 2001;Roth, Haley, Owen, Clay & Goode, 2001;Schulz & Martire, 2004;Shields, 1992). ...
... As in the original RCT, OTS consultants met with caregivers in their homes for eight weekly sessions, followed by four monthly phone calls. An overview of the session-by-session STAR-C protocol content is shown in Table 3 (Logsdon et al., 2005; Teri, McCurry, et al., 2005). ...
Article
This article describes the translation and evaluation of STAR-Community Consultants program (STAR-C), an evidence-based dementia caregiver training program, within the Oregon Department of Human Services. Staff from two regional Area Agencies on Aging (AAAs) were trained to implement all aspects of STAR-C, including screening, recruitment of caregiver/care-receiver dyads, and treatment delivery. Mailed assessments of caregiver depression, burden, and care-receiver mood, behavior, and quality of life were collected at pre-treatment, post-treatment, and 6-month follow-up. One hundred fifty-one dyads entered the program; 96 completed the 8-week intervention. Significant positive post-treatment effects were obtained for caregiver depression, burden, and reactivity to behavior problems, and care-receiver depression and quality of life. At 6-month follow-up, improvements in caregiver reactivity and care-receiver depression were maintained. Caregivers reported high levels of satisfaction with the program. STAR-C was successfully and effectively implemented by participating AAAs. Recommendations for replication, including training, recruitment, and assessment procedures are provided. © The Author(s) 2015.
... 3 Published a study of family caregivers in which A-B-C behavior modification technique was used (A-activator, B-behavior observed and C-consequence). [21][22][23][24][25] In this study, the caregiver was taught to identify alteration triggering situations and then trained to monitor patient's daily behavior and make notes when the target behavior occurred, identifying situations or whatever was associated with this occurrence. Caregivers were then taught behavioral change strategy. ...
Article
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Objective: To evaluate the effects of a neuropsychological rehabilitation program (NRP) combined with pharmacological treatment in early stage AD patients. Methods: We studied 12 AD patients (6 women), average age 75.42 (6.22) with 9.58 (5.6) years education in use of stable doses of cholinesterase inhibitors. Cognitive performance was evaluated using Mini-Mental State Examination (MMSE) and Alzheimer´s Disease Assessment Scale-cognitive (ADAS-Cog). Caregivers responded to Neuropsychiatric Inventory (NPI) and Functional Activities Questionnaire (FAQ) at initial evaluation (T1), and after 8 months of rehabilitation program (T2). The program comprised two sessions every week and family guidance every fortnight. Results: MMSE (T1:23.25 (1.82)/T2:23.42 (2.81); ADAS-Cog (T1:17.11 (6.73)/T2:21.2 (8.59); NPI (T1:23.42 (23.38)/T2:19.83 (17.73); FAQ (T1:10.67 (7.24)/T2: 13.92 (6.92). Conclusions: These results show the importance of providing guidance and support for caretakers. Study limitations were the small number of patients and absence of a control group with only drug treatment to compare with combined pharmacological and rehabilitation treatments.
... Pese a que en los últimos años se han realizado grandes avances en el estudio de diferentes tratamientos farmacológicos y no farmacológicos (Arango-Lasprilla & Fernández, 2003;Moreno, Valero & Fernández, 2003), en la actualidad no existe ningún tratamiento que pueda curar esta enfermedad. Debido a su carácter progresivo, en la gran mayoría de los casos los pacientes con demencia suelen recibir tratamientos paliativos mientras que su cuidado y supervisión constante recae principalmente en la familia de estas personas (Andrén & Elmstahl, 2005;Edelman, Kuhn, Fulton & Kyrouac, 2006;George & Gwither, 1986;Lavretzky, 2005;Logsdon, McCurry & Teri, 2005;Neundorfer y cols., 2001;Roth, Haley, Owen, Clay & Goode, 2001;Schulz & Martire, 2004;Shields, 1992). ...
Article
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The aim of this study as to: 1) To determine the most and least important family needs of 73 dementia family member caregivers from the Memory Clinic of the Central Police Hospital in Bogotá, Colombia, 2) To describe caregivers’ psychosocial functioning and 3) To determine which type of family needs best predict caregiver psychosocial functioning. Family member caregivers were administered a 27-item Caregiver Needs Questionnaire, the Patient Health Questionnaire (PHQ-9) to measure depression, Zarit Burden Interview (ZBI), the Interpersonal Support Evaluation List Short Version (ISEL-12) to evaluate social support, and The Satisfaction with Life Scale (SWLS). The three most important needs reported by the family member caregivers were the need for information about the disease, need for emotional support, and need for community support. The majority of caregivers reported high levels of burden, depression, and health problems. The need to improve physical health was the best predictor of depression and burden. The need for respite and for psychological assistance best predicted satisfaction with life.
... Interventions focusing on needs identified by caregivers which are flexible in combining strategies to meet diverse needs are likely to be most effective (Schulz & Martire, 2004). Interventions emphasizing behavioral skills training had the most impact on diminishing caregiver depression (Logsdon, McCurry, & Teri, 2005). Increases in use of services were related to the care recipient's increased frequency of memory and behavioral problems suggesting that public health nurses will increasingly serve this important role of connecting caregivers to resources for problem-solving, skills training, and psycho educational groups. ...
Article
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To examine differences between users and non-users of community services in caregivers of persons with dementia (PWD). A profile of who used services versus did not use services was developed. Existing cross-sectional data from the NINR funded National Caregiver Training Project (data collected 1995-1997) were used. The sample (N = 241) of caucasian, well-educated caregivers reflected a mix of spouse and adult caregivers with a mean age of 64.8 years. Variables measured included caregiver social support, burden, and depression as well as problem behavior of PWD. The majority of caregivers did not attend support groups (73%) or use respite services (79%). Among caregivers who did not use services, 78% lived with the recipient and 77% were spouses. The profile of non-users compared to users revealed that non-users were significantly older, more depressed, and received less social support. On the other hand, non-users provided fewer hours of care per week to recipients who had less cognitive and functional deterioration and fewer behavior problems. These findings provide public health nurses with knowledge about service use in caregivers of PWD. Recommendations regarding caregiver needs for assistance and increased use of services before a crisis ensues are presented.
... Pese a que en los últimos años se han realizado grandes avances en el estudio de diferentes tratamientos farmacológicos y no farmacológicos (Arango-Lasprilla & Fernández, 2003;Moreno, Valero & Fernández, 2003), en la actualidad no existe ningún tratamiento que pueda curar esta enfermedad. Debido a su carácter progresivo, en la gran mayoría de los casos los pacientes con demencia suelen recibir tratamientos paliativos mientras que su cuidado y supervisión constante recae principalmente en la familia de estas personas (Andrén & Elmstahl, 2005;Edelman, Kuhn, Fulton & Kyrouac, 2006;George & Gwither, 1986;Lavretzky, 2005;Logsdon, McCurry & Teri, 2005;Neundorfer y cols., 2001;Roth, Haley, Owen, Clay & Goode, 2001;Schulz & Martire, 2004;Shields, 1992). ...
Article
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El objetivo de este estudio consiste en: 1) Conocer las necesidades más y menos importantes que reportan un grupo de 73 cuidadores de personas con demencia que asisten a la Clínica de la Memoria del Hospital Central de la Policía en Bogotá, Colombia, 2) Describir las principales características psicosociales y 3) Determinar si existe una relación entre dichas necesidades y las características psicosociales. Se administró un cuestionario de necesidades familiares, el cuestionario de depresión PHQ-9, el cuestionario de sobrecarga de Zarit, la escala de apoyo social, y la escala de satisfacción con la vida. Se encontró que las necesidades más importantes para los cuidadores fueron la necesidad de recibir información sobre la enfermedad, la necesidad de recibir apoyo emocional y la necesidad de recibir apoyo de la comunidad. La mayoría de cuidadores reportaron tener altos niveles de sobrecarga, depresión y problemas de salud. La necesidad de ayuda para mejorar la salud física fue la que mejor predijo la depresión y la sobrecarga en los cuidadores de personas con demencia. Las necesidades de tiempo para descansar y de apoyo psicológico fueron las que mejor predijeron la satisfacción con la vida.
... We performed individual assessments in order to collect sociodemographic data about the premorbid history, disease history, family relationship context and main problems related to activities of daily living of patients and caregivers. The intervention followed the STAR-Caregivers model 11,12 , which aims at helping caregivers to identify, reduce and manage behavioral symptoms of people with dementia. The model has five basic steps 11,12 : (1) identify, describe and recognize the frequency of behavioral symptoms which are difficult to cope with; (2) identify the precedents of each problem and its consequences; ...
Article
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BACKGROUND: the use of intervention strategies aimed at dementia caregivers objectives the information and the creation of coping strategies to deal with the difficulties caused by dementia. OBJECTIVES: to assess the correlation between the participation in a psychoeducational group and the decrease of burden, and depressive and anxious symptoms of caregivers of people with dementia. METHODS: caregivers (n=18) assessed in a longitudinal study at baseline and after six months of participation in a psychoeducational group. There were used the Clinical Dementia Rating (CDR), Pfeffer Functional Activities Questionnaire (PFAQ), Cornell Scale for Depression in Dementia (CSDD), Quality of Life Scale in Alzheimer’ Disease (QoL-AD), Neuropsychiatric Inventory (NPI), Zarit Burden Interview (ZBI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). RESULTS: in the baseline, there was correlation between the burden and the caregivers’ depressive symptoms (p=0,048). The analysis of the differences between the baseline and the second moment has shown a decrease in caregivers’ depressive symptoms in moment 2 (p=0,011). There were no significant differences in the other variables. DISCUSSION: psychoeducational groups can be considered efficient interventions on the decrease of the depression of caregivers of people with dementia.
... Logsdon R et al., 2005 7 ...
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Facing difficulties due to dementia syndromes, systemic care is necessary. Amongst therapies assessed specifically to caregivers, psychoeducative steps seem to be the strongest effective one on neuropsychiatrics symptoms. Psychoeducations tend to teach the caregivers to modify their interactions with patients via a better understanding of illnesses and patients. Our training "Pour mieux vivre avec la maladie d'Alzheimer", applied in groups of eight to twelve persons, consists in twelve sessions of two hours each. To assure the biggest possible availability, we recently incorporated the concomitant coverage of patients into artistic workshops. These sessions of art-therapy realized in parallel to our psychoeducative program will thus be estimated according to the same rigorous methodology. The critical evaluations realized by participants at the end of our program reflect the outcome of our main objective (to teach to modify interactions with the patients) while contributing to the improvement of social contacts and to the learning of calling to existing helps. These preliminary results strongly argue for the pursuit and even extension of this kind of caregiver's management.
... Leurs résultats ont ainsi démontré que les divers programmes de psychoéducation apportent : un retard d'institutionnalisation de plus de 500 jours 7 ; une meilleure qualité de vie et une diminution du fardeau de l'aidant avec moins de stress, de détresse, de dépression et davantage de satisfaction et de bienêtre [6][7][8]10 ; une fréquence et une sévérité moindres des troubles du comportement, de l'anxiété et de la dépression 8,9 ; de meilleures réactions des aidants face aux troubles présentés par le malade 9,10 . ...
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Facing difficulties due to dementia syndromes, systemic care is necessary. But nevertheless, caregivers are generally lacking in medical welfare. Therapies assessed specifically to caregivers are missing. Amongst these, psychoeducative steps seem to be the strongest effective's one on neuropsychiatrics symptoms. Psychoeducations tend to learn to caregivers to modify their interactions with patients via a better understanding of illnesses and patients. Our training "Pour mieux vivre avec la maladie d'Alzheimer ", done in groups of eight to twelve persons, is constituted of twelve sessions of two hours each. Complete formation includes behavioural and cognitive aspects of the disease and proposes some multidimensional approach which content at least pedagogical, psychological and cognitivo behavioural aspects. We illustrate here with the use of two peculiar cases that our program can reach its objectives. These preliminary results strongly argue for the pursuit and even extension of this kind of caregiver's management.
... In the dementia caregiver intervention literature, there are two notable exceptions. Teri and colleagues have developed the STAR-C (Staff Training in Assisted-living Residences — Caregivers) program wherein paid community consultants were trained to teach family members a systematic behavioral approach for reducing mood and behavior problems in individuals with dementia ( Logsdon, McCurry, & Teri, 2005 ; Teri, McCurry, Logsdon, & Gibbons, 2005 ). These paid community consultants were masters-prepared professionals (counseling , psychology, or social work) who held 8 weekly ...
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