CHOI Scott Seung W., BUDHATHOKI Chakra, GITLIN Laura N.
Journal article citation:
International Journal of Geriatric Psychiatry, 34(7), 2019, pp.966-973.
Publisher:
Wiley
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two...
(Edited publisher abstract)
Objective: The relationship of specific dementia‐related behaviours to caregiver depression and moderating factors is unclear. This study examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods: The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. This study examined frequency of occurrence of presenting behaviours and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioural clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioural symptom clusters and caregiver depression. Results: Three of four symptom clusters (all three behaviours [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioural clusters and caregiver depression. Conclusion: Caregiver depression was associated with different combinations of behaviours but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.
(Edited publisher abstract)
Subject terms:
dementia, outcomes, carers, aggression, depression, agitation, behaviour, service uptake;
International Journal of Geriatric Psychiatry, 33(1), 2018, pp.185-192.
Publisher:
Wiley
Objective: Dementia-related restlessness is commonly endorsed by caregivers but not well understood. This study examines differences in characteristics (demographics, cognitive status, physical function, pain, and mood) of persons with dementia whose caregivers endorse restlessness versus those who do not. The authors also examine the relationship of restlessness to caregiver well-being including...
(Edited publisher abstract)
Objective: Dementia-related restlessness is commonly endorsed by caregivers but not well understood. This study examines differences in characteristics (demographics, cognitive status, physical function, pain, and mood) of persons with dementia whose caregivers endorse restlessness versus those who do not. The authors also examine the relationship of restlessness to caregiver well-being including burden, upset with behaviours, mastery, and depressive symptomatology.
Methods: The authors combined baseline data from three caregiver intervention studies of community-dwelling persons with dementia who exhibited neuropsychiatric symptoms (n = 569) as measured by the Agitated Behaviors in Dementia Scale. The authors conducted bivariate correlations and independent t-tests by using the Agitated Behaviors in Dementia Scale restlessness item.
Results: Nearly 65% (n = 367) of dementia caregivers reported restlessness. There were no significant differences between those with and without (n = 202) reported restlessness concerning functional status (physical or cognitive). However, persons with restlessness had significantly higher pain scores (p < 0.01), were more likely to be on behavioural medications (p < 0.001), and had more neuropsychiatric symptoms as compared with persons without restlessness (M = 11.11, nonrestless; M = 6.61, restless) (p < 0.001). Caregivers of persons with dementia-related restlessness reported greater burden (p < 0.001), behavioural upset (p < 0.001), depression (p < 0.001), and lower mastery providing care (p < 0.01) compared with caregivers of persons without dementia-related restlessness.
Conclusions: Restlessness is a common neuropsychiatric symptom that appears to be associated with poorer functioning in persons with dementia and greater distress in their caregivers. Further research is needed to understand the unique contributions of restlessness to care burden and quality of life of persons with dementia, as well as ways to address this distressing symptom.
(Edited publisher abstract)
Subject terms:
dementia, wandering, wellbeing, behaviour, carers, stress, home care, mental health problems, depression;
Objectives: Most individuals with dementia develop significant behavioural problems. Restlessness is a behavioural symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioural type, its prevalence, and development of effective interventions. The authors advance...
(Edited publisher abstract)
Objectives: Most individuals with dementia develop significant behavioural problems. Restlessness is a behavioural symptom frequently endorsed by caregivers as distressing, yet is variably defined and measured. Lack of conceptual and operational clarity hinders an understanding of this common behavioural type, its prevalence, and development of effective interventions. The authors advance a systematic definition and understanding of restlessness from which to enhance reporting and intervention development.
Method: The literature for existing definitions and measures of restlessness, is reviewed and common elements across existing definitions are identified. Fit with relevant theoretical frameworks are assessed, and the relationship between restlessness and other behavioural symptoms in a data set of 272 community-dwelling persons with dementia are explored.
Results: Twenty-five scales assessing restlessness were identified. Shared components included motor/neurological, psychiatric, and needs-based features. Exploratory analyses suggest that restlessness may co-occur primarily with argumentation, anxiety, waking the caregiver, delusions/hallucinations, and wandering. The authors propose that restlessness consists of three key attributes: diffuse motor activity or motion subject to limited control, non-productive or disorganised behavior, and subjective distress. Restlessness should be differentiated from and not confused with wandering or elopement, pharmacological side effects, a (non-dementia) mental or movement disorder, or behaviours occurring in the context of a delirium or at end-of-life.
Conclusion: Restlessness appears to denote a distinct set of behaviours that have overlapping but non-equivalent features with other behavioural symptoms. The authors propose that it reflects a complex behaviour involving three key characteristics. Understanding its specific manifestations and which components are present can enhance tailoring interventions to specific contexts of this multicomponent behavioural type.
(Edited publisher abstract)
REGIER Natalie G., HODGSON Nancy A., GITLIN Laura N.
Journal article citation:
Gerontologist, 57(5), 2017, pp.987-997.
Publisher:
Oxford University Press
Purpose: To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioural symptoms.
Design and Methods: Data involved 158 activity prescriptions or written documents detailing...
(Edited publisher abstract)
Purpose: To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioural symptoms.
Design and Methods: Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorised as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal–Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal–Wallis tests, pairwise comparisons utilized the Mann–Whitney U test.
Results: Activity categories and instructions for set up were significantly related to cognitive and functional levels. Persons with mild dementia were most often prescribed complex arts and crafts and cognitive activities. Persons with moderate dementia were most often prescribed music/entertainment. Persons with severe dementia were most often prescribed simple physical exercises and manipulation/sensory/sorting activities. Average time prescribed for activities was less for those in severe (15min) versus moderate (24min) and mild (28min) stages. The severe group required more assistance with activity initiation and cueing/redirection.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 31(9), 2016, pp.1056-1063.
Publisher:
Wiley
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were
(Edited publisher abstract)
Background: Previous research shows that nonpharmacological strategies may effectively manage behavioural symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. This study examines the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
Methods: Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioural symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviours) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.
Results: By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviours and higher confidence. Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.
Conclusion: By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioural symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioural management but not other caregiver outcomes.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 29(1), 2014, pp.93-102.
Publisher:
Wiley
Nonpharmacologic strategies to manage dementia-related behavioural symptoms depend upon caregiver implementation. Caregivers may vary in readiness to use strategies. Using data from a randomized trial involving 119 caregivers in a nonpharmacologic intervention for managing behavioural symptoms, this study examines characteristics of carers associated with readiness, extent readiness changed
(Edited publisher abstract)
Nonpharmacologic strategies to manage dementia-related behavioural symptoms depend upon caregiver implementation. Caregivers may vary in readiness to use strategies. Using data from a randomized trial involving 119 caregivers in a nonpharmacologic intervention for managing behavioural symptoms, this study examines characteristics of carers associated with readiness, extent readiness changed during intervention, and predictors of change in readiness. The intervention involved 12 sessions over 16 weeks to help carers identify a range of strategies (such as communication techniques and environmental modifications) to manage problem behaviours. Baseline measures included caregiver, patient, and treatment-related factors. At initial (2 weeks from baseline) and final (16 weeks) intervention sessions, interventionists rated caregiver readiness as pre-action (precontemplation = 1; contemplation = 2; preparation = 3) or action (= 4). Ordinal logistic regression identified baseline characteristics associated with initial readiness. Mc Nemar–Bowker test of symmetry described change in readiness; binary logistic regression identified baseline predictors of change in readiness (initial to final sessions). One-way multivariate analysis of variance identified treatment factors (dose/intensity, number of strategies used, perceived benefits, and therapeutic engagement) associated with change in readiness. At initial intervention session, 67.2% (N = 80) of caregivers were in pre-action and 32.8% (N = 39) in action. Initial high readiness was associated with better caregiver mood, less financial difficulty, lower patient cognition, and more behavioral symptoms. By final session, 72% (N = 79) were in action and 28% in pre-action; caregivers with less financial difficulty improved in readiness; those in action were more therapeutically engaged and perceived greater intervention benefits. Whereas patient and caregiver-related factors were associated with initial readiness, financial stability, therapeutic engagement, and perceived benefits enhanced probability of change. Understanding caregiver readiness and factors associated with its change may be important considerations in nonpharmacologic interventions.
(Edited publisher abstract)
Families of dementia patients receiving skilled homecare do not receive supportive services. This study evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into the homecare practices of occupational therapists and reimbursed through Medicare Part B. A 2-year...
Families of dementia patients receiving skilled homecare do not receive supportive services. This study evaluated whether a proven intervention, Environmental Skill-building Program (ESP), which reduces caregiver burden and enhances skills managing patient functioning, can be integrated into the homecare practices of occupational therapists and reimbursed through Medicare Part B. A 2-year translational project was conducted by occupational therapists in a private practice, Fox Rehabilitation, which provides house calls. Five translational activities included refining ESP, site preparation, therapist training, establishing referral mechanisms, and evaluating outcomes using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM). Of the 30 occupational therapists approached for participation, 23 agreed, 22 completed training, and 21 used ESP and intended to continue use. Of the 69 eligible caregivers, 41 agreed to participate averaging 4.7 sessions. Of 20 returned caregiver surveys, enhancements were reported in all targeted areas of knowledge and skills. Fidelity monitoring revealed inconsistency in therapists’ use of problem solving, yet caregiver enactment of ESP strategies was high. ESP sessions integrated within patient-directed therapy were reimbursed by Medicare Part B. The article concludes that the RE-AIM indicators suggest moderate translational success. As ESP was reimbursed through Medicare B, its delivery may be sustainable and meet the needs of family caregivers of dementia patients receiving therapies at home.
Subject terms:
home care, intervention, occupational therapists, occupational therapy, outcomes, stress, carers, dementia;
...of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. The TAP assessment, a combination
The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioural symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. TAP involves 8 sessions for a period of 4 months. Interventionists identify preserved capabilities, previous roles, habits, and interests of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. The TAP assessment, a combination of neuropsychological tests, standardized performance-based observations, and clinical interviewing, yielded information on capabilities from which to identify and tailor activities. Assessments were easy to administer, taking an average of two 1-hr sessions. Of 170 prescribed activities, 81.5% were used, for an average of 4 times for 23 min by families between treatment sessions for a period of months. Caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%). Interventionists observed enhanced engagement (100%) and pleasure (98%) in individuals with dementia during sessions. TAP offers families knowledge of their relative's capabilities and easy-to-use activities. The program was well received by caregivers. Prescribed activities appeared to be pleasurable and engaging to individuals with dementia. TAP merits further evaluation to establish efficacy with larger more diverse populations and consideration as a nonpharmacological approach to manage behavioural symptoms.
Subject terms:
intervention, occupational therapy, quality of life, activities of daily living, behaviour, carers, dementia;
Little is known about the specific behavioral strategies used by families to manage the physical dependency of persons with Alzheimer's disease and related disorders (ADRD). This American study reports the psychometric properties of the Task Management Strategy Index (TMSI), a measure designed to identify actions taken by caregivers to simplify everyday self-care tasks for persons with ADRD. Relationships between use of these strategies and caregiver and care-recipient characteristics were also examined. Results provide preliminary evidence that the TMSI is an easily administered, reliable, valid scale. Caregivers with lower education may benefit from instruction in the use of these strategies.
Little is known about the specific behavioral strategies used by families to manage the physical dependency of persons with Alzheimer's disease and related disorders (ADRD). This American study reports the psychometric properties of the Task Management Strategy Index (TMSI), a measure designed to identify actions taken by caregivers to simplify everyday self-care tasks for persons with ADRD. Relationships between use of these strategies and caregiver and care-recipient characteristics were also examined. Results provide preliminary evidence that the TMSI is an easily administered, reliable, valid scale. Caregivers with lower education may benefit from instruction in the use of these strategies.
Subject terms:
informal care, older people, psychology, stress, Alzheimers disease, dementia, families;
Article examines short-term effects of a home environmental intervention in the U.S. on self-efficacy and upset in caregivers and daily function of dementia patients. Also examines whether treatment effect varied by caregiver gender, race, and relationship to patient. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social...
Article examines short-term effects of a home environmental intervention in the U.S. on self-efficacy and upset in caregivers and daily function of dementia patients. Also examines whether treatment effect varied by caregiver gender, race, and relationship to patient. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications. Compared with controls, intervention caregivers reported fewer declines in patients' instrumental activities of daily living and less decline in self-care and fewer behaviour problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset, women reported enhanced self-efficacy in managing behaviours, and women and minorities reported enhanced self-efficacy in managing functional dependency. Concludes that The environmental program appears to have a modest effect on dementia patients' IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.
Subject terms:
intervention, occupational therapists, older people, randomised controlled trials, stress, activities of daily living, Alzheimers disease, attitudes, carers, black and minority ethnic people, dementia, evaluation, gender;