Search results for ‘Author:"gitlin laura n."’ Sort:
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Conducting research on home environments: lessons learned and new directions
- Author:
- GITLIN Laura N.
- Journal article citation:
- Gerontologist, 43(5), October 2003, pp.628-637.
- Publisher:
- Oxford University Press
The study of home environments is a research domain within the field of environmental gerontology that addresses issues related to aging in place. Despite the importance of aging at home, there are few recent studies in this area and most are descriptive and lack theoretical direction. This article examines the current state of research on home environments from which methodological challenges and new directions for future research are identified. Three broad research queries are posed: What should we measure and why in home environments? How do older people and their family members use the home environment in health, illness, and caregiving? What are the interrelationships between the home environment, psychological well-being, and daily functioning throughout the aging process? Suggestions for future research on home environments are discussed and the implications for advancing environmental gerontology highlighted. Specifically, the home environment offers a testing ground for generic environmental constructs and their measurement as well as a unique setting from which new understandings and constructs of person -environment fit can emerge.
A randomised, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia
- Author:
- GITLIN Laura N.
- Journal article citation:
- Gerontologist, 41(1), February 2001, pp.4-14.
- Publisher:
- Oxford University Press
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.
Delivery characteristics, acceptability, and depression outcomes of a home-based depression intervention for older African Americans: the Get Busy Get Better Program
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 56(5), 2016, pp.956-965.
- Publisher:
- Oxford University Press
Purpose of the Study: To facilitate replication, the authors examined delivery characteristics, acceptability, and depression outcomes of a home-based intervention, Get Busy Get Better, Helping Older Adults Beat the Blues (GBGB). GBGB, previously tested in a randomised trial, reduced depressive symptoms and enhanced quality of life in African Americans. Design and Methods: A total of 208 African Americans aged above 55 years with Patient Health Questionnaire (PHQ-9) scores ≥5 on two subsequent screenings were randomised to receive GBGB immediately or 4 months later. GBGB involves up to 10 home sessions consisting of care management, referral/linkage, depression education/symptom recognition, stress reduction, and behavioural activation. Interventionists recorded delivery characteristics (dose, intensity) and perceived acceptability of sessions. Baseline and post-tests were used to characterise participants and examine associations between dose/intensity and depression scores. Participant satisfaction and perceived benefits were examined at 8 momths. Results: Of 208 participants, 181 (87%, mean age = 69.6) had treatment data. Of these, 165 (91.2%) had ≥3 treatment sessions (minimal dose). Participants had on average 8.1 sessions (SD = 2.6) for an average of 65.4min (SD = 18.3) each. Behavioural activation and care management were provided the most (average of six sessions for average duration = 17.9 and 22.2min per session respectively), although all participants received each treatment component. GBGB was perceived as highly acceptable and beneficial by interventionists and participants. More sessions and time in programme were associated with greater symptom reduction. Implications: GBGB treatment components were highly acceptable to participants. Future implementation and sustainability challenges include staffing, training requirements, reimbursement limitations, competing agency programmatic priorities, and generalisability to other groups. (Edited publisher abstract)
Impact of caregiver readiness on outcomes of a nonpharmacological intervention to address behavioral symptoms in persons with dementia
- Authors:
- GITLIN Laura N., ROSE Karen
- Journal article citation:
- 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 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)
Factors associated with caregiver readiness to use nonpharmacologic strategies to manage dementia-related behavioral symptoms
- Authors:
- GITLIN Laura N., ROSE Karen
- Journal article citation:
- 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 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)
Enhancing quality of life in functionally vulnerable older adults: from randomized trial to standard care
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Generations, 34(1), Spring 2010, pp.84-87. Published online.
- Publisher:
- American Society on Aging
Individuals at any age can learn new strategies to engage in valued activities. Advancing Better Living for Elders or ABLE is a home-based intervention for functionally vulnerable older adults based on the Lifespan Theory of Control. An active phase of the intervention involves five occupational therapy sessions and one physical therapy home session (90 minutes) over six months. Use and challenges around the ABLE program are discussed.
The tailored activity program to reduce behavioral symptoms in individuals with dementia: feasibility, acceptability, and replication potential
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 49(3), June 2009, pp.428-439.
- Publisher:
- Oxford University Press
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.
Harvest health: translation of the chronic disease self-management program for older African Americans in a senior setting
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 48(5), October 2008, pp.698-705.
- Publisher:
- Oxford University Press
The translation of K. R. Lorig and colleagues' Chronic Disease Self-Management Program (CDSMP) for delivery in a senior centre and evaluate pre–post benefits for African American participants is described. Modifications to the CDSMP included a name change; an additional introductory session; and course augmentations involving culturally relevant foods, stress reduction techniques, and communicating with racially/ethnically diverse physicians. Participants were recruited from senior centre members, area churches, and word of mouth. Baseline and 4-month post-interviews were conducted. A total of 569 African American elders attended an introductory session, with 519 (91%) enrolling in the 6-session program. Of the 519, 444 (86%) completed 4 sessions and 414 (79%) completed pre–post interviews. We found small but statistically significant improvements for exercise, use of cognitive management strategies, energy/fatigue, self-efficacy, health distress, and illness intrusiveness in different life domains. No changes were found for health utilization. Outcomes did not differ by gender, number of sessions attended, number and type of chronic conditions, facilitator, leader, or recruitment site. The CDSMP can be translated for delivery by trained senior centre personnel to African American elders. Participant benefits compare favourably to original trial outcomes. The translated program is replicable and may help to address health disparities.
Enhancing quality of life of families who use adult day services: short- and long-term effects of the adult day services plus program
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 46(5), October 2006, pp.630-639.
- Publisher:
- Oxford University Press
This study examined the short- and long-term effects of Adult Day Services Plus (ADS Plus), a low-cost care management intervention designed to enhance family caregiver well-being, increase service utilization, and decrease nursing home placement of impaired older adults enrolled in adult day care. The study used a quasi-experimental design, to recruit 129 caregivers from three adult day centres. Two centres offered adult day services and ADS Plus (n = 67); the third centre (n = 62) offered only routine adult day services. ADS Plus involved a staff social worker who provided care management and support to family caregivers through face-to-face and telephone contact. Education, counselling, and referral services were offered for 12 months. At 3-month follow-up, ADS Plus participants (n = 106) reported less depression, improved confidence managing behaviours and enhanced well-being compared with controls. Long-term effects analyses (n = 69) showed that, compared with controls, ADS Plus participants continued to report less depression and enhanced confidence managing behaviours. Also, intervention participants used adult day services on average 37 days more than controls and had fewer nursing home placements (n = 8) than controls (n = 17). ADS Plus is cost efficient and is easy to implement within adult day centres. It affords important clinical and public health benefits, including enhanced caregiver well-being, greater adult day service use, and fewer nursing home placements.
Effects of the Home Environmental Skill-Building Program on the caregiver–care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative
- Authors:
- GITLIN Laura N., et al
- Journal article citation:
- Gerontologist, 43(4), August 2003, pp.532-546.
- Publisher:
- Oxford University Press
The authors examine 6-month effects of the Environmental Skill-Building Program on caregiver well-being and care recipient functioning and whether effects vary by caregiver gender, race (White or non-White), and relationship (spouse or nonspouse). Researchers enrolled 255 family caregivers of community-residing persons with Alzheimer's disease or related disorders, of whom 190 participated in a follow-up interview. Caregivers were randomized to a usual care control group or intervention group that received five home contacts and one telephone contact by occupational therapists, who provided education, problem-solving training, and adaptive equipment. Baseline and 6-month follow-up included self-report measures of caregiver objective and subjective burden, caregiver well-being, and care recipient problem behaviors and physical function. Compared with controls (n = 101), intervention caregivers (n = 89) reported less upset with memory-related behaviors, less need for assistance from others, and better affect. Intervention spouses reported less upset with disruptive behaviors; men reported spending less time in daily oversight; and women reported less need for help from others, better affect, and enhanced management ability, overall well-being, and mastery relative to control group counterparts. Statistically significant treatment differences were not found for hours helping with instrumental activities of daily living, upset with providing assistance with instrumental activities of daily living and activities of daily living, perceived change in somatic symptoms, White versus non-White caregivers, or care recipient outcomes. The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses.