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Dementia-related restlessness: relationship to characteristics of persons with dementia and family caregivers
- Authors:
- REGIER Natalie G., GITLIN Laura N.
- Journal article citation:
- 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 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)
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)
Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable Medicare service: outcomes and lessons learned
- Authors:
- GITLIN Laura N., JACOBS Mimi, EARLAND Tracy Vause
- Journal article citation:
- Gerontologist, 50(6), December 2010, pp.847-854.
- Publisher:
- Oxford University Press
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.
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.
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.