Yvonne Yueh Feng Lu

Long term caregiving: helping families of persons with mild cognitive impairment cope.

The purpose of the paper is to describe common psychological and caregiving issues that can cause stress in family members of persons with mild cognitive impairment (PwMCI) in order to assist family members in providing care and support to the PwMCI while also caring for themselves over long periods of time. Because PwMCI and their family members have time to prepare for the future should the PwMCI no longer be able to participate in their own care, it is important that clinicians offer support, education, and referrals for services and interventions when needed. The results of a review and synthesis of the caregiving literature found that much information exists from educational and intervention programs designed to help caregivers of Alzheimer disease however little empirical information is available for clinicians to assist PwMCI and their family members. This paper provides valuable and practical information for clinicians and other care providers to assist family members of PwMCI to cope with the uncertainty of the diagnosis, prepare for the future, and manage their stress over the long-term.

Distress Responses and Self-Care Behaviors in Dementia Family Caregivers With High and Low Depressed Mood

BACKGROUND: Most caregiving intervention studies have focused on reducing caregiver depression. Little is known about how caregivers manage their own symptoms, particularly caregivers with high depressed mood. OBJECTIVES: To compare caregiving stress, health status, physical function, symptom presence and severity, and self-care behaviors in family caregivers with high and low depressed mood. STUDY DESIGN: This study used a cross-sectional design. RESULTS: Caregivers with high depressed mood reported higher levels of caregiving stress, experienced more symptoms and more symptom severity, and had more physical performance difficulty than those caregivers with low depressed mood. However, they did not report a higher rate of asking for professional help per symptom. CONCLUSIONS: There is a need for developing outreach programs and coordinating information to encourage caregivers to address their own symptoms, identify services available in the community, and learn how to access them.

Frontotemporal Dementia Caregivers and Researchers Partnering for Brain Donation

This study utilized a community-based, participatory research model between the Association for Frontotemporal Degeneration (AFTD) and the Education Core of the Indiana Alzheimer Disease Center. A total of 30 caregivers of persons with frontotemporal dementia (FTD) participated in 6 focus groups in 3 cities. The majority of participants were spouses of the person with FTD and had been providing care for an average of 6 years. Transcript analysis revealed 7 prominent themes: willingness to participate, when/how the issue of brain donation is raised, who initiates discussion about brain donation, who is involved in decisions about brain donation, motivation for participating in brain donation, lack of effective communication, and barriers to research participation. Caregivers demonstrated a strong desire to participate in research and contribute to advancing knowledge. The lack of effective communication between the clinicians and caregivers was a barrier to developing positive rapport, detrimentally impacting research participation.

Content validity and acceptability of the daily enhancement of meaningful activity program: intervention for mild cognitive impairment patient-spouse dyads.

ABSTRACT Persons with mild cognitive impairment (PwMCI) are at greater risk for developing Alzheimer disease and experience various difficulties that decrease their quality of life. Very few interventions focus on helping PwMCI improve or maintain functional performance and enhance quality of life through meaningful activity engagement. The purpose of the study was to explore PwMCI and their spouses’ perspectives on the content validity, usefulness, and acceptability of the Daily Enhancement of Meaningful Activity (DEMA) program, which included 6 biweekly face-to-face sessions between session assignments and a self-management tool kit of written educational handouts. Nine PwMCI–care partner dyads participated in 3 focus groups (PwMCI alone, spouses alone, and couples) to capture their perspectives on DEMA. The transcribed focus group data were analyzed through content analysis. The three groups provided support for content validity and acceptability of the program, and they suggested additional content areas important to couples experiencing MCI. They also attested to the usefulness of the tool kit and gave suggestions for its further improvement. The findings provide evidence of the content validity and acceptability of the DEMA program. A pilot study to assess feasibility and preliminary efficacy of the DEMA on health-related outcomes is the recommended next research step for this program.

Impact of Noncaregiving-Related Stressors on Informal Caregiver Outcomes.

Background: Caregivers of persons with dementia are stressed. Stressors not related to care recipients’ needs impact caregiver outcomes, yet are seldom reported. The purpose of this study was to report the most stressful events experienced by spouse caregivers of older adults with Alzheimer s disease during a 6-month period. Methods: 31 caregivers completed the Most Stressful Event form, Patient Health Questionnaire (PHQ-9) and the Revised Memory Behavioral Problem Checklist (R-MBPC). Fisher’s exact test and two-sample t-test were used to compare Most Stressful Events between caregivers. ANOVA model tested whether the PHQ-9 and R-MBPC subscales differed by stressor. Results: Caregivers reported no stressors 21.5% of the time, 1-2 stressors 25% of the time, and 3 stressors 53% of the time with 318 stressors reported in total. Care recipient needs (30.2%), caregiver needs (26.7%), and decision-making (16.7%) were the most frequently reported stressors. Using a mixed effects model, there were associations between the Most Stressful Events and depression (p = 0.016), mobility (p = 0.024) and caregiver issues (p = 0.009) subscales of R-MBPC. Conclusion: Results can be used to develop targeted intervention and support strategies for spouse caregivers experiencing non-caregiving related stressorsas well as the traditional challenges with caregiving related issues.

Pilot Testing a Couples-Focused Intervention for Mild Cognitive Impairment

The purpose of this pilot was to evaluate the acceptability, feasibility, and potential benefits of the multicomponent, Daily Enhancement of Meaningful Activity (DEMA) intervention, which was tailored to help couples facing mild cognitive impairment (MCI) work together to meet goals, remain engaged in meaningful activities, and adapt to changes over time. Using a single-group design, 10 individuals with MCI and their family caregivers were recruited to participate in the DEMA intervention over 6 biweekly sessions. Data were collected pre-and at 1 week and 3 months postintervention completion rates indicated the program and study procedures were well accepted. Qualitative and quantitative finding indicated positive trends in meaningful activity performance and maintenance of health-related outcomes, as well as high program satisfaction. The DEMA intervention is potentially promising but needs further testing in a randomized clinical trial.

Cost template for meaningful activity intervention for mild cognitive impairment.

Purpose: The objective of the study was to describe and compare cost estimates for a pilot study of the Daily Enhancement of Meaningful Activity intervention for persons with mild cognitive impairment–caregiver dyads. Background: The increasing complexity of the healthcare system and rising healthcare costs have forced nurse scientists to find ways to effectively improve healthcare quality and control cost, but no studies have examined costs for new programs that target persons with mild cognitive impairment–caregiver dyads. Description of the Project: Pilot study data were used to develop a cost template and calculate the cost of implementing the Daily Enhancement of Meaningful Activity. Outcomes: Mean cost per dyad was estimated to be

Exploration of Perceived Psychosocial Benefits of Senior Companion Program Participation Among Urban-Dwelling, Low-Income Older Adult Women Volunteers

1327.97 in the clinical setting, compared with

Intervention fidelity in Qigong randomized controlled trials: A method review

1069.06 if a telephone delivery mode had been used for 4 of the 6 face-to-face sessions. This difference was largely due to transportation-related expenses and staff cost. Implications: Daily Enhancement of Meaningful Activity should be evaluated further with larger and more diverse samples as a technology-delivered health promotion program that could reduce costs.

Satisfaction with a family-focused intervention program for persons with mild cognitive impairment and their caregivers

Abstract Background As the older adult population increases, it is imperative to increase older adults’ opportunities for social involvement, thus maintaining their important roles and contributions to society. While there are known health-related benefits of volunteerism among older adults, a dearth of information exists on the perceived benefits of volunteerism among low-income and ethnic minority older adults. Purpose To understand the perceived psychosocial benefits of volunteering in the Senior Companion Program and to present findings of focus groups conducted with urban-dwelling, low-income older adult women volunteers. Design and Methods Inductive content analysis and the Dedoose qualitative data analysis software were used for analyzing data obtained from 59 older adult women Senior Companions who participated in nine focus groups. Results Content analyses of the focus group transcripts identified four major themes: (1) Reducing social isolation; (2) Improving quality of life; (3) Finding purpose and meaning; and (4) Increasing understanding of aging. The majority of our participants (81%) were African American women, with a mean age of 70 years. Approximately 83.1% had completed high school and 62.7% lived below the poverty line. Discussion and Implications Findings provided data rich in descriptions of positive psychosocial outcomes, finding meaning and purpose, and a better understanding of aging in urban-dwelling, low-income older women volunteers. The findings also provide support for the need for policies and programs that promote civic engagement in this population.