Post on 12-Jun-2018
Implementation in Health Care Implementation in Health Care and Social Service Systems: and Social Service Systems:
REACH VAREACH VA
Linda Olivia Nichols, PhD
Jennifer Martindale-Adams, EdD
VA Medical Center at Memphis, University of Tennessee Health Science Center
Resources for Enhancing Resources for Enhancing Alzheimer's Caregivers HealthAlzheimer's Caregivers Health
Multi-component 6 month, randomized clinical trial, 6/02 to 12/04
Funded by NIA and NINR, additional supportfrom VA
Five sites and Coordinating Center Recruited 642 caregiver dyads
African Americans/BlacksHispanics/LatinosCaucasians/Whites
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InterventionInterventionInterventionTwelve individual sessions over six months in home and via telephone Five telephone support group sessions Intervention addressed:
EducationSafetyEmotional well beingSelf-careSocial supportPatient problem behaviors/caregiver skills
Twelve individual sessions over six months in home and via telephone Five telephone support group sessions Intervention addressed:
EducationSafetyEmotional well beingSelf-careSocial supportPatient problem behaviors/caregiver skills
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Primary outcome - multivariate quality of life Depressive symptomsBurdenSelf-careSocial supportPatient problem behaviors/caregiver skills
Secondary outcomes Caregiver clinical depressionPatient institutional placement Vigilance
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OutcomesOutcomesOutcomes
Improvement in quality of life for intervention, compared to control:
Hispanic/Latino caregivers (p < .001) White/Caucasian caregivers (p = .037)Black/African American spouse caregivers (p = .003)
Lower prevalence of clinical depression (p = .001) for intervention caregivers
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FindingsFindingsFindings
Belle et al., Ann Int Med, 2006, 145,727Belle et al., Ann Int Med, 2006, 145,727--738738
Hours/DayTask On Duty
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
Change in Hours Over 6 Months
ControlControl
InterventionIntervention
F = 7.02F = 7.02
P = .008P = .008
.6.6--.5.5
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Nichols et al., JAGS, 2008, 56:413Nichols et al., JAGS, 2008, 56:413--420420
-2
-1.5
-1
-0.5
0
0.5
1
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Change in Hours Over 6 Months
InterventionIntervention
ControlControl.6.6
.2.2
F = 2.98F = 2.98
P = .085P = .085
One additional hour of non-caregiving time per day
at a
Cost of $4.96 per day per caregiver
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Nichols et al., JAGS, 2008, 56:413Nichols et al., JAGS, 2008, 56:413--420420
REACH II implemented into a clinical setting
VHA SettingCaregiver Assistance pilot programHome Based Primary CarePsychologist, Social Worker, or NurseAdded to normal dutiesR
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REACH II implemented into a clinical setting
VHA SettingCaregiver Assistance pilot programHome Based Primary Care120 caregiversAdded to normal dutiesR
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Intervention Goals
Identify and reduce modifiable risk factorsEnhance quality of care of care recipientEnhance emotional and physical well-being of caregiver
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InterventionR
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A Twelve individual sessions over six months in home and via telephone Five telephone support group sessions Intervention addresses:
EducationSafetyEmotional well beingSelf-careSocial supportPatient problem behaviors/caregiver skills
Twelve individual sessions over six months in home and via telephone Five telephone support group sessions Intervention addresses:
EducationSafetyEmotional well beingSelf-careSocial supportPatient problem behaviors/caregiver skills
Materials
Training ManualInterventionist ManualSupport Group Leader ManualCaregiver Notebook
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Behavioral Topics
ActivitiesBathingCombativenessCommunicationConfusionDental CareDepression (patient)DressingDrivingEarly Stage DementiaEatingEnvironmentFeelings (patient)GriefHallucinations/Delusions
Holidays (patient)HospitalizationIncontinenceMedicationsNutritionRepeated QuestionsSafetySexuality (patient)ShadowingSleepingSundowningTelling the Patient/OthersTravelingVisitingWandering
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Stress and Coping Topics
Adult Day CareAsking for Help CommunicatingDepression (Caregiver)Early Stage DementiaFeelings (Caregiver)Financial/Legal IssuesGetting Help (Resources)GriefHealthy Lifestyle
Holidays (Caregiver)Making New FriendsPositive ThinkingProblem SolvingSexuality (Caregiver)Stress Management
Signal BreathMusicStretchingPleasant Events
Visiting
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Risk Areas, Treatments, and OutcomesRisk Areas, Treatments, and Outcomes
Caregiver Risk Area Intervention Options Outcomes
Safety (driving, Safety (driving, access to weapons, access to weapons, medications, medications, household household obstacles)obstacles)
WanderingWandering
Home assessments Home assessments and alterations; and alterations; patient monitoring patient monitoring devices; removing devices; removing accessaccess
SecuringSecuring doorsdoors, developingdeveloping safesafepathspaths, IDID braceletbracelet
Reduction or Reduction or elimination of elimination of targeted risk areatargeted risk area
Decreased or Decreased or safer wanderingsafer wandering
Schulz et al. Schulz et al. Am J Geriatr Psychiatry.Am J Geriatr Psychiatry. 2004;12:2402004;12:240--249.249.
Certification
ReadingsCentral training Learning Process WorksheetsCoaching
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Sites
Albany, NYBath, NYSyracuse, NYWellsville, NYElmira, NYRome, NYNew York City, NYNorthport, NYButler, PAPittsburgh, PAPhiladelphia, PADurham, NCAtlanta GAAugusta, GA
Memphis, TNMt. Home, TNHuntington, WVCincinnati, OHAnn Arbor, MIBattle Creek, MIGrand Rapids, MIHouston, TXSalt Lake City, UT Minneapolis, MNAlbuquerque, NMDenver, CONewington, CTWesthaven, CTSacramento, CA
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REACH VA implemented in a social service setting
AoA evidence-based demonstration grantRosalynn Carter Institute, Georgia Southwestern State UniversityAAA aging network service partners delivering intervention and groupsTargeting 150 caregivers in rural Georgia 2 interventionists1 group leaderR
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REACH VA implemented in a social service setting
AoA evidence-based demonstration grantRosalynn Carter Institute, Georgia Southwestern State UniversityAAA aging network service partners delivering intervention and groups150 caregivers in rural Georgia2 interventionists1 group leader
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Memphis REACH Coordinating Center
MaterialsCentral training CoachingCertificationEvaluation orEvaluation consultation
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Memphis REACH Coordinating Center
MaterialsCentral training CoachingCertificationEvaluation orEvaluation consultation
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