Developing Behavioral Coding to Understand Family Communication Breakdown in Dementia Care

Communication breakdown is a challenge for family caregivers of persons living with dementia. We adapted established theory and scales for computer-assisted behavioral coding to characterize caregiver communication for a secondary analysis. We developed verbal, nonverbal, and breakdown coding schemes and established reliability (κ > .85). Within the 221 family caregiving videos analyzed, 55% of exchanges were interactive, 30% were silence, 4% consisted of talking to self or others, and 8% included a breakdown. An average of 2.4 ( SD = 1.9) breakdowns occurred per observation and were successfully resolved 85% of the time, with 31% being resolved most successfully following only one flag and repair strategy. Caregivers were the primary speakers (67%); their communication preceded most breakdown (65%), and they primarily initiated the repairs after a breakdown (70%). Common repair strategies included clarifications (31%), asking questions (24%), and repeating information (24%). Associations between communication strategies and repair success will provide evidence for caregiver training.

Family Caregiver Training During Medicare Home Health Care: Clinician Perspectives

During Medicare home health care, providers often rely on family caregivers to help meet patients’ care needs. Beginning in 2018, CMS requires home health agencies to provide training to family caregivers. This qualitative study is the first research to examine current patterns of family caregiver training, and related facilitators and barriers, during Medicare-funded home health care. We conducted semi-structured key informant interviews with home health nurses and physical therapists (n=19) from 4 diverse agencies, then performed thematic analysis of interview transcripts using a hybrid inductive and deductive coding approach. Clinicians described family caregiver education as a dynamic and cyclical process: simultaneously providing patient care, training family caregivers, and gathering additional information about patient needs and caregiver capabilities, then adjusting the care plan accordingly. We present a model of this cyclic process and describe its four major stages: Initial Assessment, Education, Reassessment, and Adjustment. Additionally, clinicians identified a range of structural, individual, and interpersonal factors which impact their ability to successfully train family caregivers. We define each factor and, using illustrative quotes from our interviews, elucidate its role as a facilitator and/or barrier to clinicians’ educational efforts. Findings provide the first model of caregiver training during home health care and highlight policy and practice changes to better support clinicians in these efforts; including greater visit flexibility, access to more experienced clinical mentors, and standardized caregiver assessment tools designed for this unique care setting.

Evaluation of the Savvy Caregiver Program for LGBTQIA Adults Living With Alzheimer's Disease and Related Dementias

Approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing 1 million by 2030. LGBTQIA+ older adults face challenges in receiving adequate and inclusive care and caregiving support due to the inability to rely on traditional family networks, greater disability, and discrimination when seeking aging services. Working with the Los Angeles LGBT Center Aging in Community Initiative, we evaluated the: 1) Adaptation of the Savvy caregiver training program for care providers of LGBTQIA+ persons living with ADRD; and 2) Feasibility and acceptability of the program. Care providers were very satisfied with the program, strategies, information, and activities of the tailored Savvy program. For psychosocial outcomes, there were trends in greater care planning, increases in asking friends/family for support, and decreased loneliness. Additional research is needed on culturally-relevant aging services and behavioral interventions for care providers of LGBTQIA+ persons living with ADRD.

National Family Caregiver Support Program Participants' Recommendations to Boost Caregiver Supports

For more than 20 years, family caregivers have been supported through the National Family Caregiver Support Program (NFCSP) of the Older Americans Act (Title IIIE). The NFCSP provides information to caregivers about available services; assistance in gaining access to services; counseling, support groups and caregiver training; respite care; and supplemental services. In the 2019 National Survey of Older Americans Act Participants, 1,909 NFCSP caregivers were asked “What recommendations do you have for improving the service?” The resulting 748 open-ended responses were thematically coded. The thematic analysis yielded six major themes: Additional Resources, Staffing, Communication, Care Coordination, Quality of Services, and Eligibility. Sub-themes were identified for Additional Resources and Staffing. The most common sub-themes for Additional Resources were requests for more help or services (e.g., grocery shopping), increased funding or financial assistance, and more service hours (e.g., overnight or holiday care). The most common sub-theme for Staffing was the need for consistent staffing due to high turnover of staff. Chi-Squared tests and Fisher’s Exact tests indicated that there were no significant associations between any of the recommendation themes and the gender of the caregiver, employment status of the caregiver, or whether the care recipient has Alzheimer’s or dementia. Many of the themes align with results from a recent RAISE Family Caregiving Advisory Council Report. Recommendations from both sets of findings indicate ways that programs, services, and policies can be enhanced to support the needs of care recipients and caregivers.

Effects of a social support family caregiver training program on changing blood pressure and lipid levels among elderly at risk of hypertension in a northern Thai community

Hypertension is becoming increasingly prevalent among the elderly. Family caregivers play an important role in caring for elderly people and empowering them to care for themselves. This study’s goal was to see how social support training for family caregivers affected changes in hypertension, total cholesterol, and high-density lipoprotein (HDL), and how such support led to the prevention of hypertension behaviors among the elderly in rural areas. This was a quasi-experimental study with 268 elderly people at risk of hypertension and their caregivers. Sixty seven pairs of elderly people and their caregivers were assigned to the intervention and control groups. Baseline data were collected in November 2020. The intervention group received the Social Support Family Caregiver Training Program (SSFCTP), while the control group received a regular program from the local health authority. The activity lasted 12 weeks, with home visits and telephone check-ups along the way, and data collection took place after the program ended. The final data were collected three months after the end of the intervention. An analysis of repeated measures ANOVA showed the overall effect of the SSFCTP on knowledge, self-efficacy, health care behaviors, and blood pressure among elderly people during three different time periods (p<0.05). Furthermore, the intervention program had a time-dependent effect on knowledge, blood pressure, and total cholesterol levels (p<0.05). In terms of caregiver outcomes, there was an overall difference among the degrees of knowledge, self-efficacy, and behaviors toward health care displayed by elderly hypertensive patients during the three different time periods (p<0.05). The average knowledge and self-efficacy of the participants improved after the intervention. As a result, better self-care behaviors and lower blood pressure and total cholesterol levels were observed among the elderly participants after the intervention. The programs emphasized the importance of caregivers’ roles in providing social support, boosting confidence, and encouraging participation in caring, monitoring, and assisting the elderly in controlling blood pressure and other health issues.

Evaluation of the Impact of Rehabilitation Training on the Knowledge and Attitude of Caregivers of COVID-19 Patients in Iran

Applying rehabilitative measures is shown to be influential in relieving the medical complications of the COVID-19 disease. Herein, we aimed to assess the effect of a rehabilitation training class on the knowledge and attitude of the caregivers of the COVID-19 patients. Twenty-three caregivers voluntarily filled the questionnaire before and after attending a training class that evaluated the participants' beliefs about the four types of rehabilitations in COVID-19, including musculoskeletal, respiratory, gastrointestinal, and deep vein thrombosis (DVT) prevention. Significant improvement in the caregiver's attitude about the importance of all four rehabilitation types was detected. Also, the knowledge was increased about the necessity of DVT prevention. The level of knowledge in the caregivers of COVID-19 patients in Iran is not satisfactory, which necessitates proper education to achieve the rehabilitation goals rapidly. In-person caregiver training along with presenting pamphlets is of the most useful methods.

Hear to Care: The role of caregivers in the spiritual care of residents in New Zealand Rest Homes

<p>This thesis argues that caregivers are exposed to the spiritual needs of rest home residents much more than might have previously been recognised, and that they are a more important part of the matrix of spiritual care than has been understood or acknowledged. By employing a qualitative research methodology, staff, residents and management at two rest homes in the greater Wellington region were interviewed to address the question: to what extent and in what ways is spiritual care a part of the caregiver role in New Zealand rest homes? The research explores current understandings and perceptions of the caregivers' role in attending to the spiritual needs of the residents by addressing a key set of related questions that arise from consideration of the rest home milieu. The research indicates that the move into a rest home is a turning point in the life of the residents. The changes involved in this transition may lead to a spiritual search for meaning, and to questioning that arises from a sense of being in transition from life to death. In the course of daily work, caregivers, as members of the team that provides holistic care, therefore relate to residents who are experiencing various spiritual challenges associated with rest home life and the vulnerability of ageing. Caregivers' confidence to respond to residents' spiritual needs was explored. The thesis suggests that there would be value in extending caregiver training to strengthen their capacity to recognise and respond to spiritual issues when they occur in the course of their work. Such training is seen as important if provision of care in rest homes for the aged population in New Zealand is to be truly holistic.</p>

Hear to Care: The role of caregivers in the spiritual care of residents in New Zealand Rest Homes

<p>This thesis argues that caregivers are exposed to the spiritual needs of rest home residents much more than might have previously been recognised, and that they are a more important part of the matrix of spiritual care than has been understood or acknowledged. By employing a qualitative research methodology, staff, residents and management at two rest homes in the greater Wellington region were interviewed to address the question: to what extent and in what ways is spiritual care a part of the caregiver role in New Zealand rest homes? The research explores current understandings and perceptions of the caregivers' role in attending to the spiritual needs of the residents by addressing a key set of related questions that arise from consideration of the rest home milieu. The research indicates that the move into a rest home is a turning point in the life of the residents. The changes involved in this transition may lead to a spiritual search for meaning, and to questioning that arises from a sense of being in transition from life to death. In the course of daily work, caregivers, as members of the team that provides holistic care, therefore relate to residents who are experiencing various spiritual challenges associated with rest home life and the vulnerability of ageing. Caregivers' confidence to respond to residents' spiritual needs was explored. The thesis suggests that there would be value in extending caregiver training to strengthen their capacity to recognise and respond to spiritual issues when they occur in the course of their work. Such training is seen as important if provision of care in rest homes for the aged population in New Zealand is to be truly holistic.</p>