Faculty Bibliography

PURPOSE OF THE STUDY: This study determined whether the NYU Caregiver Intervention for Adult Children (the NYUCI-AC) significantly reduced primary subjective stress for adult child caregivers of persons with dementia. DESIGN AND METHODS: The NYUCI-AC was evaluated within a single-blinded randomized controlled trial. The sample included 107 adult child caregivers of persons with dementia (n = 54 assigned to the multicomponent treatment group; n = 53 assigned to a contact control group). Participants completed comprehensive assessments at baseline and at 4-month intervals during the first year and every 6 months thereafter. The focus of the current analysis was on the effects of the NYUCI-AC on change in primary subjective stress over 8, 12, and 18 months. RESULTS: Individual growth curve models found that caregivers in the NYUCI-AC treatment condition indicated statistically significant (p < .05) linear declines in overall negative reactions to behavior problems over a 1-year period when compared with controls. Adult child caregivers in the NYUCI-AC also indicated greater decreases in negative reactions to disruptive behavior problems when compared with controls over 8, 12, and 18 months. IMPLICATIONS: The NYUCI-AC offered adult child caregivers counseling and support that improved their ability to manage their reactions to disruptive behaviors. This occurred despite the fact that other primary subjective stressors, such as role captivity and role overload, were not reduced.

BACKGROUND/RATIONALE: This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). METHODS: Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms. RESULTS/CONCLUSION: The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia.

OBJECTIVES: This study determined whether the NYU Caregiver Intervention for Adult Children (the NYUCI-AC) significantly reduced depressive symptoms and improved quality of life for adult child caregivers of persons with dementia. METHODS: The NYUCI-AC was evaluated within a single-blinded randomized controlled trial. The sample included 107 adult child caregivers of persons with dementia (N = 54 assigned to the multi-component treatment group; N = 53 assigned to a contact control group). Participants completed comprehensive assessments every 4 months during the first year and every 6 months thereafter for at least 2 years and up to 3.79 years. RESULTS: Individual growth curve models found that caregivers in the NYUCI-AC treatment condition indicated statistically significant (p <0.05) curvilinear decreases in symptoms of depression indicating withdrawal, apathy, and lack of vigor and increases in perceptions of overall quality of life over a 3-year period in comparison to control caregivers. CONCLUSIONS: The NYUCI-AC offered adult child caregivers the capacity, via individual and family counseling as well as ongoing support, to enhance their quality of life and overcome their social withdrawal and apathy over time. These findings lend additional support to the NYUCI as an evidence-based approach to support family caregivers of persons with dementia.

The aim of this study was to develop an Internet-based self-directed training program for Australian healthcare workers to facilitate learning and competence in delivery of a proven intervention for caregivers of people with dementia: The New York University Caregiver Intervention (NYUCI). The NYUCI is a nonpharmacological, multicomponent intervention for spousal caregivers. It is aimed at maintaining well-being by increasing social support and decreasing family discord, thereby delaying or avoiding nursing home placement of the person with dementia. Training in the NYUCI in the United States has, until now, been conducted in person to trainee practitioners. The Internet-based intervention was developed simultaneously for trainees in the U.S. and Australia. In Australia, due to population geography, community healthcare workers, who provide support to older adult caregivers of people with dementia, live and work in many regional and rural areas. Therefore, it was especially important to have online training available to make it possible to realize the health and economic benefits of using an existing evidence-based intervention. This study aimed to transfer knowledge of training in, and delivery of, the NYUCI for an Australian context and consumers. This article details the considerations given to contextual differences and to learners' skillset differences in translating the NYUCI for Australia.

Background: As the number of people with dementia increases, there is a growing need for trained providers of evidence-based interventions to support family caregivers.A20-year randomized controlled trial demonstrated many benefits of the NYUC are giver Intervention (NYUCI)-reduced caregiver depression and stress and improved physical health, and delayed nursing home placement of the person with dementia. The intervention has been widely implemented, but until now, clinician training was provided in person by the original investigator and an expert counselor. Online training, if equally effective, would provide a technological solution, accessible 24/7, reducing cost and increasing accessibility. Methods: We developed an Internet-based training program that contains text, videos of interviews with experts, role play and case studies as well as certification and continuing education credits. We conducted a cluster randomized controlled trial to test the hypothesis that online training was no worse than in-person training. Participants were asked to complete a 100-item multiple choice and true-false test of knowledge of the NYUCI, 2 and 4 months after the training. The 2-month follow-up results have just become available. Results: We enrolled 261 participants in the US and Canada over a 2-year period. Among enrollees, 173 (66.2%) completed the 2 month follow-up test; 72.9% of those assigned to in person and 59.4% of those assigned to online training. Follow-up completion increased significantly, from 43.1% in year 1 to 74.4% in year 2, after efforts to assure buy-in from supervisors, clarification of expectations, and restricting the time interval for online training. There was no difference in test scores between clinicians trained in person and online (in-person mean= 79.4, sd= 5.8, vs online mean= 80.9, sd=7.7; t=-1.46, p=0.15). Only 2 participants assigned to online training dropped because of difficulty with the technology while 9 were unable to attend the in-person training due to scheduling or personal conflicts. Conclusions: While there are challenges in assuring high rates of completion, Internet-based training in implementing an evidence-based caregiver intervention can be as effective as in person training for social service providers, is more accessible and cost-effective and can lead to widespread availability of a skilled workforce to support family caregivers

The current study developed prognostic tools to identify dementia caregivers at-risk for clinically relevant burden or depressive symptoms following nursing home admission (NHA) of their family members. A retrospective, longitudinal design was used that included 1,610 dementia caregivers who provided data prior to and up to 6 months following nursing home admission. Response operant characteristic (ROC) curves were constructed to test and validate two prognostic tools: the NHA-Burden and NHA-Depression tools. An ROC curve yielded a sensitivity of 77% and a specificity of 62.5% at a cutoff score of 5.41 for the NHA-Burden Prognostic tool. A second ROC curve indicated a sensitivity of 75.4% and a specificity of 62.5% at a cutoff score of 7.45 for the NHA-Depression tool. Clinicians may wish to utilize cutpoints on the NHA-Burden and NHA-Depression tools to ensure that more persons who are at-risk for clinically significant burden or depression during NHA are identified.

PURPOSE: This study determined whether the NYU Caregiver Intervention, adapted in Minnesota for adult child caregivers (NYUCI-AC), prevented or delayed residential care placement for persons with dementia. DESIGN AND METHODS: A single-blinded randomized controlled trial design was used. One hundred and seven adult child caregivers of persons with dementia were randomly assigned to the NYUCI-AC treatment group who received individual and family counseling, support group referral, and ad hoc consultation or a contact control group. Participants were asked to complete structured assessments quarterly during Year 1 and every 6 months thereafter for a minimum of 2 years. RESULTS: Two thirds (66%) of adult child caregivers in the control condition admitted their parent to a residential care setting compared with 37% in the treatment condition. Logistic regression and Cox proportional hazards models found that NYUCI-AC participants were significantly less likely (p < .05) to admit their parents to a residential care setting and delayed their parents' time to admission significantly longer (228.36 days longer on average) than those in the control group. IMPLICATIONS: The multicomponent NYUCI-AC offered adult children the psychosocial support required to continue providing care to cognitively impaired parents at home.