Faculty Bibliography

INTRODUCTION/BACKGROUND:The New York University Caregiver Intervention plus Enhanced Support Project is a randomized controlled trial of a family-based psychosocial intervention to enhance social support and reduce cardiometabolic risk for Chinese and Korean American dementia caregivers, using culturally tailored recruitment strategies. METHODS:We reviewed reflections from research staff, weekly meeting minutes, debriefing sessions, and progress reports, to identify key challenges and approaches to engaging participants. RESULTS:Key challenges included reluctance to involve family members, dementia stigma, and resistance to involving family. In response, we engaged online communities, partnered with local organizations, participated in events, and adapted recruitment messages to cultural norms. For the Chinese community, we focused on practical skills while for the Korean community, we emphasized caregiving strategies and the personal/social benefits of participation, reducing rejection rates. DISCUSSION/CONCLUSIONS:Our findings underscore the importance of culturally tailored recruitment strategies in dementia research. Respectful, sensitive, and culturally informed approaches can significantly enhance engagement and participation. HIGHLIGHTS/CONCLUSIONS:Culturally adapted recruitment strategies improve study engagement with Chinese and Korean American dementia caregivers. Community partnerships with local social services agencies are essential for recruitment success. Culturally relevant social media applications were integrated to increase accessibility for study participants. This study uniquely targets and recruits Chinese and Korean American dementia caregivers with metabolic syndrome-related symptoms, incorporating a psychological intervention alongside biomarker data collection. The iterative adaptation of recruitment methods and tailored messaging to specific ethnic groups ensure the intervention is culturally aligned, enhancing both participation and relevance to the caregivers' unique health and caregiving contexts.

The main objective of the current study was to ascertain the efficacy of a newly developed online, video-based dementia training and certification program for hospital staff, the CARES® Dementia 5-Step Method for Hospitals™ Online Training and Certification Program. A parallel randomized waitlist control design was utilized. Participants (N = 272) completed online pre-evaluation measures. Forty-five days after completion of CARES® (treatment) or pre-evaluation measures (control), participants completed a post-evaluation online assessment. Analyses of variance found that participants in the treatment condition indicated greater and statistically significant (p < .001) increases in sense of competence, approaches to dementia, and patient care. The results implied that the CARES® Dementia 5-Step Method for Hospitals™ program could serve as a dynamic resource for hospitals nationwide to update training and share experiences, perspectives, and resources. The inherent scalability of the program regarding its acceptability, feasibility, and potential to incorporate seamlessly into routine workflows and staff training suggests high implementation potential.

The purpose of this study was to evaluate the efficacy of the Residential Care Transition Module, a six-session, psychosocial, and psychoeducational telehealth intervention for family caregivers of cognitively impaired relatives living in a residential long-term care setting. Eligible participants (including care recipients, regardless of time since admission) were randomized to treatment or usual care control conditions. Survey data were collected at baseline, 4 months, 8 months, and 12 months (N = 240). Primary analytic outcomes included caregiver subjective stress (a stress process mechanism) and depressive symptoms (a measure of global well-being). Secondary analytic outcomes included secondary role strains, residential care stress, caregiver sense of competence, and self-efficacy (additional mechanisms of action). General linear models tested for the main effects of the intervention at 4 months, and longitudinal mixed models examined the 12-month effects of the intervention. Post hoc analyses also examined the influence of moderators. No significant differences between the treatment and control groups for any primary analytic outcome were apparent. Caregivers in the treatment group whose relatives were admitted to residential long-term care in the prior 3 months were more likely to indicate reductions in depressive symptoms over the first 4 months of participation. Over the 12-month study period, caregivers in the treatment group who were employed reported increased self-efficacy over time. The heterogeneity of dementia care requires a broader consideration of key contextual factors that may influence the efficacy of nonpharmacological interventions. Aligning measures with the preferences, goals, and values of dementia caregivers may further demonstrate the direct benefits of interventions such as the Residential Care Transition Module. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

BACKGROUND/UNASSIGNED:Chinese and Korean Americans are among the fastest-growing minority groups in the US but face disparities in income and limited English proficiency, leading to health inequities in Alzheimer's disease and related dementias (ADRD) care. OBJECTIVE/UNASSIGNED:This study aims to understand cultural influences in ADRD care from the perspectives of Chinese and Korean American caregivers to inform culturally sensitive support for caregivers in Asian immigrant populations. METHODS/UNASSIGNED:We conducted a study that was part of a broader project aimed at informing the cultural adaptation of the NYU Caregiver Intervention-Enhanced Support (NYUCI-ES) program specifically for Chinese and Korean American caregivers managing multiple chronic conditions. In our interviews with 14 Chinese American and 11 Korean American caregivers, we focused on how their roles as primary caregivers were influenced by cultural and family expectations, the impact of caregiving on their personal and emotional well-being, and the specific barriers they face in accessing healthcare for themselves and their relatives with dementia. RESULTS/UNASSIGNED:Cultural beliefs and values significantly influenced the perceptions and utilization of support systems among Chinese and Korean American caregivers. Family stigma and adherence to cultural norms impacted their caregiving experiences. The study also highlighted the added burden during the pandemic and the potential benefits of telehealth and information technology in ADRD care. CONCLUSIONS/UNASSIGNED:Developing culturally tailored, person-centered programs is crucial to meeting the unique needs of Chinese and Korean American caregivers. This research contributes to understanding and supporting this vulnerable population, promoting healthcare equity for ADRD patients and caregivers.

BACKGROUND/UNASSIGNED:More than 50 million people in the United States serve as uncompensated informal caregivers to chronically ill friends or family members. Providing care to a sick loved one can contribute to personal growth but can also cause significant strain. Caregiver distress refers to a constellation of physiological, psychological, interpersonal, and spiritual impairments that typically result when an individual's own health becomes affected while caring for another. Caregiver distress is highly prevalent, affecting an estimated 30-70% of individuals across various caregiver populations. Although evidence-based treatments for caregiver distress exist, they do not sufficiently address all its components. In recent years, clinical trials have demonstrated that psychedelic-assisted psychotherapy (PAP) may have applications for treating a range of medical and psychiatric conditions that have significant overlap in symptoms to those seen in caregiver distress. While no studies to date have examined PAP for caregiver distress, this article provides a rationale for investigating PAP as a potential novel treatment for this indication. METHODS/UNASSIGNED:A narrative review on the effects and clinical applications of PAP that significantly overlap with the dimensions of caregiver distress was conducted. Safety considerations, psychedelic selection, and therapeutic structure for studying PAP in the treatment of caregiver distress were also examined. RESULTS/UNASSIGNED:Psychologically, PAP has been shown to treat anxiety, depression, and reduce suicidal ideation. Physiologically, evidence suggests that psychedelics have anti-inflammatory properties, which may aid caregivers suffering from chronic inflammation. Interpersonally, PAP has been demonstrated to enhance feelings of empathy, connectedness, and strengthen social relationships, which can often become strained while caregiving. Spiritually, PAP has been shown to ameliorate existential distress and hopelessness in cancer patients, which may similarly benefit demoralized caregivers. CONCLUSION/UNASSIGNED:PAP has the potential to comprehensively treat all biopsychosocial-spiritual dimensions of caregiver distress.

OBJECTIVES/OBJECTIVE:In response to the needs of dementia caregivers during the COVID-19 pandemic, the NYU Langone Alzheimer's Disease and Related Disorders Family Support Program (FSP) quickly transitioned to providing most services online. To understand how dementia caregivers experienced FSP services after the switch to video telehealth, we conducted qualitative interviews of spouse or partner dementia caregivers. PARTICIPANTS/METHODS:Ten participants were recruited from a convenience sample of dementia spouse or partner caregivers who used one or more online FSP services offered during the pandemic. DESIGN/METHODS:Caregivers engaged in semi-structured interviews held via videoconference between May and June 2020. Qualitative analysis of interviews was conducted according to the principles of framework analysis. RESULTS:Caregivers reported high satisfaction with the FSP pre-pandemic and continued to feel supported when services were provided online. They transitioned to video telehealth services with little difficulty. CONCLUSIONS:While video telehealth is frequently cited as beneficial for those in rural communities, socioeconomically disadvantaged groups, or homebound individuals, our findings suggest that video telehealth is also advantageous for dementia caregivers, given their unique barriers, including lack of time due to caregiving responsibilities, lack of respite care for the person with dementia, and the additional burdens of travel time to access in-person services.

We applied machine learning algorithms to examine the relationship between demographics and outcomes of the social work services used by Hispanic family caregivers of persons with dementia recruited for a clinical trial in New York City. The social work service needs were largely concentrated on instrumental support to gain access to the healthcare system rather than other concrete services (e.g., housing or food programs) or to address psychological needs among the caregivers with relatively higher income. A finding from the machine learning approach was that among those who receive medical-related social work services, frequent users (≥10 times) with high family friend support(>4) were more likely than frequent users without such support to have their issues resolved (Accuracy: 81.9%, AUC: 0.82, F-measure: 0.86 by J48). Even though half of the participants received social work services multiple times, the needs of the caregivers remained unmet unless they sought social work services frequently (more than ten times).

We applied mixed-methods to refine our first version of the Twitter message library (English 400, translated into Spanish 400) for African Americans and Hispanic family caregivers for a person with dementia. We conducted a series of expert panels to collect quantitative and qualitative data using surveys and in-depth interviews. Using mixed methods to ensure unbiased results, the panelists first independently scored them (1 message/5 panelist) on a scale of 1 to 4 (1: lowest, 4: highest), followed by in-depth interviews and group discussions. Survey results showed that the average score was 3.47, indicating good to excellent (SD 0.35, ranges from 1.8 to 4). Quantitative surveys and qualitative interviews showed different results in emotional support messages.

OBJECTIVE:We designed an mHealth application (app) user interface (UI) prototype informed by participatory design sessions, persuasive systems design (PSD) principles, and Lorig and Holman's self-management behavior framework to support self-management activities of Hispanic informal dementia caregivers and assessed their perceptions and preferences regarding features and functions of the app. MATERIALS AND METHODS/METHODS:Our observational usability study design employed qualitative methods and forced choice preference assessments to identify: (1) the relationship between user preferences for UI features and functions and PSD principles and (2) user preferences for UI design features and functions and app functionality. We evaluated 16 pairs of mHealth app UI prototype designs. Eight paper-based paired designs were used to assess the relationship between PSD principles and caregiver preferences for UI features and functions to support self-management. An Apple iPad WIFI 32GB was used to display another 8 paired designs and assess caregiver preferences for UI functions to support the self-management process. RESULTS:Caregivers preferred an app UI with features and functions that incorporated a greater number of PSD principles and included an infographic to facilitate self-management. Moreover, caregivers preferred a design that did not depend on manual data entry, opting instead for functions such as drop-down list, drag-and-drop, and voice query to prioritize, choose, decide, and search when performing self-management activities. CONCLUSION/CONCLUSIONS:Our assessment approaches allowed us to discern which UI features, functions, and designs caregivers preferred. The targeted application of PSD principles in UI designs holds promise for supporting personalized problem identification, goal setting, decision-making, and action planning as strategies for improving caregiver self-management confidence.