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Capacity building for dealing with dementia in developing countries: Lessons from the Maracaibo Aging Study
P430
Oral Sessions: O3-02: Social-Behavioral and Care Research and Practice: Models of Community-Based Care
dependence, as assessed by the Dependence scale, responds to changes in functional disability, cognitive impairment and less significantly to changes in behavioural problems. ORAL SESSIONS: O3-02 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: MODELS OF COMMUNITY-BASED CARE O3-02-01
A MODEL FOR SOCIAL BEHAVIORAL CARE: COMMUNITY-BASED DEMENTIA TREATMENT
Catherine Piersol, Tracey Earland, Janice P. Burke, Thomas Jefferson University, Philadelphia, Pennsylvania, United States. Background: Individuals with Alzheimer’s disease and related dementias require oversight and assistance with daily living activities and routines, which increases as the disease progresses. Seventy percent of individuals with dementia live at home and are cared for by their families, who do not have any formal training. Physical and social environments impact the functional capacity and behavior of individuals with dementia. The resulting behavioral manifestations are often the most challenging for families to manage. Teaching families about dementia and how to modify environments and tasks to match functional capacity and minimize neuropsychiatric symptoms will enhance patient participation in daily activities, lesson caregiver upset, and enhance their confidence. Methods: This presentation will describe an evidence-based occupational therapy program provided to patients and their families in the home. The patient evaluation comprises the MMSE, Timed Up and Go test, ADL/IADL assessment, and Allen cognitive assessment battery. The Functional Capacity Card Sort (FCCS) and the Caregiver Assessment of Management Problems (CAMP) is administered to the family caregiver. Guided by the evaluation results, a comprehensive intervention plan is developed and tailored to meet the needs of the patient and family dyad. The family receives training in specific skills such as problem-solving and strategy building. Using Skills2Care, the caregiver learns to simplify communication, modify tasks and environments, and engage patient in activities in order to effectively manage complex behaviors and promote participation. Results: Based on clinical data from 50 cases, the following targeted program outcomes will be presented: increased patient participation and safety in daily living activities; reduced patient neuropsychiatric symptoms; effective environmental modifications; decreased caregiver upset and enhanced confidence in management of daily challenges; and caregiver satisfaction. Trends regarding program dosage will be reviewed. Ecological and cognitive disability constructs underlying the program will be discussed with case examples. Conclusions: This dementia program is reimbursed by Medicare Part B. Integrated within patient treatment, teaching caregivers new skills facilitates improved function and safety in the individual with dementia and reduces behavioral manifestations. Treatment is developed and implemented in a culturally sensitive, tailored manner to address the unique needs of the patient/family dyad. O3-02-02
COMMON DISORDERS DEMAND EXPERT CARE: THE NEED FOR SPECIALIZED PROFESSIONAL EDUCATION IN DISORDERS OF DEMENTIA
Daniel Kaplan1, Troy Andersen2, 1Columbia University School of Social Work, New York, New York, United States; 2University of Utah College of Social Work, Salt Lake City, Utah, United States. Background: The World Health Organization has identified the need for significant changes in policy, practice and service delivery systems to address the rapidly growing burdens associated with mental, neurological and substance use disorders. Individuals confronting these disorders, especially the diseases which cause symptoms of dementia, face significant barriers to quality of life. Many education programs for health and mental health professions aim to prepare future workers to meet the needs of older adults by exposing students to a wide breadth of aging-related content during their academic professional training. Yet disorders of dementia continue to challenge new graduates and seasoned professionals alike. Professional health providers may have outdated competencies and may not be able to meet current and future needs. Building professional workforces and up-
grading the capacity of these workforces must be the backbone of efforts to improve dementia care in all settings. Graduate education holds the greatest opportunity to impact academic pre-professional training to guarantee competence throughout the dementia care and service spectrum. Methods: A review of the professional literature was conducted to survey the most important articles and reports pertaining to higher education, professional practice, and workforce preparation in dementia care. This literature is summarized in order to give readers the necessary background to understand recommendations for bolstering the quality of dementia care through improved professional education and training in fields of health and mental health. Results: The authors offer several possible solutions to the curriculum dilemma in graduate education, including content infusion, elective courses, and specialized practicum experiences. Debates between generalist and specialist education are positioned within the contexts of course requirements, faculty limitations, and a rapidly evolving knowledge base, and implications are drawn for academic training programs in medicine, nursing, social work, psychology, and public health. Conclusions: As rapid population aging demands greater professional workforce capacity, schools of higher education must prepare tomorrow’s professionals for competent practice with individuals confronting age-associated disorders. Specialized curricula are needed in order to cover the complex multidimensional considerations and sophisticated methods involved in competent practice with older adults living with dementia. O3-02-03
CAPACITY BUILDING FOR DEALING WITH DEMENTIA IN DEVELOPING COUNTRIES: LESSONS FROM THE MARACAIBO AGING STUDY
Marialcira Quintero-Osorio1, Luis Falque-Madrid1, Orlando Sega2, Carlos Chavez1, Gladys Amaya2, Joseph Lee3, Joseph Terwilliger3, Gladys Maestre3, 1University of Zulia, Maracaibo, Venezuela; 2 FundaConCiencia, Maracaibo, Venezuela; 3Columbia University, New York, New York, United States. Background: Dementia affects an increasing number of individuals and their families worldwide. Most of the affected individuals reside in developing countries, where psychosocial needs are overwhelming, and where dementia is the primary cause of disability. A multilevel strategy was developed and implemented in Venezuela, as part of the Maracaibo Aging Study (MAS), to build and sustain a workforce that 1) brought together a critical mass of dementia researchers, 2) provided early detection of dementia, 3) delivered quality care to individuals with dementia, 4) provided support services to individuals with early-stage dementia and their families, and 5) increased public knowledge about prevention and caregiving. Methods: Strategic alliances were established between the University of Zulia, international universities, and local NGOs. Communitybased participatory research (CBPR) was used to develop collaborations among academics, clinicians, and communities. The research used a mixed-methods evaluation system, including interviews, process notes, and open-ended and closed survey questions. Results: Training programs were developed at local institutions, with the support of foreign institutions, to strengthen capacity at various interdependent levels. These included certificate programs, courses, postgraduate courses, and training specifically for caregivers and for trainers of caregivers. Working within established networks was key to obtaining funding. Academic outputs—publications, citations, funded grants, etc.—were tallied at individual and institutional levels. Focus groups and interviews ultimately led to a program of knowledge translation and dissemination that engaged thousands of people in public activities related to dementia. Conclusions: It is possible to increase the number of dementia researchers in a developing country, but retaining them is a major challenge. Limited numbers of qualified mentors and teachers continue to be the greatest barrier to education at the doctoral levels. Enhancement of psychosocial capacities was achieved in the present program through mutual interpersonal aid and support. As many modalities of adult learning were incorporated as possible, with particular attention to multi-cultural and literacy issues. This influenced outreach, the way training was designed and textbooks produced. Development of infrastructure between the university and community was essential to maintaining the partnership.
Oral Sessions: O3-02: Social-Behavioral and Care Research and Practice: Models of Community-Based Care
dependence, as assessed by the Dependence scale, responds to changes in functional disability, cognitive impairment and less significantly to changes in behavioural problems. ORAL SESSIONS: O3-02 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: MODELS OF COMMUNITY-BASED CARE O3-02-01
A MODEL FOR SOCIAL BEHAVIORAL CARE: COMMUNITY-BASED DEMENTIA TREATMENT
Catherine Piersol, Tracey Earland, Janice P. Burke, Thomas Jefferson University, Philadelphia, Pennsylvania, United States. Background: Individuals with Alzheimer’s disease and related dementias require oversight and assistance with daily living activities and routines, which increases as the disease progresses. Seventy percent of individuals with dementia live at home and are cared for by their families, who do not have any formal training. Physical and social environments impact the functional capacity and behavior of individuals with dementia. The resulting behavioral manifestations are often the most challenging for families to manage. Teaching families about dementia and how to modify environments and tasks to match functional capacity and minimize neuropsychiatric symptoms will enhance patient participation in daily activities, lesson caregiver upset, and enhance their confidence. Methods: This presentation will describe an evidence-based occupational therapy program provided to patients and their families in the home. The patient evaluation comprises the MMSE, Timed Up and Go test, ADL/IADL assessment, and Allen cognitive assessment battery. The Functional Capacity Card Sort (FCCS) and the Caregiver Assessment of Management Problems (CAMP) is administered to the family caregiver. Guided by the evaluation results, a comprehensive intervention plan is developed and tailored to meet the needs of the patient and family dyad. The family receives training in specific skills such as problem-solving and strategy building. Using Skills2Care, the caregiver learns to simplify communication, modify tasks and environments, and engage patient in activities in order to effectively manage complex behaviors and promote participation. Results: Based on clinical data from 50 cases, the following targeted program outcomes will be presented: increased patient participation and safety in daily living activities; reduced patient neuropsychiatric symptoms; effective environmental modifications; decreased caregiver upset and enhanced confidence in management of daily challenges; and caregiver satisfaction. Trends regarding program dosage will be reviewed. Ecological and cognitive disability constructs underlying the program will be discussed with case examples. Conclusions: This dementia program is reimbursed by Medicare Part B. Integrated within patient treatment, teaching caregivers new skills facilitates improved function and safety in the individual with dementia and reduces behavioral manifestations. Treatment is developed and implemented in a culturally sensitive, tailored manner to address the unique needs of the patient/family dyad. O3-02-02
COMMON DISORDERS DEMAND EXPERT CARE: THE NEED FOR SPECIALIZED PROFESSIONAL EDUCATION IN DISORDERS OF DEMENTIA
Daniel Kaplan1, Troy Andersen2, 1Columbia University School of Social Work, New York, New York, United States; 2University of Utah College of Social Work, Salt Lake City, Utah, United States. Background: The World Health Organization has identified the need for significant changes in policy, practice and service delivery systems to address the rapidly growing burdens associated with mental, neurological and substance use disorders. Individuals confronting these disorders, especially the diseases which cause symptoms of dementia, face significant barriers to quality of life. Many education programs for health and mental health professions aim to prepare future workers to meet the needs of older adults by exposing students to a wide breadth of aging-related content during their academic professional training. Yet disorders of dementia continue to challenge new graduates and seasoned professionals alike. Professional health providers may have outdated competencies and may not be able to meet current and future needs. Building professional workforces and up-
grading the capacity of these workforces must be the backbone of efforts to improve dementia care in all settings. Graduate education holds the greatest opportunity to impact academic pre-professional training to guarantee competence throughout the dementia care and service spectrum. Methods: A review of the professional literature was conducted to survey the most important articles and reports pertaining to higher education, professional practice, and workforce preparation in dementia care. This literature is summarized in order to give readers the necessary background to understand recommendations for bolstering the quality of dementia care through improved professional education and training in fields of health and mental health. Results: The authors offer several possible solutions to the curriculum dilemma in graduate education, including content infusion, elective courses, and specialized practicum experiences. Debates between generalist and specialist education are positioned within the contexts of course requirements, faculty limitations, and a rapidly evolving knowledge base, and implications are drawn for academic training programs in medicine, nursing, social work, psychology, and public health. Conclusions: As rapid population aging demands greater professional workforce capacity, schools of higher education must prepare tomorrow’s professionals for competent practice with individuals confronting age-associated disorders. Specialized curricula are needed in order to cover the complex multidimensional considerations and sophisticated methods involved in competent practice with older adults living with dementia. O3-02-03
CAPACITY BUILDING FOR DEALING WITH DEMENTIA IN DEVELOPING COUNTRIES: LESSONS FROM THE MARACAIBO AGING STUDY
Marialcira Quintero-Osorio1, Luis Falque-Madrid1, Orlando Sega2, Carlos Chavez1, Gladys Amaya2, Joseph Lee3, Joseph Terwilliger3, Gladys Maestre3, 1University of Zulia, Maracaibo, Venezuela; 2 FundaConCiencia, Maracaibo, Venezuela; 3Columbia University, New York, New York, United States. Background: Dementia affects an increasing number of individuals and their families worldwide. Most of the affected individuals reside in developing countries, where psychosocial needs are overwhelming, and where dementia is the primary cause of disability. A multilevel strategy was developed and implemented in Venezuela, as part of the Maracaibo Aging Study (MAS), to build and sustain a workforce that 1) brought together a critical mass of dementia researchers, 2) provided early detection of dementia, 3) delivered quality care to individuals with dementia, 4) provided support services to individuals with early-stage dementia and their families, and 5) increased public knowledge about prevention and caregiving. Methods: Strategic alliances were established between the University of Zulia, international universities, and local NGOs. Communitybased participatory research (CBPR) was used to develop collaborations among academics, clinicians, and communities. The research used a mixed-methods evaluation system, including interviews, process notes, and open-ended and closed survey questions. Results: Training programs were developed at local institutions, with the support of foreign institutions, to strengthen capacity at various interdependent levels. These included certificate programs, courses, postgraduate courses, and training specifically for caregivers and for trainers of caregivers. Working within established networks was key to obtaining funding. Academic outputs—publications, citations, funded grants, etc.—were tallied at individual and institutional levels. Focus groups and interviews ultimately led to a program of knowledge translation and dissemination that engaged thousands of people in public activities related to dementia. Conclusions: It is possible to increase the number of dementia researchers in a developing country, but retaining them is a major challenge. Limited numbers of qualified mentors and teachers continue to be the greatest barrier to education at the doctoral levels. Enhancement of psychosocial capacities was achieved in the present program through mutual interpersonal aid and support. As many modalities of adult learning were incorporated as possible, with particular attention to multi-cultural and literacy issues. This influenced outreach, the way training was designed and textbooks produced. Development of infrastructure between the university and community was essential to maintaining the partnership.