- Email: [email protected]
A PILOT STUDY WHICH SUPPORTS STAFF TO ENGAGE OLDER ADULTS IN RESIDENTIAL CARE WITH TABLET DEVICES
P160
TD-P-007
Poster Presentations: Saturday, July 15, 2017
STAR-C-TELEMEDICINE: ACCESSIBLE CAREGIVER SUPPORT
Allison Lindauer1,2, Deniz Erten-Lyons1,2, Jeffrey Kaye1,3,4, Katherine Mincks1,2, Nora Mattek1,3, Hiroko Dodge1,3,5, Linda Teri6,7, 1Oregon Health & Science University, Portland, OR, USA; 2NIA-Layton Aging and Alzheimer’s Disease Center, Portland, OR, USA; 3NIA-Layton Aging & Alzheimer’s Disease Center, Portland, OR, USA; 4Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA; 5University of Michigan, Ann Arbor, MI, USA; 6University of Washington, Seattle, WA, USA; 7Northwest Roybal Center, Seattle, WA, USA. Contact e-mail: [email protected] Background: Caregiving for persons with Alzheimer’s Disease and
Related Dementias (ADRD) can contribute to psychological distress, including depression and burden. Individualized education and support programs can help reduce these negative aspects of caregiving, but stigma, inconvenient meeting times, lack of respite care and transportation challenges interfere with program usage. To address these barriers, professionals are using Internet-based programs (known as “telehealth” or “telemedicine”) to provide support. Many of these options are group-based or automated (without a live interventionist). Of concern, few of the telehealth interventions found in the literature are individually-based interventions tailored to the needs of the caregivers. More options for oneon-one, effective, person-centered telehealth interventions are needed. STAR-C is an example of such an intervention and is well-suited for translation into a direct-to-home telehealth program. The aim of this pilot was to assess the feasibility and acceptability of STAR-C when delivered via direct-to-home telehealth videoconferencing. Methods: In this mixed-methods study we administered the 8-week STAR-C intervention via telehealth direct-tohome video-conferencing. This included teaching caregivers about the triggers for bothersome behaviors and how to avoid the triggers. Caregivers were assessed prior to and after the intervention with measures of depression, burden and desire to institutionalize. Qualitative data from the sessions and one focus group provided depth to our findings. Results: Of the 16 caregivers enrolled (Tables 1, 2), four withdrew and nine have completed post-intervention testing. None withdrew due to technical difficulties. To date, 100 % of the caregivers who completed STAR-C were satisfied with this telehealth program. There were some easily-resolved technical issues. Quantitative measures show a reduction in burden, depression and Table 1 STAR-C-TM demographics (n ¼ 15: 1 withdrawal prior to data collection) Caregivers Age (mean, SD, range) Sex, (% women) Race (% white) Number of years caregiving (mean, SD, range) Care-recipients Age (mean. SD. range) Sex, (% women) Race (% white) Number of years with dementia (mean, SD, range) Montreal Cognitive Assessment (n¼13) Both Distance from OHSU. miles (mean, range) Income, (% reported, “I can’t make ends meet)
63, 11.6, 30-74 67% 93% 3.8, 2.4, 0.5-8
70, 5.8, 61-82 47% 93% 2.9, 2.3, 0.5-8 13.6, 8, 0-26 45, 3-154 6%
desire to institutionalize (significance is unknown due to small sample size) (Table 3). Qualitative findings revealed a positive experience for most caregivers: “It’s been a wonderful tool for me to lean on.” Conclusions: These early findings indicate that implementing STAR-C using telehealth technology is an acceptable option for these caregivers, suggesting that this technology can fill a wide gap in caregiver support. More work is needed to successfully translate STAR-C into a telemedicine program; this pilot lays the foundation.
Table 2 STAR-C-TM Enrollment and Feasibility Enrolled Withdrawn Completed Intervention active (pending) Set-up time (mean, range) Intervention time (mean, range)
16 4 9 3 32, 10-120 46, 23-63
Table 3 STAR-C Telemedicine Pre-Post Measures Measures
Pre (n¼9)
Post (n¼9)
Revised Memory and Behavior Problem Checklist (RMBPC) Frequency Total RMBPC Reaction Total Screen for Caregiver Burden (SCB) Objective Total SCB Subjective Total Desire to Institutionalize Question 6 Center for Epidemiologic Studies Depression Scale Total Modified Conflicts Tactics Scale Response
47.2 [29 - 69]
43.3 [28 - 56]
32.7 [10 - 59] 12 [7 - 19]
26.4 [6 - 54] 11.1 [8 - 18]
40.2 [28 - 58] 1.3 [1 - 2] 17.3 [4 - 38]
36.9 [28 - 46] 1.1 [1 - 2] 15.7 [0 - 36]
11%
0%
TD-P-008
A PILOT STUDY WHICH SUPPORTS STAFF TO ENGAGE OLDER ADULTS IN RESIDENTIAL CARE WITH TABLET DEVICES
Samantha M. Loi1,2, Alissa Westphal1, Nicola T. Lautenschlager2,3,4, Anita Goh1,2, 1University of Melbourne, Melbourne, Australia; 2Melbourne Health, Melbourne, Australia; 3University of Western Australia, Perth, Australia; 4The University of Melbourne, Melbourne, Australia. Contact e-mail: [email protected] Background: Tablet devices are starting to be used to engage older adults in residential care. However, support for staff is required for successful implementation. There is scarce knowledge in the area of what methods could assist staff to accept and engage with this new technology, and what applications (apps) the residents may use. Methods: Prior to introduction of the tablet devices in residential facilities, staff were administered a questionnaire to elicit information regarding previous experience using tablet devices and what training methods staff would like to feel more confident to engage residents with these devices. The type, frequency and duration of app usage by residents was recorded. Results: Three residential aged care facilities located in Melbourne, Australia, which
Poster Presentations: Saturday, July 15, 2017
accommodated older adults who had a variety of psychiatric conditions such as dementia, schizophrenia and bipolar disorder, were involved in this exploratory pilot study. Both Apple iPad and Samsung tablets were used. Staff training methods included written instructions, practical demonstrations and group workshops. These workshops focused on improving knowledge and confidence in using tablet devices with residents. A list of apps were provided depending on the residents’ preferences, and included games, puzzles and relaxation. Following completion of the study, 80% of staff were confident in using tablet devices with residents and 24% used these more than weekly. The majority of them (85.7%) reported that the residents enjoyed using the devices. Conclusions: Tablet devices and apps can successfully be used to engage residents but it is essential that staff are involved in the implementation process. Further research involving larger sample sizes are recommended.
TD-P-009
CONTINUOUS, OBJECTIVE, AND HOMEBASED ASSESSMENT OF ACTIVITY AND EFFORT RELATED TO CAREGIVING
Neil W. Thomas1, Nora Mattek2, Thomas Riley2, Phelps Witter2, Christina Reynolds1, Johanna Austin2, Nicole Sharma2, Jeffrey Kaye2, 1Oregon Health and Science University, Portland, OR, USA; 2Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: The majority of caregiver instruments use questionnaires that assess subjective aspects related to caregiving, which can be subject to bias and in-accuracies in self-reporting. There is a need for tools that can objectively measure and quantify aspects related to caregiving. Home-based, remote-sensing computer systems provide the ability to capture outcome measures related to cognition and everyday functioning. These systems could also be used to provide more accurate and unbiased measures of daily activities related to caregiving and time spent on caregiving. The goals of this study are to determine the feasibility of collecting objective measure related to caregiving, to assess how they compare to conventional caregiver tools and to develop a set of digital biomarkers that predict effort and time related to caring for an individual with Alzheimer’s disease. Methods: Data is derived from EVALUATE-AD (Ecologically Valid, Ambient, Longitudinal and Unbiased Assessment of Treatment Efficacy in Alzheimer’s Disease), a pragmatic proof-of-concept clinical trial to detect standard dementia treatment transitions. Participants are MCI or early-stage AD patients living with a care partner identified through the NIAOregon Aging & Alzheimer’s Center. A pervasive sensing and computing system is deployed in each couple’s home continuously providing data on measures related to caregiver engagement (e.g. time together in same room, sleep disruption related to partner activity). Each caregiver is administered self-report assessment scales (Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory (NPI-Q)) at baseline and every three months throughout the yearlong trial. Convergent validity is assessed by examining the correlation between novel outcome measures and the ZBI and NPI-Q. Results: Enrollment is ongoing for the EVALUATE-AD study, which commenced in January, 2017. Thirty caregivers will be fully enrolled by July. The home-based computing system is well accepted by study participants and provides continuous data on objective measures related to caregiving. Conclusions: Home-based
P161
remote-sensing systems provide a novel method to objectively measure outcomes related to effort and time spent on caregiving. These outcomes could be used to assess for quantifiable changes in activities related to caregiving in future intervention trials. Continuous, longitudinally acquired measures could also examine the evolution of caregiver engagement as a patient’s condition advances.
TD-P-010
EVALUATE-AD (ECOLOGICALLY VALID, AMBIENT, LONGITUDINAL AND UNBIASED ASSESSMENT OF TREATMENT EFFICACY IN ALZHEIMER’S DISEASE): A PRAGMATIC PROOF-OF-CONCEPT CLINICAL TRIAL
Neil W. Thomas1, Nora Mattek2, Thomas Riley2, Phelps Witter2, Christina Reynolds2, Johanna Austin2, Nicole Sharma2, Jeffrey Kaye2, 1 Oregon Health and Science University, Portland, OR, USA; 2Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: Conventional trials methodology for testing dementia
treatments is limited due to an assessment paradigm that acquires data in an episodic, infrequent manner and relies on subjective self- and proxy-based reports. Home-based pervasive computing and sensing systems provide a means to acquire objective, high-frequency, longitudinal data generating ecologically valid outcome measures directly related to in-the-moment cognitive and functional status. The goals of this study are to determine the feasibility of using a home-based pervasive computing system to identify changes in meaningful outcomes in typical patients with MCI or early Alzheimer’s disease (AD), and to compare the outcome measures of the automated system to conventional clinical outcome measures while patients transition on or off typical AD-related treatments. Methods: This natural history, pragmatic proof of concept clinical trial enrolls MCI or early-stage AD patients living with a care partner identified through the NIA-Oregon Aging & Alzheimer’s Center. Over the course of a year patients naturally transition on and off standard AD therapies for cognitive and behavioral change (e.g., cholinesterase inhibitors, SSRI’s). A pervasive sensing and computing system is deployed in each couple’s home continuously providing data regarding key outcomes: physical activity and mobility, sleep, computer use, driving and medication adherence. Each participant undergoes a conventional neurological and cognitive battery at baseline, and weekly on-line reports on changes to their health and medications. Conventional tests are compared to the continuous data. N-of-one analysis (facilitated by high-frequency data capture) is used to detect changes as medications are added, adjusted or discontinued over time. Results: The study commenced in January, 2017. Enrollment is ongoing. Sixty participants will be fully enrolled by July. The technologies are currently well accepted by study participants and provide reliable data streams on a daily basis. Conclusions: Outcome metrics comprising multiple functional and health related domains can be successfully collected and analyzed from multi-person homes. The use of continuous home-based assessment provides a novel approach to test the impact of new or existing dementia treatments generating objective, clinically meaningful measures related to cognition and everyday functioning. The approach may ultimately reduce trial durations, sample size needs and reliance on clinicbased assessment.
TD-P-007
Poster Presentations: Saturday, July 15, 2017
STAR-C-TELEMEDICINE: ACCESSIBLE CAREGIVER SUPPORT
Allison Lindauer1,2, Deniz Erten-Lyons1,2, Jeffrey Kaye1,3,4, Katherine Mincks1,2, Nora Mattek1,3, Hiroko Dodge1,3,5, Linda Teri6,7, 1Oregon Health & Science University, Portland, OR, USA; 2NIA-Layton Aging and Alzheimer’s Disease Center, Portland, OR, USA; 3NIA-Layton Aging & Alzheimer’s Disease Center, Portland, OR, USA; 4Oregon Center for Aging & Technology (ORCATECH), Portland, OR, USA; 5University of Michigan, Ann Arbor, MI, USA; 6University of Washington, Seattle, WA, USA; 7Northwest Roybal Center, Seattle, WA, USA. Contact e-mail: [email protected] Background: Caregiving for persons with Alzheimer’s Disease and
Related Dementias (ADRD) can contribute to psychological distress, including depression and burden. Individualized education and support programs can help reduce these negative aspects of caregiving, but stigma, inconvenient meeting times, lack of respite care and transportation challenges interfere with program usage. To address these barriers, professionals are using Internet-based programs (known as “telehealth” or “telemedicine”) to provide support. Many of these options are group-based or automated (without a live interventionist). Of concern, few of the telehealth interventions found in the literature are individually-based interventions tailored to the needs of the caregivers. More options for oneon-one, effective, person-centered telehealth interventions are needed. STAR-C is an example of such an intervention and is well-suited for translation into a direct-to-home telehealth program. The aim of this pilot was to assess the feasibility and acceptability of STAR-C when delivered via direct-to-home telehealth videoconferencing. Methods: In this mixed-methods study we administered the 8-week STAR-C intervention via telehealth direct-tohome video-conferencing. This included teaching caregivers about the triggers for bothersome behaviors and how to avoid the triggers. Caregivers were assessed prior to and after the intervention with measures of depression, burden and desire to institutionalize. Qualitative data from the sessions and one focus group provided depth to our findings. Results: Of the 16 caregivers enrolled (Tables 1, 2), four withdrew and nine have completed post-intervention testing. None withdrew due to technical difficulties. To date, 100 % of the caregivers who completed STAR-C were satisfied with this telehealth program. There were some easily-resolved technical issues. Quantitative measures show a reduction in burden, depression and Table 1 STAR-C-TM demographics (n ¼ 15: 1 withdrawal prior to data collection) Caregivers Age (mean, SD, range) Sex, (% women) Race (% white) Number of years caregiving (mean, SD, range) Care-recipients Age (mean. SD. range) Sex, (% women) Race (% white) Number of years with dementia (mean, SD, range) Montreal Cognitive Assessment (n¼13) Both Distance from OHSU. miles (mean, range) Income, (% reported, “I can’t make ends meet)
63, 11.6, 30-74 67% 93% 3.8, 2.4, 0.5-8
70, 5.8, 61-82 47% 93% 2.9, 2.3, 0.5-8 13.6, 8, 0-26 45, 3-154 6%
desire to institutionalize (significance is unknown due to small sample size) (Table 3). Qualitative findings revealed a positive experience for most caregivers: “It’s been a wonderful tool for me to lean on.” Conclusions: These early findings indicate that implementing STAR-C using telehealth technology is an acceptable option for these caregivers, suggesting that this technology can fill a wide gap in caregiver support. More work is needed to successfully translate STAR-C into a telemedicine program; this pilot lays the foundation.
Table 2 STAR-C-TM Enrollment and Feasibility Enrolled Withdrawn Completed Intervention active (pending) Set-up time (mean, range) Intervention time (mean, range)
16 4 9 3 32, 10-120 46, 23-63
Table 3 STAR-C Telemedicine Pre-Post Measures Measures
Pre (n¼9)
Post (n¼9)
Revised Memory and Behavior Problem Checklist (RMBPC) Frequency Total RMBPC Reaction Total Screen for Caregiver Burden (SCB) Objective Total SCB Subjective Total Desire to Institutionalize Question 6 Center for Epidemiologic Studies Depression Scale Total Modified Conflicts Tactics Scale Response
47.2 [29 - 69]
43.3 [28 - 56]
32.7 [10 - 59] 12 [7 - 19]
26.4 [6 - 54] 11.1 [8 - 18]
40.2 [28 - 58] 1.3 [1 - 2] 17.3 [4 - 38]
36.9 [28 - 46] 1.1 [1 - 2] 15.7 [0 - 36]
11%
0%
TD-P-008
A PILOT STUDY WHICH SUPPORTS STAFF TO ENGAGE OLDER ADULTS IN RESIDENTIAL CARE WITH TABLET DEVICES
Samantha M. Loi1,2, Alissa Westphal1, Nicola T. Lautenschlager2,3,4, Anita Goh1,2, 1University of Melbourne, Melbourne, Australia; 2Melbourne Health, Melbourne, Australia; 3University of Western Australia, Perth, Australia; 4The University of Melbourne, Melbourne, Australia. Contact e-mail: [email protected] Background: Tablet devices are starting to be used to engage older adults in residential care. However, support for staff is required for successful implementation. There is scarce knowledge in the area of what methods could assist staff to accept and engage with this new technology, and what applications (apps) the residents may use. Methods: Prior to introduction of the tablet devices in residential facilities, staff were administered a questionnaire to elicit information regarding previous experience using tablet devices and what training methods staff would like to feel more confident to engage residents with these devices. The type, frequency and duration of app usage by residents was recorded. Results: Three residential aged care facilities located in Melbourne, Australia, which
Poster Presentations: Saturday, July 15, 2017
accommodated older adults who had a variety of psychiatric conditions such as dementia, schizophrenia and bipolar disorder, were involved in this exploratory pilot study. Both Apple iPad and Samsung tablets were used. Staff training methods included written instructions, practical demonstrations and group workshops. These workshops focused on improving knowledge and confidence in using tablet devices with residents. A list of apps were provided depending on the residents’ preferences, and included games, puzzles and relaxation. Following completion of the study, 80% of staff were confident in using tablet devices with residents and 24% used these more than weekly. The majority of them (85.7%) reported that the residents enjoyed using the devices. Conclusions: Tablet devices and apps can successfully be used to engage residents but it is essential that staff are involved in the implementation process. Further research involving larger sample sizes are recommended.
TD-P-009
CONTINUOUS, OBJECTIVE, AND HOMEBASED ASSESSMENT OF ACTIVITY AND EFFORT RELATED TO CAREGIVING
Neil W. Thomas1, Nora Mattek2, Thomas Riley2, Phelps Witter2, Christina Reynolds1, Johanna Austin2, Nicole Sharma2, Jeffrey Kaye2, 1Oregon Health and Science University, Portland, OR, USA; 2Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: The majority of caregiver instruments use questionnaires that assess subjective aspects related to caregiving, which can be subject to bias and in-accuracies in self-reporting. There is a need for tools that can objectively measure and quantify aspects related to caregiving. Home-based, remote-sensing computer systems provide the ability to capture outcome measures related to cognition and everyday functioning. These systems could also be used to provide more accurate and unbiased measures of daily activities related to caregiving and time spent on caregiving. The goals of this study are to determine the feasibility of collecting objective measure related to caregiving, to assess how they compare to conventional caregiver tools and to develop a set of digital biomarkers that predict effort and time related to caring for an individual with Alzheimer’s disease. Methods: Data is derived from EVALUATE-AD (Ecologically Valid, Ambient, Longitudinal and Unbiased Assessment of Treatment Efficacy in Alzheimer’s Disease), a pragmatic proof-of-concept clinical trial to detect standard dementia treatment transitions. Participants are MCI or early-stage AD patients living with a care partner identified through the NIAOregon Aging & Alzheimer’s Center. A pervasive sensing and computing system is deployed in each couple’s home continuously providing data on measures related to caregiver engagement (e.g. time together in same room, sleep disruption related to partner activity). Each caregiver is administered self-report assessment scales (Zarit Burden Interview (ZBI) and the Neuropsychiatric Inventory (NPI-Q)) at baseline and every three months throughout the yearlong trial. Convergent validity is assessed by examining the correlation between novel outcome measures and the ZBI and NPI-Q. Results: Enrollment is ongoing for the EVALUATE-AD study, which commenced in January, 2017. Thirty caregivers will be fully enrolled by July. The home-based computing system is well accepted by study participants and provides continuous data on objective measures related to caregiving. Conclusions: Home-based
P161
remote-sensing systems provide a novel method to objectively measure outcomes related to effort and time spent on caregiving. These outcomes could be used to assess for quantifiable changes in activities related to caregiving in future intervention trials. Continuous, longitudinally acquired measures could also examine the evolution of caregiver engagement as a patient’s condition advances.
TD-P-010
EVALUATE-AD (ECOLOGICALLY VALID, AMBIENT, LONGITUDINAL AND UNBIASED ASSESSMENT OF TREATMENT EFFICACY IN ALZHEIMER’S DISEASE): A PRAGMATIC PROOF-OF-CONCEPT CLINICAL TRIAL
Neil W. Thomas1, Nora Mattek2, Thomas Riley2, Phelps Witter2, Christina Reynolds2, Johanna Austin2, Nicole Sharma2, Jeffrey Kaye2, 1 Oregon Health and Science University, Portland, OR, USA; 2Oregon Health & Science University, Portland, OR, USA. Contact e-mail: [email protected] Background: Conventional trials methodology for testing dementia
treatments is limited due to an assessment paradigm that acquires data in an episodic, infrequent manner and relies on subjective self- and proxy-based reports. Home-based pervasive computing and sensing systems provide a means to acquire objective, high-frequency, longitudinal data generating ecologically valid outcome measures directly related to in-the-moment cognitive and functional status. The goals of this study are to determine the feasibility of using a home-based pervasive computing system to identify changes in meaningful outcomes in typical patients with MCI or early Alzheimer’s disease (AD), and to compare the outcome measures of the automated system to conventional clinical outcome measures while patients transition on or off typical AD-related treatments. Methods: This natural history, pragmatic proof of concept clinical trial enrolls MCI or early-stage AD patients living with a care partner identified through the NIA-Oregon Aging & Alzheimer’s Center. Over the course of a year patients naturally transition on and off standard AD therapies for cognitive and behavioral change (e.g., cholinesterase inhibitors, SSRI’s). A pervasive sensing and computing system is deployed in each couple’s home continuously providing data regarding key outcomes: physical activity and mobility, sleep, computer use, driving and medication adherence. Each participant undergoes a conventional neurological and cognitive battery at baseline, and weekly on-line reports on changes to their health and medications. Conventional tests are compared to the continuous data. N-of-one analysis (facilitated by high-frequency data capture) is used to detect changes as medications are added, adjusted or discontinued over time. Results: The study commenced in January, 2017. Enrollment is ongoing. Sixty participants will be fully enrolled by July. The technologies are currently well accepted by study participants and provide reliable data streams on a daily basis. Conclusions: Outcome metrics comprising multiple functional and health related domains can be successfully collected and analyzed from multi-person homes. The use of continuous home-based assessment provides a novel approach to test the impact of new or existing dementia treatments generating objective, clinically meaningful measures related to cognition and everyday functioning. The approach may ultimately reduce trial durations, sample size needs and reliance on clinicbased assessment.