An Affect Education Model for Caregivers: A Two-Person Centred Approach for Managing Behavioral and Psychological Symptoms of Dementia in Long-Term Care

2014 AAGP Annual Meeting

status. The association of apathy with stroke severity, motor function and executive impairment suggests that apathy is more common after severe strokes that affect multiple domains of function. The association of apathy with pre-morbid intelligence suggests that greater cognitive reserve may protect against apathy following stroke. Apathy was not associated with depression, which illustrates the discriminable nature of these neuropsychiatric syndromes post-stroke. Given its association with function status, the diagnosis and management of apathy is a worthwhile path to investigate with the aim of improving patient outcomes in rehabilitation. This research was funded by: Grant Support: 1R01HD055525 (PI: Whyte).

Poster Number: NR 21

Depression, anxiety, burden and coping mechanisms in the family caregivers of Alzheimer’s dementia patients in a turkish sample Ozlem Erden Aki, MD1; Yildiz Kaya, MD3; Sedat Isikli, PhD2; Seda Kibaroglu, MD3; Eda Derle Ciftci, MD3; Ufuk Anik Can, MD3 1

Hacettepe University Department of Psychiatry, Ankara, Turkey Hacettepe University Department of Psychology, Ankara, Turkey 3 Baskent University Department of Neurology, Ankara, Turkey 2

Introduction: The aim of this study was to investigate the characteristics of and the factors related to burden, depression and anxiety levels in the family caregivers of Alzheimer’s patients in a Turkish sample. Methods: The family caregivers of Alzheimer’s dementia patients who visit the outpatient psychiatry and neurology clinics of Hacettepe University Hospital and Baskent University Hospital were recruited for the study. Diagnosis of AD patients was given according to the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) diagnostic criteria. Alzheimer’s dementia patients were assessed with MMSE (Mini Mental State Examination), Katz’s ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living) and behavioral and psychological symptoms were assessed using NPI (Neuropsychiatric Inventory). A sociodemographic form both for patients and their caregivers were filled out to collect data on age, gender, education levels, occupation, relationship, length of disease, daily caregiving time, financial and emotional support and past psychiatric problems. The caregivers were evaluated with Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Zarit Burden Interview short form, Coping with Stress Scale, Self-Efficacy Scale, and Caregiver Well-Being Scale. Results: The study was comprised of 53 caregivers and their patients. Most of the caregivers (N¼41) were women as expected. Gender had no effect on burden levels but women had higher scores on depression and anxiety scales (P<0.05). Children as caregivers had significantly higher burden scores compared to other caregivers (wife/husband or sister/brother) (P<0.05). The caregivers who assumed caregiver role without their consent had more burden than the ones who assumed their role willingly (P<0.001). NPI total scores, and NPI disinhibition and eating problems subscores had a positive correlation with burden scores (P<0.05). Self-confident and optimistic ways of coping were found to correlate negatively with caregiver burden (P>0.001 and P¼0.005 respectively). Conclusions: This study aimed to demonstrate the determinants of burnout in the caregivers of Alzheimer’s dementia patients in a sample in Turkey. Gender, relationship, voluntariness in caregiving, behavioral problems and ways of coping were the prominent determinants in predicting burnout. These results should be replicated in larger samples and measures should be developed to help these groups with higher risk of burden.

Poster Number: NR 22

An Affect Education Model for Caregivers: A Two-Person Centred Approach for Managing Behavioral and Psychological Symptoms of Dementia in Long-Term Care Ken Schwartz, MD, FRCPC Baycrest, Toronto, ON, Canada Introduction: Behavioral and psychological symptoms of dementia (BPSD) represent some of the most common and challenging psychiatric problems associated with dementia in long-term care. Much caregiver distress is associated with this. The use of nonpharmacologic treatment interventions is refuted as a safer alternative and is best practice in the first-line management of BPSD (Perkins, 2012). But how effective actually are these approaches? As well, there is increasing controversy over the use of pharmacologic medications. However, the effectiveness of nonpharmacologic and/or pharmacologic treatments may be S124

Am J Geriatr Psychiatry 22:3, Supplement 1

2014 AAGP Annual Meeting

enhanced by a two-person centred approach that focuses on understanding and working with the affect of both individuals with BPSD and their caregivers, be they health-care professionals and/or family members. Reference Perkins, R. (2012). Evidence-based practice interventions for managing behavioral and psychological symptoms of dementia in nursing home residents. Annals of Long-Term Care Clinical Care and Aging. 20(12): 20-24. Methods: The psychoeducational approach utilizing Zeisel’s Seven Question Model (Zeisel, 2009), developed to improve one’s interpersonal relationships, is adapted for the first time to help improve the relationship between caregivers and an individual with BPSD. Better self-understanding and use of a caregiver’s feelings contributes to more effective interpersonal interactions and interventions with the person with BPSD. The approach will be demonstrated by the use of a case example. Reference Zeisel, E. (2009). Affect education and the development of the interpersonal ego in modern group psychoanalysis. International Journal of Group Psychotherapy. 59(3): 421-432. Results: The affect education model of approach will demonstrate an improved outcome of both decreased BPSD symptoms and use of medication. As well, caregiver distress is lessened. Conclusions: The use of both nonpharmacologic and pharmacologic treatments may be greatly enhanced by an interpersonal two-person centred affect education model. This model seeks to understand the underlying psychological determinants of BPSD by reflecting on and understanding the underlying feelings of both the person with BPSD and caregivers. This research was funded by: N/A.

Poster Number: NR 23

Suicidal Behavior in Racially and Ethnically Diverse Older Americans Amy L. Byers, PhD, MPH 1 2

University of California, San Francisco, San Francisco, CA San Francisco VA Medical Center, San Francisco, CA

Introduction: Little is known about suicide-related behaviors (i.e., ideation, plans, and attempts) in older adults, which are strong risk factors for actual suicide and strong indicators of extreme emotional and mental distress. Even more so, differences in suicidal behavior by race/ethnicity have hardly been investigated at all, as most studies are from non-diverse clinic samples. The current study aimed to determine nationally representative prevalence estimates and differences of suicide-related behaviors in ethnically-diverse older Americans using data from three nationally representative studies. Methods: We evaluated data on 4,521 adults 55 years and older from the Collaborative Psychiatric Epidemiology Surveys (CPES 2001-2003). The CPES comprises three nationally representative studies: 1) the Nationally Comorbidity Survey Replication (NCS-R), a probability sample of the general U.S.; 2) the National Survey of American Life (NSAL), a probability sample of African-American, Afro-Caribbean, and non-Hispanic White Americans; and 3) the National Latino and Asian American Study (NLAAS), a probability sample of Latinos and Asian Americans. Suicide-related behaviors were assessed by in-depth questions as part of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). Respondents were asked questions about the lifetime history of suicide ideation (“Have you ever seriously thought about committing suicide?”), suicide plans (“Have you ever made a plan for committing suicide?”), and suicide attempts (“Have you ever attempted suicide?”). Analyses included weights and complex design-corrected statistical tests. Results: The average age of the sample was approximately 67 years (SD ¼ 8.9). The distribution was 59.2% women, 46.5% Non-Hispanic White, 29.0% Non-Hispanic Black, 14.1% Hispanic, 10.4% Asian. Of the respondents, 9.4% reported lifetime suicidal ideation, 2.5% a plan, and 2.5% an attempt. In examining differences across race/ethnicity, there were no statistically significant (P > .05) differences across the four race/ethnic groups; all had very similar rates of ideation, plans, and attempts. However, in examining the association of race/ethnicity with suicidal behavior among older men and women separately, a strong and significant (P < .05) difference in behavior was present among women but not men for suicidal ideation and among men but not women for suicide attempts. Older Asian women had the highest prevalence rate of suicidal ideation (12.5%) followed by Non-Hispanic White women (10.7%), Hispanic (9.3%), and NonHispanic Black women (5.9%). While older Asian men had the highest prevalence rate of attempted suicide (4.3%) over their lifetime followed by Non-Hispanic Black men (2.5%) and lastly Hispanic (1.1%) and Non-Hispanic White men (1.3%). Conclusions: This is the first comprehensive study of prevalence rates of suicidal behavior in older Americans based on a national sample. The results of this study suggest that older Asian American women and men are at increased risk of suicidal ideation and attempts compared with other race/ethnic groups. This study supports that racial disparities by gender are important to consider in the study of suicide-related behaviors in older adults. Thus, findings from this research are important for identifying those older men and women most at risk of suicide and with great need of care. This research was funded by: This work was supported by a NIH R01 grant (MD007019), which was administered by the Northern California Institute for Research and Education. Am J Geriatr Psychiatry 22:3, Supplement 1

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