- Email: [email protected]
REDUCING AND PREVENTING CAREGIVERS’ BURDEN: THE EFFICACY OF DEMENTIA CARE MANAGEMENT FOR INFORMAL DEMENTIA CAREGIVERS
P1442
Poster Presentations: Wednesday, July 19, 2017
Impairment (MCI) and even prior to MCI. How best to measure early functional changes, and whether self-report or informantreport are differentially sensitive remains under debate. In the present study we examined the utility of self- and informant-reported functional abilities in predicting risk of transitioning from normal cognition to MCI or transition from MCI to dementia. Methods: Participants of this study were part of a longitudinal, observational research cohort at the University of California, Davis Alzheimer’s Disease Center (ADC). Older adult participants had been diagnosed with normal cognition or MCI at study baseline, had an informant who could complete informant-based ratings, and had at least one follow-up visit (average of 3-4 years). Participants and informants each completed the Everyday Cognition (ECog) scale, a questionnaire-based instrument designed to measure early and mild everyday functional changes across six cognitively-relevant domains (Everyday Memory, Language, Visuospatial abilities, Planning, Organization and Divided Attention). Risk of progression to MCI or dementia by baseline ECog scores (and demographic data) was evaluated using Cox proportional hazard models. Results: Both self- and informant-reported functional limitations on the ECog (Total score) were associated with a significant increase in risk of diagnostic progression to MCI (HR¼2.3, CI ¼ 1.4-3.6 and HR¼2.0, CI ¼ 1.3-3.2, respectively). When examining risk of progression from MCI to dementia, again both self- and informant-reported baseline Total ECog (HR ¼1.8, 1.2-2.8 and HR¼4.2, 3.0-5.8, respectively) were significant predictors although informant-report was much more strongly associated with conversion. Even when controlling for baseline cognitive abilities, results both for predicting MCI and dementia remained similar. Conclusions: Findings indicate that early cognitively-based functional limitations have prognostic value and help identify older adults at risk for developing MCI or dementia. Both self- and informant-reported everyday function are useful in predicting the development of MCI, whereas later in the disease (the transition from MCI to dementia) informant-reported everyday function is most strongly predictive.
P4-388
AND THEN THERE WERE THREE: INCORPORATING A LIVE-IN CAREGIVER INTO THE HOME OF A COUPLE WHERE ONE SPOUSE HAS DEMENTIA
Michal Karen Herz, University of Worcester Association for Dementia Studies, Worcester, United Kingdom. Contact e-mail: [email protected] Background: In the UK, two thirds of people living with demen-
tia live at home (Prince et al., 2014). In Israel, where the present research was conducted, people living with dementia are entitled by law to have a full-time live-in caregiver, when they reach a stage that they require constant support and supervision. For the most part, these live-in caregivers are migrants on a work visa specially designated for caregivers. This research focused on the transition from a couple to a triad comprising the live-in caregiver, spouse, and person with dementia, using
the concept of mentalization to explore the dynamics of interpersonal relationships between the three people. The aim was to understand what creates a good care environment for the person living with dementia and a good quality of life and satisfaction level for all members of the triad. Methods: Following the literature review, and based on the Interpretive-Phenomenological Approach (Smith, 1996) a semi-structured interview protocol was constructed. This was used as a basis for interviewing 5 triads. Interviews were recorded and transcribed for 18 interviews (13 interviews and 5 reflective essays). Analysis was conducted using NVIVO 11, using Malterud’s Systematic text condensation, which is a strategy for qualitative analysis based on a phenomenological approach (Malterud, 2012). As a result of the analysis, a new tentative framework was created. Results: The analysis formed a basis a new framework to conceptualise the triadic relationship. The term which represents this framework is Triadic Attentiveness. Triadic attentiveness (TAT) reflects the idea that in order to provide good support for all members of the triad, attentiveness should be encouraged at all times for all three members, each according to their own ability. Triadic attentiveness is composed of four elements: mutual respect, challenges, ambiguity, and identifying the third person in the triad. Conclusions: In a state of triadic attentiveness genuine interest in understanding the different and changing needs of the other members of the triad, but it also represents the ability to be attentive towards oneself.
P4-389
REDUCING AND PREVENTING CAREGIVERS’ BURDEN: THE EFFICACY OF DEMENTIA CARE MANAGEMENT FOR INFORMAL DEMENTIA CAREGIVERS
Ina Zwingmann1, Jochen Rene Thyrian2, Bernhard Michalowsky2, Diana Wucherer2, Adina Dreier-Wolfgramm3, Wolfgang Hoffmann2,4, 1 Deutsches Zentrum f€ur Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/ Greifswald DZNE, Greifswald, Germany; 2German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany; 3 Institute for Community Medicine/ University of Greifswald, Greifswald, Germany; 4Institute for Community Medicine / University of Greifswald, Greifswald, Germany. Contact e-mail: [email protected] Background: The provision of appropriate support for informal caregivers is a major challenge for the healthcare system in Germany. To provide an optimal support for informal dementia caregivers, we conducted a cluster-randomized controlled trial of a comprehensive Dementia Care Management (DCM) for persons with dementia (PWD) and their informal caregivers in a primary care setting. Methods: The analyses are based on longitudinal data of the general practitioner-based, cluster-randomized DCM intervention trial DelpHi-MV (Dementia: life- and person-centered help) with baseline and 12-month follow-up assessment as well as two arms (intervention group versus care as usual). A sample of n ¼ 317 community dwelling PWD screened positive for dementia (DemTect < 9) and their
Poster Presentations: Wednesday, July 19, 2017
caregivers provided written informed consent to participate. Results: Intervention caregivers reported significant improvements in caregiver burden, especially in caregivers’ subjective burden due to behavioral change and caregivers’ subjective burden due to perceived conflicts between needs and responsibilities to care. Post-hoc subgroup analyses revealed that especially caregivers living together with PWD benefit from DCM compared to caregivers not living together with PWD. Conclusions: DCM provided by specifically trained nurses at patients’ domesticity using an IMS resulted in significant improvement in caregivers’ burden. These improvements were achieved by reducing caregivers’ subjective burden due to behavioral change and perceived conflicts between needs and responsibilities to care.
P4-390
THE ASSOCIATION BETWEEN HEAD CIRCUMFERENCE WITH DEMENTIA PREVALENCE
Thien Kieu Thi Phung1, Monique Chaaya2, Martin J. Prince3, Gunhild Waldemar4, 1Danish Dementia Research Center, Copenhagen, Denmark; 2Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; 3Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; 4Danish Dementia Research Centre, Copenhagen, Denmark. Contact e-mail: thien.phung@mail. mcgill.ca Background: Adult leg length and adult head circumference are in-
dicators of early life nutrition and brain development, respectively. Previous studies have shown inverse association between leg length and skull circumference and prevalent dementia. The aim of the
P1443
study was to study this association in a Lebanese population. Methods: A random sample of 508 participants older than 65 years
from Beirut governorate and two districts of Mount Lebanon governorate (Shouf and Aley) were recruited through multi-stage cluster sampling. The research workers door-knocked the households and interviewed any person who was 65 years old and above. Dementia was diagnosed though the Arabic validated 10/66 Dementia Research Group diagnostic assessment. Risk factor questionnaires were administered to the participants and anthropometric measures were taken. A binomial logistic regression was performed to ascertain the effects of age, gender, cognitive reserve (formal education, bilingualism, skull circumference); vascular risk factors (self-reported hypertension, diabetes, heart disease, stroke, transient ischemic attack, and obesity with body mass index 30) on the likelihood that participants have dementia. Results: 508 participants were assessed and interviewed. We excluded 12 participants with missing data. Data for 496 participants, 56.7% female and 43.3% male, were analyzed. Mean age was 72.4 years (SD 7.3). More females than males did not have a formal education (26.2% versus 12.4%, p < 0.005). No significant difference in mean age for females and males. The logistic regression model was statistically significant, c2(13) ¼ 52.7, p < .0005, explaining 24.3% (Nagelkerke R2) of the variance in dementia and correctly classified 92.5% of cases. Of the predictor variables only three were statistically significant: age, gender and skull circumference (Table 1). Females had 3.7 times higher odds to have dementia than men. Increasing age was associated with an increased likelihood of having dementia, but increasing skull circumference was associated with a reduction in the likelihood of having dementia. Conclusions: Optimal environment for brain development in early life may be protective against dementia.
Table 1 Logistic regression predicting the likelihood of dementia 95% C.l.for EXP(B)
OBESITY SKULL CIRCUMFERENCE BILINGUALISM FORMAL EDUCATION AGE FEMALE HYPERTENSION HEART DISEASE STROKE TRANSIENT ISCHEMIC ATTACK DIABETES LEG LENGHTH CONSTANT
B
S.E.
Wald
df
P value
Odd ratio
Lower
Upper
,001 -,089 -,957 -,296 ,072 1,306 ,952 ,263 ,491 ,150 ,381 ,012 -5,744
,427 ,034 ,579 ,430 ,026 ,506 ,525 ,427 ,747 ,987 ,414 ,012 2,795
,000 7,026 2,729 ,474 7,900 6,665 3,293 ,379 ,432 ,023 ,847 1,048 4.223
1 1 1 1 1 1 1 1 1 1 1 1 1
,998 ,008 ,099 ,491 ,005 ,010 ,070 ,538 ,511 ,879 ,357 ,306 ,040
1,001 ,914 ,384 ,744 1,075 3,693 2,591 1,301 1,634 1,161 1,464 1,013 ,003
,433 ,856 ,123 ,321 1,022 1,370 ,927 ,563 ,378 ,168 ,650 ,989
2,313 ,977 1,195 1,727 1,130 9,957 7,242 3,005 7,071 8,034 3,298 1,037
Poster Presentations: Wednesday, July 19, 2017
Impairment (MCI) and even prior to MCI. How best to measure early functional changes, and whether self-report or informantreport are differentially sensitive remains under debate. In the present study we examined the utility of self- and informant-reported functional abilities in predicting risk of transitioning from normal cognition to MCI or transition from MCI to dementia. Methods: Participants of this study were part of a longitudinal, observational research cohort at the University of California, Davis Alzheimer’s Disease Center (ADC). Older adult participants had been diagnosed with normal cognition or MCI at study baseline, had an informant who could complete informant-based ratings, and had at least one follow-up visit (average of 3-4 years). Participants and informants each completed the Everyday Cognition (ECog) scale, a questionnaire-based instrument designed to measure early and mild everyday functional changes across six cognitively-relevant domains (Everyday Memory, Language, Visuospatial abilities, Planning, Organization and Divided Attention). Risk of progression to MCI or dementia by baseline ECog scores (and demographic data) was evaluated using Cox proportional hazard models. Results: Both self- and informant-reported functional limitations on the ECog (Total score) were associated with a significant increase in risk of diagnostic progression to MCI (HR¼2.3, CI ¼ 1.4-3.6 and HR¼2.0, CI ¼ 1.3-3.2, respectively). When examining risk of progression from MCI to dementia, again both self- and informant-reported baseline Total ECog (HR ¼1.8, 1.2-2.8 and HR¼4.2, 3.0-5.8, respectively) were significant predictors although informant-report was much more strongly associated with conversion. Even when controlling for baseline cognitive abilities, results both for predicting MCI and dementia remained similar. Conclusions: Findings indicate that early cognitively-based functional limitations have prognostic value and help identify older adults at risk for developing MCI or dementia. Both self- and informant-reported everyday function are useful in predicting the development of MCI, whereas later in the disease (the transition from MCI to dementia) informant-reported everyday function is most strongly predictive.
P4-388
AND THEN THERE WERE THREE: INCORPORATING A LIVE-IN CAREGIVER INTO THE HOME OF A COUPLE WHERE ONE SPOUSE HAS DEMENTIA
Michal Karen Herz, University of Worcester Association for Dementia Studies, Worcester, United Kingdom. Contact e-mail: [email protected] Background: In the UK, two thirds of people living with demen-
tia live at home (Prince et al., 2014). In Israel, where the present research was conducted, people living with dementia are entitled by law to have a full-time live-in caregiver, when they reach a stage that they require constant support and supervision. For the most part, these live-in caregivers are migrants on a work visa specially designated for caregivers. This research focused on the transition from a couple to a triad comprising the live-in caregiver, spouse, and person with dementia, using
the concept of mentalization to explore the dynamics of interpersonal relationships between the three people. The aim was to understand what creates a good care environment for the person living with dementia and a good quality of life and satisfaction level for all members of the triad. Methods: Following the literature review, and based on the Interpretive-Phenomenological Approach (Smith, 1996) a semi-structured interview protocol was constructed. This was used as a basis for interviewing 5 triads. Interviews were recorded and transcribed for 18 interviews (13 interviews and 5 reflective essays). Analysis was conducted using NVIVO 11, using Malterud’s Systematic text condensation, which is a strategy for qualitative analysis based on a phenomenological approach (Malterud, 2012). As a result of the analysis, a new tentative framework was created. Results: The analysis formed a basis a new framework to conceptualise the triadic relationship. The term which represents this framework is Triadic Attentiveness. Triadic attentiveness (TAT) reflects the idea that in order to provide good support for all members of the triad, attentiveness should be encouraged at all times for all three members, each according to their own ability. Triadic attentiveness is composed of four elements: mutual respect, challenges, ambiguity, and identifying the third person in the triad. Conclusions: In a state of triadic attentiveness genuine interest in understanding the different and changing needs of the other members of the triad, but it also represents the ability to be attentive towards oneself.
P4-389
REDUCING AND PREVENTING CAREGIVERS’ BURDEN: THE EFFICACY OF DEMENTIA CARE MANAGEMENT FOR INFORMAL DEMENTIA CAREGIVERS
Ina Zwingmann1, Jochen Rene Thyrian2, Bernhard Michalowsky2, Diana Wucherer2, Adina Dreier-Wolfgramm3, Wolfgang Hoffmann2,4, 1 Deutsches Zentrum f€ur Neurodegenerative Erkrankungen e.V. (DZNE) Standort Rostock/ Greifswald DZNE, Greifswald, Germany; 2German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany; 3 Institute for Community Medicine/ University of Greifswald, Greifswald, Germany; 4Institute for Community Medicine / University of Greifswald, Greifswald, Germany. Contact e-mail: [email protected] Background: The provision of appropriate support for informal caregivers is a major challenge for the healthcare system in Germany. To provide an optimal support for informal dementia caregivers, we conducted a cluster-randomized controlled trial of a comprehensive Dementia Care Management (DCM) for persons with dementia (PWD) and their informal caregivers in a primary care setting. Methods: The analyses are based on longitudinal data of the general practitioner-based, cluster-randomized DCM intervention trial DelpHi-MV (Dementia: life- and person-centered help) with baseline and 12-month follow-up assessment as well as two arms (intervention group versus care as usual). A sample of n ¼ 317 community dwelling PWD screened positive for dementia (DemTect < 9) and their
Poster Presentations: Wednesday, July 19, 2017
caregivers provided written informed consent to participate. Results: Intervention caregivers reported significant improvements in caregiver burden, especially in caregivers’ subjective burden due to behavioral change and caregivers’ subjective burden due to perceived conflicts between needs and responsibilities to care. Post-hoc subgroup analyses revealed that especially caregivers living together with PWD benefit from DCM compared to caregivers not living together with PWD. Conclusions: DCM provided by specifically trained nurses at patients’ domesticity using an IMS resulted in significant improvement in caregivers’ burden. These improvements were achieved by reducing caregivers’ subjective burden due to behavioral change and perceived conflicts between needs and responsibilities to care.
P4-390
THE ASSOCIATION BETWEEN HEAD CIRCUMFERENCE WITH DEMENTIA PREVALENCE
Thien Kieu Thi Phung1, Monique Chaaya2, Martin J. Prince3, Gunhild Waldemar4, 1Danish Dementia Research Center, Copenhagen, Denmark; 2Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; 3Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; 4Danish Dementia Research Centre, Copenhagen, Denmark. Contact e-mail: thien.phung@mail. mcgill.ca Background: Adult leg length and adult head circumference are in-
dicators of early life nutrition and brain development, respectively. Previous studies have shown inverse association between leg length and skull circumference and prevalent dementia. The aim of the
P1443
study was to study this association in a Lebanese population. Methods: A random sample of 508 participants older than 65 years
from Beirut governorate and two districts of Mount Lebanon governorate (Shouf and Aley) were recruited through multi-stage cluster sampling. The research workers door-knocked the households and interviewed any person who was 65 years old and above. Dementia was diagnosed though the Arabic validated 10/66 Dementia Research Group diagnostic assessment. Risk factor questionnaires were administered to the participants and anthropometric measures were taken. A binomial logistic regression was performed to ascertain the effects of age, gender, cognitive reserve (formal education, bilingualism, skull circumference); vascular risk factors (self-reported hypertension, diabetes, heart disease, stroke, transient ischemic attack, and obesity with body mass index 30) on the likelihood that participants have dementia. Results: 508 participants were assessed and interviewed. We excluded 12 participants with missing data. Data for 496 participants, 56.7% female and 43.3% male, were analyzed. Mean age was 72.4 years (SD 7.3). More females than males did not have a formal education (26.2% versus 12.4%, p < 0.005). No significant difference in mean age for females and males. The logistic regression model was statistically significant, c2(13) ¼ 52.7, p < .0005, explaining 24.3% (Nagelkerke R2) of the variance in dementia and correctly classified 92.5% of cases. Of the predictor variables only three were statistically significant: age, gender and skull circumference (Table 1). Females had 3.7 times higher odds to have dementia than men. Increasing age was associated with an increased likelihood of having dementia, but increasing skull circumference was associated with a reduction in the likelihood of having dementia. Conclusions: Optimal environment for brain development in early life may be protective against dementia.
Table 1 Logistic regression predicting the likelihood of dementia 95% C.l.for EXP(B)
OBESITY SKULL CIRCUMFERENCE BILINGUALISM FORMAL EDUCATION AGE FEMALE HYPERTENSION HEART DISEASE STROKE TRANSIENT ISCHEMIC ATTACK DIABETES LEG LENGHTH CONSTANT
B
S.E.
Wald
df
P value
Odd ratio
Lower
Upper
,001 -,089 -,957 -,296 ,072 1,306 ,952 ,263 ,491 ,150 ,381 ,012 -5,744
,427 ,034 ,579 ,430 ,026 ,506 ,525 ,427 ,747 ,987 ,414 ,012 2,795
,000 7,026 2,729 ,474 7,900 6,665 3,293 ,379 ,432 ,023 ,847 1,048 4.223
1 1 1 1 1 1 1 1 1 1 1 1 1
,998 ,008 ,099 ,491 ,005 ,010 ,070 ,538 ,511 ,879 ,357 ,306 ,040
1,001 ,914 ,384 ,744 1,075 3,693 2,591 1,301 1,634 1,161 1,464 1,013 ,003
,433 ,856 ,123 ,321 1,022 1,370 ,927 ,563 ,378 ,168 ,650 ,989
2,313 ,977 1,195 1,727 1,130 9,957 7,242 3,005 7,071 8,034 3,298 1,037