PSYCHOSOCIAL INTERVENTION FOR DEMENTIA CAREGIVER: PILOT STUDY

PSYCHOSOCIAL INTERVENTION FOR DEMENTIA CAREGIVER: PILOT STUDY

Poster Presentations: Tuesday, July 26, 2016 P3-357 POSITIVE EFFECTS OF AN INTEGRATED SUPPORT AND TRAINING PROGRAM FOR FAMILY CAREGIVERS OF ELDERLY W...

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Poster Presentations: Tuesday, July 26, 2016 P3-357

POSITIVE EFFECTS OF AN INTEGRATED SUPPORT AND TRAINING PROGRAM FOR FAMILY CAREGIVERS OF ELDERLY WITH DEMENTIA: A BEFORE AND AFTER STUDY

Byeong Kil Yeon1,2, Seong-Jin Cho1, Jae Myeong Kang1, Seonkyung Yun2, Hyejin Yoon2, 1Gachon University Gil Medical Center, Incheon, The Republic of Korea; 2Incheon Metropolitan Dementia Center, Incheon, The Republic of Korea. Contact e-mail: [email protected] Objects: Patients with dementia are increasing in the aging society

and over 60 percent of caregivers are family members in South Korea. An integrated support and training program for family caregivers is greatly required to relieve the care burden and prevent serious conflicts in families. This study aimed to determine effects of the integrated support program on the caregivers of the elderly with dementia. Methods: Total of 28 dementia family caregivers visited dementia counseling centers participated in this study. A 6 weeks of comprehensive caregiver support and training program, Hyu-Sig-Gong-Gan, developed by Incheon Metropolitan Dementia Center was provided to the participants. Hyu-Sig-Gong-Gan means resting place and it consists of education on dementia, stress coping strategy, cognitive behavior therapy, psychological counselling, linkage to social support service and self-help group. Effects of the program on caregivers were evaluated with Zarit Burden Interview-Korean version (ZBI-K), Center for Epidemiologic Studies Depression (CES-D), EuroQOL 5 Dimensions questionnaire, Medical Outcome Scale Social Support Survey, Brief Resilience Scale (BRS), Coping Self-Efficacy scale, and time spent on caregiving before and after 6 weeks of the program. Results: The evaluated levels of care burden (ZBI-K, Z¼–3.069, p¼0.002), depression (CES-D, Z¼–3.751, p<0.001), resilience (BRS, Z¼–3.597, p<0.001) in caregivers who participated the integrated support program were improved. Also, the time spent for giving medication to their patients were decreased significantly (Z¼–1.972, p<0.049) after the program. Conclusions: The integrated support and training program for family caregivers of the elderly with dementia is associated with improvement of the care burden, depression level, resilience, and reduction of time spent on caregiving by improving the efficacy.

Table 1 Sociodemographic data of participants Demographic data

Participants (n ¼ 28)

Age, year(s) Gender, female (n) Education, year(s) Cohabitation period, months(s) Dementia support period, month(s) Marital status Married Not married Relationship to patient Spouse Daughter Son Daughter in law Son in law Certificated care-helper Educated about dementia

57.8 (11.8) 23 (82.1%) 11.1 (5.3) 249.2 (269.3) 44.0 (35.4) 23 (82.1) 5 (17.9) 7 (25.0) 13 (46.4) 2 (7.1) 5 (17.9) 1 (3.6) 7 (25.0%) 13 (46.4%)

All data are indicated as mean (SD) or number (percentage, %)

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Table 2 Comparison of care burden, depressed mood, health state, social support, resilience, coping self-efficacy in participants before and after the integrated support program

ZBI-K CES-D Eq5D MOS SSS BRS CSE

Baseline

6 weeks

Z

p

47.0 (15.7) 22.1 (9.0) 1.5 (0.33) 27.6 (10.6) 12.1 (1.4) 20.3 (6.7)

37.3 (16.3) 14.3 (8.3) 1.4 (0.31) 30.1 (9.3) 15.9 (4.4) 22.3 (6.3)

-3.069 -3.751 -1.518 -1.297 -3.597 -1.482

0.002 <0.001 0.129 0.195 <0.001 0.138

All data are represented as mean (SD) ZBI-K: Zarit Burden Interview-Korean version CES-D : Center for Epidemiologic Studies Depression Eq5D : EuroQOL 5 Dimensions questionnaire MOS SSS : Medical Outcome Scale Social Support Survey BRS : Brief Resilience Scale CSE : Coping Self-Efficacv scale Table 3 Comparison of caregiving time in participants before and after the integrated support program Caregiving time (hr/m)

Baseline

6 weeks

Z

p

Using toilet Feeding Clothing Hygiene Protection Housekeeping Meal preparation Shopping for patients Giving medication Outdoor behavior

24.40 (46.2) 20.3 (33.1) 12.5 (16.5) 18.8 (33.3) 194.8 (281.0) 61.8 (135.8) 58.9 (49.2) 17.0 (13.8) 16.7 (17.3) 19.1 (22.0)

30.1 (85.2) 19.6 (37.3) 11.4 (13.3) 11.7 (15.9) 56.7 (153.0) 29.4 (26.3) 44.0 (36.8) 13.2 (19.9) 8.1 (11.9) 15.5 (19.8)

-0.153 -0.204 -0.096 -0.687 -1.893 -1.920 -1.374 -1.506 -1.972 -1.137

0.878 0.838 0.924 0.492 0.058 0.055 0.170 0.132 0.049 0.256

P3-358

PSYCHOSOCIAL INTERVENTION FOR DEMENTIA CAREGIVER: PILOT STUDY

Wai Kit Tang, Chung Yan Joanne Chan, The Chinese University of Hong Kong, Hong Kong, Hong Kong. Contact e-mail: [email protected] com Background: Caregivers of patients with dementia (PWD) often experience role overload and a decline in self-efficacy (Infurna, Gerstorf, & Zarit, 2013). Self-efficacy is defined as the belief that one can successfully execute a specific task or behavior required to produce an outcome (Bandura, 1997), and it plays a significant role in dementia caregiving (Harmell et al., 2011; Rabinowitz et al., 2007; Roepke et al., 2009). Regarding the needs of caregivers, psychosocial interventions for dementia caregivers is recommended as a clinical priority in the caring context (American Psychiatric Association, 2007). However, different psychosocial interventions have been found to have an inconsistent structure (Pinquart & S€ orensen, 2006), which may contribute to the caregivers’ readiness to use the strategies taught (Gitlin & Rose, 2014). Thus, an intervention based on an extensive literature review (Tang & Chan, 2015) is proposed to improve the self-efficacy and psychological burden of caregivers. Methods: The evidence-based intervention in the proposed RCT study adopted Bandura’s (1997) theoretical framework of self-efficacy. In particular, the intervention will address four sources of self-efficacy information. To determine the feasibility of the intervention proposed, a pilot

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Poster Presentations: Tuesday, July 26, 2016

Appendix 1 Overview of the Psychosocial Intervention Pilot Program Group size: 10 participants Session

Format

Recruitment 45 mins: and Individual Data face-to-face Collection interview Session 1 90 mins: Face-to-face group session

Main Theme      

  

Booster Session

15 mins: Individual telephone interview

  

Session 2

90 mins: Face-to-face group session

   

 



Booster Session

15 mins: Individual telephone interview

Session 3

90 mins: Face-to-face group session

    



Supporting Materials

Pamphlet Consent Orientation of the Baseline collection program Rapport building Information Introduction booklet 1 Information about dementia about communication skills and daily care routine Video of other caregivers on their problems and solution Sharing positive experiences of participants Relaxation exercise – Diaphragmatic breathing Knowledge checking Review on skill applications learnt from session 1 Consolidating the strengths and gains in Session 1 Reminder Review of Session 1 Information Information about daily booklet 2 care on dementia caregiving Exploration of maladaptive responses and thoughts during daily care Video of other caregivers on their problems and solution Cognitive restructuring and problem-solving for maladaptive responses and thoughts Sharing positive experiences of participants Relaxation exercise Knowledge checking Consolidating the strengths and gains in Session 2 Reminder Review of Session 2, Information consolidating the booklet 3 strengths and gains throughout the program Information about Behavioral and Psychological Symptoms of Dementia (BPSD) (Continued )

Appendix 1

Overview of the Psychosocial Intervention Pilot Program Group size: 10 participants (Continued ) Session

Booster Session

Format

15 mins: Individual telephone interview

Main Theme

Supporting Materials

 Exploration of maladaptive responses and thoughts during tackling BPSD  Video of other caregivers on their problems and solution  Cognitive restructuring and problem-solving for maladaptive responses and thoughts  Sharing positive experiences of participants  Relaxation exercise  Consolidating the strengths and gains throughout the program  Relaxation exercise  Knowledge checking  Booster on challenges faced in application of skills learned in the sessions

study was performed first. The intervention consists of six-sessions with an information booklet set. Ten participants were recruited from the Mental Health Clinic during PWD out-patient clinic sessions in Hong Kong. Caregivers’ self-efficacy and subjective burden were measured prior to the program, immediately after the completion of the program, and one month after the program. Data analysis was conducted using SPSS. Results: The adherence rate was over 70% among the 10 participants. Due to the limitation of the small sample size, a non-parametric test was employed to analyze the differences among the participants. The results showed improving trends in both caregiving self-efficacy and psychological burden of the participants in the two post-intervention time-points. Conclusions: After the intervention program employed in the pilot study, both the caregiving self-efficacy and psychological burden of the participants improved, which suggests that it is a feasible and cost-effective program for dementia caregivers. However, for more robust evidence, a RCT with sufficient effect size should be performed.

P3-359

PSYCHOTROPIC MEDICATION IN NURSING HOMES

Claudia Frankenberg1, Petra Wetzel1, Nadja Andrejeva1, Inga MeyerK€uhling2, Britta Wendelstein2, Christina Degen3, Andreas Zenth€ofer4, Johannes Schr€oder2, 1Section of Geriatric Psychiatry, University Hospital Heidelberg, Heidelberg, Germany; 2Institute of Gerontology, University of Heidelberg, Heidelberg, Germany; 3Section for Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany; 4University Hospital Heidelberg, Heidelberg, Germany. Contact e-mail: [email protected] med.uni-heidelberg.de