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Background: Falls are a common reason that persons with cognitive impairment or dementia (PwCID) cannot remain at home. FallsTalk is a one‐month evidence‐based falls prevention program that focuses attention on the individual causes of losses of balance or falls. FallsTalk encourages new falls prevention behaviors, which have been shown to decrease falls. We adapted FallsTalk for family Caregiver (FCG) administration to a PwCID with a recent history of falls to determine if FallsTalk‐Caregiver could influence the number of new falls prevention behaviors reported by the FCG or the number of falls. Method: Thirty‐four Dyads (FCG+PwCID) were trained to conduct brief daily falls prevention discussions together. Dyads were randomly assigned to receive either standardized paper (FallsTalk,n = 14) or computer‐tailored (FallsTalk‐Caregiver,n = 20) discussion suggestions based on prior concerns expressed by the FCG. All Dyads had FallsTalk training, had daily discussions together and received weekly check‐in calls. The FCGs reported weekly on the number of falls and new falls prevention behaviors (#newFPBs); as well as any changes in the PwCID's health, care or living arrangements during the intervention period. FCGs continued to enter the number of falls and status changes weekly into a secure web‐site using a subject ID, until medical (significant health status change) or residential (no longer living at home permanently) endpoint was reached, or 52 weeks were completed. Poisson regression models compared the number of new falls prevention behaviors and weekly fall rate between groups. Fall rates were annualized for comparison with published residential care fall rates. Result: Dyads receiving FallsTalk‐Caregiver reported significantly more #newFPBs (MeanPaper = 5.34 (SEM = 0.68, CI = 3.48‐5.93), MeanComputer = 8.46 (SEM = 0.76, CI = 7.48‐10.40); p =.004) during the intervention month. FallsTalk‐Caregiver PwCIDs experienced a significantly lower fall rate (MeanPaper = 0.073/week (SEM =.015, CI = 0.049‐0.109), MeanComputer = 0.040/week (SEM =.008, CI = 0.027‐0.060); p =.047). Annualized fall rates (Falls/year for Dyads with > = 12 weeks) were (MeanPaper = 3.64/year, n = 13; MeanComputer = 2.08/year, n = 19. Conclusion: FallsTalk‐Caregiver provides an effective means to encourage new falls prevention behaviors to prevent losses of balance and falls. Despite the diversity of the Dyad's home environment and varied PwCID diagnoses, FCGs matched or bettered the annual fall rates achieved by professional caregivers in skilled nursing facilities (Resident Falls/year = 2.33 (Residents without a PwCID diagnosis); 4.05 (Residents with a PwCID diagnosis). [ABSTRACT FROM AUTHOR]

Introduction Under the U.S. national Alzheimer's plan, the National Institutes of Health identified milestones required to meet the plan's biomedical research goal (Goal 1). However, similar milestones have not been created for the goals on care (Goal 2) and support (Goal 3). Methods The Alzheimer's Association convened a workgroup with expertise in clinical care, long-term services and supports, dementia care and support research, and public policy. The workgroup reviewed the literature on Alzheimer's care and support; reviewed how other countries are addressing the issue; and identified public policies needed over the next 10 years to achieve a more ideal care and support system. Results The workgroup developed and recommended 73 milestones for Goal 2 and 56 milestones for Goal 3. Discussion To advance the implementation of the U.S. national Alzheimer's plan, the U.S. government should adopt these recommended milestones, or develop similar milestones, to be incorporated into the national plan. [ABSTRACT FROM AUTHOR]

Background Identifying effective and accessible interventions for dementia caregivers is critical as dementia prevalence increases. Objective Examine the effects of a telephone-based intervention on caregiver well-being. Design Randomized, controlled trial. Setting Academic medical center. Participants Two hundred and fifty distressed, family, dementia caregivers. Intervention Caregivers randomized to receive 16 telephone contacts over 6 months of either the Family Intervention: Telephone Tracking—Caregiver (FITT-C) or Telephone Support (TS). Outcome Primary outcome variables were family caregivers' depressive symptoms, burden, and reactions to care recipients' behavior problems at 6 months. Results The FITT-C intervention resulted in significantly improved caregiver depressive symptoms ( P = .003; 27% net improvement) and less severe reactions to care-recipient depressive behaviors ( P = .009; 29% net improvement) compared with the control condition (TS). Conclusion An entirely telephone-based intervention improves caregivers' depressive symptoms and reactions to behavior problems in the care recipient and is comparable with reported results of face-to-face interventions. [ABSTRACT FROM AUTHOR]

Background: The Care of Persons with Dementia in their Environments translational study (COPE‐CT) is a Connecticut‐based randomized clinical trial conducted to evaluate the efficacy of behavioral intervention (COPE) vs. usual care (UC) for persons with dementia (PwD) and their caregivers. Methods: PwD in both groups were enrolled in the Connecticut Home Care Program for Elders (CHCPE) and received a monthly home care plan. COPE, an in‐home behavioral intervention delivered by occupational therapists and an advance practice nurse, was designed to maximize PwD physical functioning and improve caregivers' dementia management skills. Program costs included staff training and supervision (COPE), screening for program eligibility (COPE & UC), intervention delivery (COPE), travel time and mileage (COPE), supplies (COPE & UC), lab testing (COPE), and home care plan for one year pre‐enrollment to one year post‐enrollment (COPE & UC). Mean per‐dyad cost differences at 12 months vs. baseline were calculated for each group and compared using a difference‐in‐difference approach. Result: 291 PwD/caregiver dyads were randomized (145 COPE, 146 UC). Mean per‐dyad cost of COPE was $1,868 vs. $6.41 for UC, yielding an incremental difference‐in‐difference cost of $1,862/dyad for COPE. COPE delivery was the largest cost driver ($623/dyad) followed by travel time ($370/dyad) and lab testing ($316/dyad). UC costs were minimal and driven by supplies ($18.45/dyad). Both groups experienced a cost savings in the care plan at $82.06/dyad for COPE vs. $15.63/dyad for UC, but this difference was not statistically significant (p=0.5253). Conclusion: Given the lack of medical treatments for dementia, in‐home programs for PwD and their caregivers are critical. COPE represents a novel approach to dementia behavioral management and caregiver support, and the intervention costs we report inform its sustainability. Future work will examine potential cost offsets in health and social service expenditures. [ABSTRACT FROM AUTHOR]