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IntroductionPragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare.MethodsCommunity-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients.ResultsElectronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American.DiscussionHealth systems can successfully enroll diverse dyads in a pragmatic clinical trial.

This article celebrates the National Institute on Aging (NIA)'s successes over the past 50 years in advancing the science base and informing the need for and response to dementia caregiving. In parallel with other public and private efforts, insightful NIA leadership supported by funding initiatives established the field of dementia caregiving research. In support of the health and well-being of family caregivers, NIA was a catalyst of innovation that led to numerous evidence-based caregiving interventions informed by basic research on care tasks and consequences. As evidence of the impending burden of dementia care on US families mounted, NIA-funded multidisciplinary collaboratives of researchers generated comprehensive models of family caregiving across diverse populations. Today, the dementia caregiving evidence base is shaping public policy and making possible dementia caregiving support services in health systems and community-based organizations. NIA continues to support the scientific study of dementia caregiving with a collaboration of leading scientists and by making available state-of-the-art datasets and encouraging standardized research methodologies. NIA's leadership in the field of dementia caregiving research has never been more significant, as the number of persons living with dementia in the United States approaches 7 million and the value of family caregiving is estimated to be $350 billion. [ABSTRACT FROM AUTHOR]

Given the role of physical activity (PA) and good nutrition to delay the onset and progression of most chronic conditions, effective interventions are needed to influence lifestyle behaviors of community-dwelling populations. The purpose of this study is to examine the effectiveness of Texercise Select to improve health indicators, PA, and dietary behaviors, and confidence to engage in healthful behaviors. Texercise Select, a 12-week exercise program, was delivered. Baseline and 12-week follow-up assessments were collected from 220 participants with baseline data who were aged 45 years and older for this non-randomized one-group pre-post design trial. Linear mixed models were fitted for continuous outcome variables and GEE models with logit link function for binary outcome variables. Significant improvements (P

This study examines the effectiveness of Texercise Select, a 12-week lifestyle program to improve physical functioning (as measured by gait speed) and quality of life. Baseline and 12-week follow-up assessments were collected from 220 enrollees who were older (mean = 75 years), predominantly female (85%), White (82%), and experiencing multiple comorbidities (mean = 2.4). Linear mixed-models were fitted for continuous outcome variables and GEE models with logit link function for binary outcome variables. At baseline, over 52% of participants had Timed Up-and-Go (TUG) test times of 12 s or more, which indicates below-normal performance. On average, participants showed significant reductions in TUG test scores at the postintervention (11% reduction, p < .001). Participants also showed significant improvements in general health status (p = .002), unhealthy physical days (p = .032), combined unhealthy physical and mental days (p = .006), and days limited from usual activity (p = .045). Findings suggest that performance indicators can be objectively collected and integrated into evaluation designs of community-based, activity-rich lifestyle programs.

A collaborative partnership among community-based organizations (CBOs) could strengthen local services and enhance the capacity of a community to provide services as well as meet the diverse needs of older adults. The United Way of Tarrant County developed the LIVE WELL Initiative, partnering with six CBOs to provide nine evidence-based or evidence-informed health interventions to improve the health and lower healthcare costs of vulnerable individuals at risk for poor health. The nine programs include specific target areas, such as falls prevention, chronic disease self-management, medication management, and diabetes screening and education. A total of 63,102 clients, nearly 70% of whom were older adults, were served through the Initiative. Significant improvements in self-reported health status were observed among served clients. The percentage of clients reporting self-rated health as good, very good, and excellent increased from 47.5% at baseline to 61.1% at follow-up assessment. The mean healthy days improved from 16.9 days at baseline to 20.6 days at follow-up assessment. Additional improvements in program-specific outcomes demonstrated significant impacts of targeted intervention focus among served clients by program. The findings of this study emphasize that the impact of a collaborative partnership with multiple CBOs could promote health and well-being for older adults. [ABSTRACT FROM AUTHOR]

Home-delivered meals have shown considerable promise in overcoming nutritional challenges among homebound older adults facing food insecurity and the risk of diabetes, while nutrition counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a program combining nutrition counseling with home-delivered meals by examining the use of hospital services 6 months before and after participating in the program. This study included 1009 clients who are at risk for diabetes and who received home-delivered meals and nutrition counseling via Meals on Wheels in Fort Worth, Texas. Hospital service data were extracted from a regional claims database. Generalized linear models were performed to examine changes in use of hospital services 6 months before and after program participation. The mean number of emergency department visits and hospitalizations decreased from 0.69 to 0.50 (p <.001) and from 0.35 to 0.22 (p <.001), respectively. The findings of this study indicate that combining structured nutritional counseling with home-delivered meals may contribute to reducing healthcare use among older adults facing the challenges of diabetes and food insecurity. [ABSTRACT FROM AUTHOR]

Post-intensive care syndrome (PICS)-associated morbidities have far-reaching implications for independent functioning, employment, psychological effects, and health care utilization, costing billions annually.[1] To address the psychological sequelae, research that evaluates support groups is needed, including the I 2021 Surviving Sepsis Guideline i recommendations to conduct randomized controlled trials with survivors of sepsis and their families.[[1]] Rigorous peer support and motivational interviewing (MI) programs have positively influenced self-management in smoking cessation, alcohol use, and cancer survivorship.[[3]] Unlike clinicians, intensive care unit (ICU) survivors have first-hand experience of ICU recovery challenges and are thus well suited to prepare new ICU survivors for long-term recovery and rehabilitation. Peer-delivered motivational interviewing intervention for post-intensive care syndrome: A pilot of peer mentor training feasibility The aim of Peer Support for Post-Intensive Care Syndrome Self-Management (PS-PICS) mentor training trial was to determine the operational feasibility of implementing a training program for peer-delivered MI tailored for ICU survivors, and to assess PICS symptomology in peer mentor participants. [Extracted from the article]

The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion. We conclude with a discussion of implications and future directions for clinical intervention, research, and policy. Key Words: Caregiving, Suffering, Compassion, Health, Well-being

Agitation in nursing home residents presents a serious challenge to caregivers and may place residents at risk for harm. Understanding the etiology of agitation can assist clinicians in developing nonpharmacologic interventions for preventing and treating this problem. The purpose of this study was to examine independent and common predictors of resident agitation with structural equation modeling. Agitation was measured with both a standardized staff report rating scale and direct behavioral observation. No indirect or mediating effects were found. Cognitive impairment, vision and hearing impairment, and gender were found to be independent predictors of agitation as measured by direct behavioral observation. Only cognitive impairment was found to be predictive of agitation as measured by the standardized staff report scale. An unexpected finding was that vision impairment appeared to exert a protective effect for agitation in these severely cognitively impaired residents. The clinical implications of these findings are discussed as well as the relative merits of the two methods of measuring agitation.

Computer-assisted behavioral observation data were collected from 66 nursing home residents while they received assistance during personal care routines from a certified nursing assistant (CNA). Data were collected both before and after a comprehensive behavior-management and communication-skills training program was delivered to the nursing staff. A total of 30 residents showed 6 or more episodes of disruptive vocalization or other forms of agitation during baseline observations, and timed-event sequential analysis methods were used to test whether certain CNA behaviors either elicited or prevented onsets of agitation in these 30 residents. Simple verbal prompts used by CNAs during personal care routines before staff training were found to elicit agitation onset (p = .03), whereas positive statements to the resident were found to reduce the likelihood of agitation onset (p = .02). In a previous analysis of the effects of staff training, we found that rates of resident agitation were significantly lower after training compared with baseline and that CNAs increased their rates of positive statements to residents. In the present study, timed-event sequential analyses indicated that the verbal prompts used by CNAs during personal care routines were no longer associated with an increased rate of resident agitation after staff training among the 20 residents who showed 6 or more episodes of agitation both before and after staff training. These findings suggest that the staff training program improved the quality of CNA verbal prompts. The sequential analysis of observational data provides an important method for studying interpersonal interactions, including those of nursing home residents and the nursing staff who care for them.

This article describes a nursing staff training program in basic behavior management skills and a formal staff management system to encourage the application of these basic skills on the nursing unit. Behavioral skills training consists of a 5-hour in-service followed by three weeks of on-the-job training to ensure accurate application of behavior management skills. Following training, a staff management system is used to facilitate long-term use of the skills. Components of the staff management system include supervisory monitoring of the nursing assistants (NAs) by licensed practical nurses (LPNs), NA self-monitoring, verbal and written performance feedback, and incentives. Key Words: Behavior management, Staff training, Staff motivation, Quality of care

Informal care is a major source of long-term services and supports (LTSS) for older adults in the U.S. However, the increasing gap between available family caregivers and those needing LTSS in coming years warrants better understanding of the balance between informal and formal home or community-based LTSS to meet the growing demand. The current study aimed to 1) identify patterns of informal and formal LTSS use among community-dwelling individuals, and 2) examine if the supply of formal LTSS predicts the use of informal care. These aims were investigated by linking the market supply of formal LTSS at the state-level to the Health and Retirement Survey data (N = 7,781). Results provide important empirical evidence that patterns of informal and formal LTSS use among older adults are heterogeneous and market supply of formal home and community-based services (HCBS) significantly predicts the use of informal care. Most older adults rely on informal care in combination with some formal supports, suggesting that the two systems work in tandem to meet the growing needs of LTSS. This offers important implications for states allocating resources to meet the LTSS needs of older adults and individuals with disabilities since states play key roles in U.S. long-term care policies. [ABSTRACT FROM AUTHOR]

Many initiatives have been developed to facilitate older adults’ engagement in physical activity (PA) and document its benefits. One example is Texercise, a 12-week program with a focus on increasing participants’ self-efficacy. The goal of this paper is to augment the knowledgebase of PA program implementation and dissemination by elucidating the experience of Texercise implementation as perceived by multiple stakeholders. We conducted 28 semistructured stakeholder interviews and categorized the responses into four preset themes: (1) program delivery and advocacy; (2) value/merit of the program; (3) successes/challenges of offering and sustaining the program; and (4) recommendations for enhancing implementation and delivery. We identified emergent subthemes through further analysis. Many perceptions that are broadly applicable to community organizations emerged. Our findings highlight the importance of stakeholder support when embedding PA programs in communities. Furthermore, the findings are crucial to understanding underlying processes that support widespread program dissemination and sustainability. [ABSTRACT FROM AUTHOR]