Introduction: Published estimates of Alzheimer's disease (AD) progression do not capture the full... more Introduction: Published estimates of Alzheimer's disease (AD) progression do not capture the full disease continuum. This study provides transition probabilities of individuals with amyloid-b (Ab?) pathology across the disease continuum. Methods: Patient-level longitudinal data from the National Alzheimer's Coordinating Center were used to estimate progression rates. Progression rates through five clinically defined AD stages-asymptomatic, mild cognitive impairment due to AD (MCI-AD), mild AD dementia, moderate AD dementia, severe AD dementiaand death were measured as transition probabilities. Rates were assessed in ''incident'' patients who recently entered the stage, controlling for covariates. Transition probabilities were generated from multinomial logit regression models that predicted an individual's health state as a function of health state at the previous visit and adjusted for time between initial and follow-up visits, age, sex, years of education, and concomitant symptomatic AD medications. Results: Annual transition probabilities to more severe dementia stages for surviving incident Ab? patients were as follows: asymptomatic to MCI-AD, 40.8%; MCI-AD to mild AD dementia or worse, 21.8%; mild AD dementia to moderate AD dementia or worse, 35.9%; moderate AD dementia to severe AD dementia, 28.6%. Transition probabilities to less severe dementia stages were: 5.3% annual reversion from MCI-AD to asymptomatic, 3.0% mild AD dementia to MCI-AD, 1.8% moderate AD dementia to mild AD dementia, and 1.3% for severe AD dementia to moderate AD dementia. Conclusions: These transition probabilities reflect the full continuum of AD progression in Ab? individuals and can be used to assess the impact of treatment on expected transitions.
In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to ... more In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to identify effective methods to screen for dementia. We suggest that this include detection of the mild cognitive impairment (MCI) syndrome, where there is objective decline in cognitive functioning. Longitudinal clinical studies indicate that participants with amnestic MCI have a substantially increased rate of progression to clinically probable Alzheimer disease. 2 As the authors point out, it is extremely unusual to find reversible causes of dementia. However, many potentially reversible factors can contribute to MCI with cognitive performance that is worse than expected as a result of aging alone, such as medical illness, depression, medication adverse effects, or cardiovascular factors. Many of these may be amenable to intervention if a patient screens positive on routine testing. Moreover, nonpharmacological therapies such as psychosocial interventions have been reported as effective in improving cognitive performance in aging persons. 3 A negative screen for MCI can be used to reassure individuals who are concerned about their self-perceived decline in cognitive performance and confirm that they are most likely experiencing age-related changes, rather than the beginnings of Alzheimer disease or another dementia. Two of the larger studies of normal aging vs MCI 4,5 have demonstrated benefits derived from screening asymptomatic individuals in a primary care setting. In both studies, more than 90% of patients identified with MCI had a progressive disorder as the underlying cause of the cognitive impairment. The potential for intervention and delaying disease progression in most of these patients argues for detection as early as possible, in the MCI stage, so that the underlying cause of the cognitive impairment can be treated when possible. If one applied to diabetes mellitus the approach of not screening at-risk asymptomatic individuals and instead waited until symptoms developed, many of these symptoms (including neuropathy, retinopathy, nephropathy, and cerebrovascular disease) would not reverse with treatment. This would be considered unacceptable clinical practice for diabetes. We do not think that Alzheimer disease should be viewed differently, given that there is at least some substantive evidence that at-risk individuals can be diagnosed in the earliest stages and that potentially reversible factors contributing to cognitive performance declines can be further investigated and treated.
BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled i... more BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not.MethodsData were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts.ResultsThe high‐intensity cohort was minimally younger (85±7.6 vs. 86...
Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, c... more Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. Methods. Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer’s disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman’s rho, Mann-Whitney U ,...
Dementia care partner (CP) self-care is an important intervention target to enhance resilience an... more Dementia care partner (CP) self-care is an important intervention target to enhance resilience and reduce risk of negative physical and psychological outcomes, such as illness, functional decline, depression and anxiety. Yet few studies have explored CP perceptions of what helps vs prevents them from consistently engaging in self-care activities. This exploratory study examined data from 100 semi-structured CP interviews on the barriers and facilitators to self-care. Inductive thematic analysis identified multiple facilitators and barriers that can be characterized as actual (did affect self-care) or potential (would affect self-care). CP capacity to participate in self-care activities was influenced by internal (e.g. setting boundaries) or external (e.g. social support) factors. We developed a framework to illustrate these mechanisms and guide interventions for optimizing self-care behaviors.
Background Older adults with cognitive impairment have more emergency department visits and 30-da... more Background Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Depar...
Dr Borson reported serving as an author of an information sheet prepared by the American Geriatri... more Dr Borson reported serving as an author of an information sheet prepared by the American Geriatrics Society for consumers and patients regarding aducanumab. No other disclosures were reported.
BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons... more BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Our objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end‐of‐life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC.MethodsThis mixed‐methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata‐matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Inverse probability of treatment weighting propensity score‐adjusted models were used to compare time‐to‐first hospital‐based utilization and, for decedents, home palliative and hospice care and place of death. Care experience was captured through caregiver interviews.ResultsPatients re...
The Journal of Prevention of Alzheimer's Disease, 2020
Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clin... more Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clinical development; once approved, new healthcare infrastructures and services, including primary healthcare, will be necessary to accommodate a huge demand for early and large-scale detection of AD. The increasing global accessibility of digital consumer electronics has opened up new prospects for early diagnosis and management of mild cognitive impairment (MCI) with particular regard to AD. This new wave of innovation has spurred research in both academia and industry, aimed at developing and validating a new “digital generation” of tools for the assessment of the cognitive performance. In light of this paradigm shift, an international working group (the Global Advisory Group on Future MCI Care Pathways) convened to elaborate on how digital tools may be optimally integrated in screening-diagnostic pathways of AD The working group developed consensus perspectives on new algorithms for lar...
BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associ... more BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes.MethodA total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs.ResultsA total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of...
The Journal of Prevention of Alzheimer's Disease, 2020
Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to ... more Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals’ cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihoo...
Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ab... more Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ability to endure and recover from stressors that arise during the caring process. However, it is unknown what behaviors can indicate resilience in care partners (CPs) of PWDs. We examined 46 peer-reviewed articles (1990 to 2018) that included measures or definitions of resilience in CPs of PWDs. Our goal is to identify resilience-related behaviors and create a behavior-based model/framework for CPs of PWDs. Three major themes emerged: (1) Problem-response behaviors (problem-identifying, problem-solving, problem-distancing, learning, and reflection); (2) self-growth behaviors (self-care, creative/spiritual activities, and developing/maintaining meaningful social relationships); (3) help-related behaviors (help-seeking and help-receiving). These findings informed the development of a behavior-based Care Partner Resilience (CPR) measure. Future steps in this research include evaluating to wh...
OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and c... more OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence‐based psychotherapy program to reduce obstacles to care.DESIGNA practice improvement initiative providing no‐fee evidence‐based mental health care at home in clients' primary languages.SETTINGIndependence at Home, a community service of SCAN Health Plan in Southern California.PARTICIPANTSDiverse older adults and adult caregivers of older people with age‐related disability (mainly dementia).INTERVENTIONRedesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.MEASUREMENTSWe describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.RESULTSInsights successfully served demographically diverse clients experiencing a broad ran...
Caregivers' (CGs) self-reports of resilience may differ from their actual behaviors. We examined ... more Caregivers' (CGs) self-reports of resilience may differ from their actual behaviors. We examined how their perceptions relate to specific, measurable behaviors empirically associated with resilience. Semi-structured interviews were conducted with 20 CGs of people living with dementia (PWD) who had a recent health crisis and measures of CG help-seeking, self-care and problem solving. We empirically assigned a level of resilience based on day-to-day behavior and actions in response to a personalized stress scenario, and compared this with scores on the Brief Resilience Scale. CG self-ratings of resilience were generally high, but behavioral reports did not reflect consistent utilization of resilience promoting behaviors. CGs' global self-reports of resilience may not be a reliable indicator of what they do under stress. Future resilience interventions should focus on identifying, measuring, and targeting CG behaviors associated with resilience and foster CGs' understanding of how these behaviors support their ability to "bounce back".
Introduction: Published estimates of Alzheimer's disease (AD) progression do not capture the full... more Introduction: Published estimates of Alzheimer's disease (AD) progression do not capture the full disease continuum. This study provides transition probabilities of individuals with amyloid-b (Ab?) pathology across the disease continuum. Methods: Patient-level longitudinal data from the National Alzheimer's Coordinating Center were used to estimate progression rates. Progression rates through five clinically defined AD stages-asymptomatic, mild cognitive impairment due to AD (MCI-AD), mild AD dementia, moderate AD dementia, severe AD dementiaand death were measured as transition probabilities. Rates were assessed in ''incident'' patients who recently entered the stage, controlling for covariates. Transition probabilities were generated from multinomial logit regression models that predicted an individual's health state as a function of health state at the previous visit and adjusted for time between initial and follow-up visits, age, sex, years of education, and concomitant symptomatic AD medications. Results: Annual transition probabilities to more severe dementia stages for surviving incident Ab? patients were as follows: asymptomatic to MCI-AD, 40.8%; MCI-AD to mild AD dementia or worse, 21.8%; mild AD dementia to moderate AD dementia or worse, 35.9%; moderate AD dementia to severe AD dementia, 28.6%. Transition probabilities to less severe dementia stages were: 5.3% annual reversion from MCI-AD to asymptomatic, 3.0% mild AD dementia to MCI-AD, 1.8% moderate AD dementia to mild AD dementia, and 1.3% for severe AD dementia to moderate AD dementia. Conclusions: These transition probabilities reflect the full continuum of AD progression in Ab? individuals and can be used to assess the impact of treatment on expected transitions.
In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to ... more In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to identify effective methods to screen for dementia. We suggest that this include detection of the mild cognitive impairment (MCI) syndrome, where there is objective decline in cognitive functioning. Longitudinal clinical studies indicate that participants with amnestic MCI have a substantially increased rate of progression to clinically probable Alzheimer disease. 2 As the authors point out, it is extremely unusual to find reversible causes of dementia. However, many potentially reversible factors can contribute to MCI with cognitive performance that is worse than expected as a result of aging alone, such as medical illness, depression, medication adverse effects, or cardiovascular factors. Many of these may be amenable to intervention if a patient screens positive on routine testing. Moreover, nonpharmacological therapies such as psychosocial interventions have been reported as effective in improving cognitive performance in aging persons. 3 A negative screen for MCI can be used to reassure individuals who are concerned about their self-perceived decline in cognitive performance and confirm that they are most likely experiencing age-related changes, rather than the beginnings of Alzheimer disease or another dementia. Two of the larger studies of normal aging vs MCI 4,5 have demonstrated benefits derived from screening asymptomatic individuals in a primary care setting. In both studies, more than 90% of patients identified with MCI had a progressive disorder as the underlying cause of the cognitive impairment. The potential for intervention and delaying disease progression in most of these patients argues for detection as early as possible, in the MCI stage, so that the underlying cause of the cognitive impairment can be treated when possible. If one applied to diabetes mellitus the approach of not screening at-risk asymptomatic individuals and instead waited until symptoms developed, many of these symptoms (including neuropathy, retinopathy, nephropathy, and cerebrovascular disease) would not reverse with treatment. This would be considered unacceptable clinical practice for diabetes. We do not think that Alzheimer disease should be viewed differently, given that there is at least some substantive evidence that at-risk individuals can be diagnosed in the earliest stages and that potentially reversible factors contributing to cognitive performance declines can be further investigated and treated.
BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled i... more BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not.MethodsData were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts.ResultsThe high‐intensity cohort was minimally younger (85±7.6 vs. 86...
Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, c... more Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. Methods. Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer’s disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman’s rho, Mann-Whitney U ,...
Dementia care partner (CP) self-care is an important intervention target to enhance resilience an... more Dementia care partner (CP) self-care is an important intervention target to enhance resilience and reduce risk of negative physical and psychological outcomes, such as illness, functional decline, depression and anxiety. Yet few studies have explored CP perceptions of what helps vs prevents them from consistently engaging in self-care activities. This exploratory study examined data from 100 semi-structured CP interviews on the barriers and facilitators to self-care. Inductive thematic analysis identified multiple facilitators and barriers that can be characterized as actual (did affect self-care) or potential (would affect self-care). CP capacity to participate in self-care activities was influenced by internal (e.g. setting boundaries) or external (e.g. social support) factors. We developed a framework to illustrate these mechanisms and guide interventions for optimizing self-care behaviors.
Background Older adults with cognitive impairment have more emergency department visits and 30-da... more Background Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Depar...
Dr Borson reported serving as an author of an information sheet prepared by the American Geriatri... more Dr Borson reported serving as an author of an information sheet prepared by the American Geriatrics Society for consumers and patients regarding aducanumab. No other disclosures were reported.
BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons... more BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Our objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end‐of‐life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC.MethodsThis mixed‐methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata‐matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Inverse probability of treatment weighting propensity score‐adjusted models were used to compare time‐to‐first hospital‐based utilization and, for decedents, home palliative and hospice care and place of death. Care experience was captured through caregiver interviews.ResultsPatients re...
The Journal of Prevention of Alzheimer's Disease, 2020
Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clin... more Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clinical development; once approved, new healthcare infrastructures and services, including primary healthcare, will be necessary to accommodate a huge demand for early and large-scale detection of AD. The increasing global accessibility of digital consumer electronics has opened up new prospects for early diagnosis and management of mild cognitive impairment (MCI) with particular regard to AD. This new wave of innovation has spurred research in both academia and industry, aimed at developing and validating a new “digital generation” of tools for the assessment of the cognitive performance. In light of this paradigm shift, an international working group (the Global Advisory Group on Future MCI Care Pathways) convened to elaborate on how digital tools may be optimally integrated in screening-diagnostic pathways of AD The working group developed consensus perspectives on new algorithms for lar...
BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associ... more BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes.MethodA total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs.ResultsA total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of...
The Journal of Prevention of Alzheimer's Disease, 2020
Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to ... more Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals’ cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihoo...
Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ab... more Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ability to endure and recover from stressors that arise during the caring process. However, it is unknown what behaviors can indicate resilience in care partners (CPs) of PWDs. We examined 46 peer-reviewed articles (1990 to 2018) that included measures or definitions of resilience in CPs of PWDs. Our goal is to identify resilience-related behaviors and create a behavior-based model/framework for CPs of PWDs. Three major themes emerged: (1) Problem-response behaviors (problem-identifying, problem-solving, problem-distancing, learning, and reflection); (2) self-growth behaviors (self-care, creative/spiritual activities, and developing/maintaining meaningful social relationships); (3) help-related behaviors (help-seeking and help-receiving). These findings informed the development of a behavior-based Care Partner Resilience (CPR) measure. Future steps in this research include evaluating to wh...
OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and c... more OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence‐based psychotherapy program to reduce obstacles to care.DESIGNA practice improvement initiative providing no‐fee evidence‐based mental health care at home in clients' primary languages.SETTINGIndependence at Home, a community service of SCAN Health Plan in Southern California.PARTICIPANTSDiverse older adults and adult caregivers of older people with age‐related disability (mainly dementia).INTERVENTIONRedesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.MEASUREMENTSWe describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.RESULTSInsights successfully served demographically diverse clients experiencing a broad ran...
Caregivers' (CGs) self-reports of resilience may differ from their actual behaviors. We examined ... more Caregivers' (CGs) self-reports of resilience may differ from their actual behaviors. We examined how their perceptions relate to specific, measurable behaviors empirically associated with resilience. Semi-structured interviews were conducted with 20 CGs of people living with dementia (PWD) who had a recent health crisis and measures of CG help-seeking, self-care and problem solving. We empirically assigned a level of resilience based on day-to-day behavior and actions in response to a personalized stress scenario, and compared this with scores on the Brief Resilience Scale. CG self-ratings of resilience were generally high, but behavioral reports did not reflect consistent utilization of resilience promoting behaviors. CGs' global self-reports of resilience may not be a reliable indicator of what they do under stress. Future resilience interventions should focus on identifying, measuring, and targeting CG behaviors associated with resilience and foster CGs' understanding of how these behaviors support their ability to "bounce back".
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Papers by Soo Borson