Benefits of dementia education on caregivers March 15
Benefits of dementia education on caregivers March 15, 2019
Jennifer Allbright, RN, BSN is the Manager for St. Vincent Medical Group Center for Healthy Aging and Senior Services. Jenny is a 1985 graduate of Indiana University School of nursing and has graduate education in Business and Nursing. Her scope of nursing practice in both the Chicago and Indianapolis areas includes critical care, ambulatory surgery, physician support in hospital, case management, geriatric ambulatory care, practice and project management, program development, process improvement, and conference planning/speaking. Jenny has extensive experience in disease and transitions of care education for geriatric patients and their families, specifically regarding dementia and geriatric syndromes. She works closely with outside community agencies and health systems on the improvement of support and care for older adults. Jenny enjoys community education and program development and has been an active leader in support for dementia caregivers. 2
Disclosure This speaker has no conflict of interest to disclose. 3
Objectives § Identify factors impacting caregiver stress/burden on dementia caregivers § Explore the benefits of educational programs for dementia caregivers in working toward “What Matters” § Identify education options for dementia caregivers 4
“What Matters” to caregivers Receiving the diagnosis of dementia can be devastating to patients and their families or caregivers and many are unprepared to meet the future demands this role will place on them. There is an overwhelming need to prepare informal caregivers for the future needs of loved their ones. According to the National Alliance for Caregiving, (Dementia Caregiving in the U. S. , 2017) § Many dementia caregivers want greater support from healthcare professionals in caring for their loved one as well as themselves. Less than half of dementia caregivers (44%) report having a doctor, nurse, or social worker ever ask them what they need to care for their loved one 24% report having ever been asked about their own self care needs 26% report wanting conversations regarding self care but have never had them § Education and support are significant factors in improving the care of those living with dementia and decreasing the stress of their caregivers. 5
Picture of dementia caregiving Compared with caregivers of people without dementia, twice as many dementia caregivers indicate substantial emotional, financial and physical difficulties (2018 Alz. Facts and Figures, 2018) § § 6 30 40% of dementia caregivers experience depression Often at increased risk health concerns
Picture of caregiving Caregiving tasks: § § ADLs: bathing, dressing, toileting, eating, mobility IADLs: shopping, meal preparation, medications, transportation, cleaning, finances, communication Managing behaviors: sleep/sun downing, wandering, paranoia, repetitiveness, hallucinations/delusions, aggressiveness, depression/apathy Self care Burden/stress: § Caregiver burden related to behaviors and care dependency and patient QOL is predominant reason for institutionalization (Hebert, et al. , 2003) § Caregiver’s health declines correlate strongly with rates of emotional stress and physical strain (Dementia Caregiving in the U. S. , 2017) 7
Picture of dementia in Indiana According to Indiana Alzheimer’s Statistics in 2018 there were 110, 000 individuals with Alzheimer’s and is the 6 th leading cause of death in IN. § IN statistics (2017): § § § 338, 000 caregivers 385 million hours of unpaid care Total value of unpaid care was $4, 857 billion § Medicare recipients with dementia: § § § Increased likelihood to have other chronic conditions Have twice as many hospital stays per year as other older adults Higher ER and readmission rates § Individual lifetime cost for care: § 8 $341, 840
Education Types 9 In-person group education classes Individual/family education On-line/Web based options (videos, articles, research, on-line communities) Reading materials
Psychoeducation for dementia caregivers Psychoeducational groups aim to educate participants on a particular condition and how to better manage or cope with the symptoms arising from the condition. Participants are able to learn and grow from other participants, share stories, and develop relationships that may continue beyond. Psychoeducational groups for dementia caregivers provides an opportunity to comprehensive education and support which is often limited in a clinic setting and connect caregivers with others individuals sharing similar experiences. 10
Objectives for dementia psychoeducation groups § § § § 11 Comfortable and familiar setting for family members/caregivers to receive education and support regarding dementia. Provide basic education to caregivers of the newly diagnosed regarding dementia. Provide additional education for caregivers Provide education regarding tools effective in managing behaviors common with those who have dementia. Provide socialization opportunities as a means for caregiver group members to engage and find support with others providing care to someone with dementia. Facilitate a safe environment in which members are encouraged to learn from each other and their experiences. Provide caregivers with information and tools necessary to provide appropriate care to their loved one with the goal of decreasing caregiver burden and need for urgent/emergent staff intervention.
Benefits to caregiver § Basic dementia knowledge § Communication techniques § Assessment and management of behavioral symptoms associated with dementia § When and who to contact for medical concerns § Community resources § Financial resources § Care options § Self care techniques § Socialization § Building a network of support § Keeping loved one in the environment of their choosing 12
Benefits to healthcare systems § Reduced ER visits, hospitalization, and geri psych admissions for patients § Potential reduction in health costs § Fewer office calls for behavioral concerns § More efficient office visits § Increased satisfaction with the care provided § Reduced or delayed institutionalization 13
Caregiver education and support is a “team effort” Studies show significant reduction in caregiver burden with psychoeducational interventions, but in this benefit is noted to decline over time. (Pahlavanzadeh et al. , 2010) Therefore, support, education and continual reinforcement of appropriate interventions need to be provided and modeled throughout the span of care: The team approach : § § 14 Medical practices (PCP and consults) Acute care (ER, hospital settings) Post acute care (SNF, home care, outpatient rehabilitation, remote care monitoring, pharmacy) Community partners
In Summary It is necessary for healthcare providers and professionals to assess What Matters to patients and develop care that aligns with these goals. Consequences of caregiver burden: § § Physical �fatigue, pain from physical demands, disruption of sleep patterns, increased risk of cardiovascular and other medical disorders Psychological/emotional �increased risk of depression, anxiety and guilt Social �isolation and loneliness Financial �unemployment, cost of specialized equipment Interventions to impact caregiver stress and burden: § § § 15 Medical �interventions to treat/manage the behavioral symptoms of dementia and caregiver depression/fatigue. Psycho social �group or one on one teaching on the emotional repercussions of caregiving, and coping strategies to reduce stress Educational �provide information about dementia and skills training for handling behavioral problems with loved ones
Bibliography Dementia Caregiving in the U. S. (Rep. ). (2017). Retrieved January 19, 2019, from http: //www. caregiving. org/wp content/uploads/2014/01/Dementia Caregiving in the US_February 2017. pdf 2018 ALZHEIMER’S DISEASE FACTS AND FIGURES(Rep. ). (2018). doi: https: //doi. org/10. 1016/j. jalz. 2018. 02. 001 Hebert, R. , Levesque, L. , Vezina, J. , Lavoie, J. , Ducharme, F. , Gendron, C. , . . . Dubois, M. (2003). Efficacy of a Psychoeducative Group Program for Caregivers of Demented Persons Living at Home: A Randomized Controlled Trial. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(1), 58 67. doi: 10. 1093/geronb/58. 1. s 58 Alzheimer's Statistics Indiana. (n. d. ). Retrieved January 20, 2019, from https: //www. alz. org/getmedia/49 e 03721 5795 48 bd a 24 d 191930 db 5 e 93/statesheet_indiana Pahlavanzadeh, S. , Heidari, F. G. , Maghsudi, J. , Ghazavi, Z. , & Samandari, S. (2010). The effects of family education program on the caregiver burden of families of elderly with dementia disorders. Iranian Journal of Nursing and Midwifery Research, 15(3), 1 9. Retrieved January 23, 2019. Christie, H. L. , Bartels, S. L. , Boots, L. M. , Tange, H. J. , Verhey, F. R. , & Vugt, M. E. (2018). A systematic review on the implementation of e. Health interventions for informal caregivers of people with dementia. Internet Interventions, 13, 51 59. doi: 10. 1016/j. invent. 2018. 07. 002 Zimmerman, S. , Sloane, P. D. , Ward, K. , Beeber, A. , Reed, D. , Lathren, C. , . . . Gwyther, L. (2018). Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource. American Journal of Alzheimer's Disease & Other Dementias®, 33(3), 176 183. doi: 10. 1177/1533317517749466 16
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