A - 29 Understanding the Role of Caregiver Self-Efficacy in Dementia Healthcare: Findings from the Care Ecosystem Program.

Abstract

Identify changes in healthcare utilization (HCU) and admission risk scores (ARS) by caregiver self-efficacy levels (CGSE) in persons with dementia (PWD). 179 community-dwelling dyads (PWD-CG) with at least 1 emergency or hospital admission 12-months prior to enrollment in the Care Ecosystem (dementia care-management program), provided data at baseline, 6, and 12-months. Analyzed data included caregiver self-reported HCU, dementia ratings (QDRS, NPI), wellbeing (ZBI-12, NPI-Distress, PHQ9), and CGSE scales. HCU confirmation and ARS were extracted from electronic medical records. Repeated measures ANOVA and paired sample t-tests compared ARS and HCU across time points by baseline CGSE. On average, PWD and caregivers were 80 (SD:8) and 64years-old (SD:11); predominantly female (PWD:63%, CG: 77%) and white (62%), with 12+ years of education (PWD: 84%, CG: 98%). Self-efficacy improved over time [F(1.92, 281.74 = 11.56, p < 0.001, ηp2 = 0.13]; post-hoc Bonferroni indicated increases from 19.37 to 20.62 at 6-months (95% CI, 0.59-1.92) and 20.56 at 12-months (95% CI, 0.41-1.98). Reductions in ARS [t(178) = 2.63, p = 0.009, MD = 3.34, d = 0.2] and HCU [t(177) = 5.37, p < 0.001, MD = 0.85, d = 0.4] were observed at program completion. The high-CGSE group demonstrated significant ARS [t(98) = 3.43, p = 0.001, d = 0.4] and HCU reductions [t(98) = 3.65, p < 0.001, d = 0.4]. HCU also decreased for the moderate-CGSE cohort [t(43) = 4.17, p < 0.001, d = 0.6]. Groups with higher CGSE experienced greater reductions in ARS and HCU compared to lower CGSE. Self-reported measures and CGSE-group sample sizes may limit our findings.