Motivational Interviewing Promotes Self‐Determination of LGBTQ Adults with Dementia and Caregivers in First Intervention Study

Abstract

AbstractBackgroundLGBTQ adults experience higher rates of dementia and rely more heavily on informal social support to meet care needs compared to cisgender, heterosexual peers. As dementia progresses and they enter new systems of care, LGBTQ adults must make important choices not only about health promoting behaviors and care plans generally, but also about identity disclosure, building and maintaining a care team with families of choice, and navigating potential discrimination specific to their identities as sexual and gender minorities. A culturally relevant intervention is urgently needed to protect self‐determination and meet their unique care needs.MethodUsing findings from a longitudinal study of LGBTQ adults, a team of interventionist researchers adapted Reducing Disabilities in Alzheimer’s Disease (RDAD) by integrating culturally relevant modifications and enhanced empowerment strategies through motivational interviewing (MI). The team developed and implemented a training protocol for study interventionists called “coaches,” trialed the intervention with 150 dyads of adults with dementia and care providers in the LGBTQ community, and collected case reports from coaches and qualitative data from trial participants to inform intervention adaptations.ResultMI added unique theoretical and practical contributions, resulting in a culturally relevant, efficacious intervention (Aging with Pride: IDEA), designed for adults with dementia and care providers in the LGBTQ community and adapted for online delivery during the COVID pandemic. Qualitative data from the trial demonstrates that participants discovered “new possibilities for managing changes” as dementia progressed and finished feeling “empowered rather than stuck.”ConclusionMI uniquely supported trial participants’ self‐determination to develop and implement strategies for dementia care and coping. Practice examples are included to illustrate applications of MI and relevant theory to promote self‐determination and implementation of strategies to navigate dementia for LGBTQ adults.