Caregiver Training Research Articles

ENGAGEMENT DURING POST–ACUTE CARE TRANSITION: PERCEPTIONS AND EXPERIENCES OF DEMENTIA FAMILY CAREGIVERS

Abstract Hospitalized persons with dementia (PwD) are three times more likely to discharge to skilled nursing facilities (SNF) than those without dementia, and family caregivers are essential during post-acute care transitions (PACT). Descriptions of caregiver engagement are largely provider-centric, derived from either acute or residential settings. Little is known about PACT experiences of family caregivers. This study explored meaning, barriers, and facilitators of engagement for family caregivers navigating PACT, and elucidated caregiver support needs. An interpretive descriptive approach, using Meleis’s Middle Range Transition Theory was used to interview family caregivers during a PACT. Data were inductively coded and thematically analyzed. A conceptual framework illustrating caregivers’ meaning of engagement was developed, and facilitators, barriers, and needs were described. Participants (n=15), mostly white (n=12, 80%), female (n=13, 87%), married (n=7, 47%), adult children (n=11, 73%), average age of 63 (range: 38-81, SD=12.9). The core concept was advocacy. Key related themes were caregivers’ sense of being present, communication with providers, and meaningful connections with the PwD. Barriers to engagement centered on poor communication from professional caregivers and being isolated from the PwD. A facilitator to engagement was effective communication with professional caregivers. Similarly, caregivers’ support needs included receiving information related to the transition, and the health status of the PwD. Communication was central to both caregiver engagement and advocacy of PACT. Future policy/practice recommendations should include communication training for both providers and caregivers. Interventions that facilitate caregivers’ shared access and input into health information during PACT will promote integral roles on the care team.

CHALLENGES OF E-INTERVENTION RESEARCH: LESSONS FROM THE ISUPPORT FOR DEMENTIA-PT FEASIBILITY STUDIES

Abstract E-interventions have become popular in delivering healthcare services, offering benefits such as increased accessibility and scalability. However, they also present ethical, technological, and research-related challenges. This poster aims to identify challenges of e-intervention research by analyzing feasibility studies of “iSupport for Dementia-PT”, an online training and support program for informal dementia caregivers (IDC) culturally adapted to Portugal from the original version by the Word Health Organization. A mixed-methods study collected data on user satisfaction and requirements for the program’s contents and interface through focus groups and usability test sessions with IDC (N=17) and health/social support professionals (N=13). A subsequent pilot study followed a mixed-methods experimental parallel between-group design with two arms (iSupport, N=21 and e-book, N=21). Ethical challenges unearthed by both studies included data privacy, e-consent reliability, equity in accessing e-health interventions, and e-health literacy. Challenging methodological decisions for an RCT protocol included defining criteria for a per protocol analysis in the context of a self-help e-intervention, timing for post-test or follow-up assessments, managing attrition, and the implications of resorting to online outcome measurements. The feasibility studies suggest that iSupport for Dementia-PT is a promising resource to support informal dementia caregivers. However, innovation is required in e-intervention research as replicating conventional procedures and methods have shown to be inadequate. Guidelines are needed on how to address the ethical, technological, and research-related challenges in e-intervention research.

NAVIGATING CAREWORKER CURRICULUM REVISION IN SOUTH KOREA: CHARTING COURSES FOR ELEVATING PRACTICE COMPETENCIES

Abstract The purpose of this study is to comprehensively investigate and analyze the process of revising the careworker curriculum in South Korea with a primary focus on augmenting practice competencies. This research involved an analysis of the existing 240-hour curriculum, complemented by a comprehensive literature review. Additionally, Focus Group Interviews were conducted with a cohort of 20 present careworkers to effectively identify the prevailing needs within the practice field. This study expanded the curriculum duration from 240 to 320 hours. Subsequently, pilot courses were executed, incorporating enhanced content related to dementia care, humanity in caregiving, and infectious disease management. These modifications were delivered via webinars to 64 active care workers, a method chosen due to the constraints imposed by the COVID-19 pandemic. This study employed a pre-post design to inquire about the perceptions of older adults and their job skills. Fifty-four female care workers (84.2%) and eleven male care workers (15.8%) participated in the study, with an average age of 52 years, experiencing 3 years and 8 months. Several areas exhibited statistical significance; understanding and managing depression and anxiety (2.175*), supporting leisure activities(2.956**), implementing abuse prevention behaviors (3.187**), creating a safe environment(2.496**), assisting with mobility(2.978**), aiding in illness management(2.805**), transferring responsibilities(2.726**), documenting cases(2.238*), and overseeing caregiver health and safety(2.805*). Based on our findings, we have devised a plan to incorporate the following content within the additional 80 hours. In a broader context, this study contributes to the ongoing discourse on caregiver education and training in South Korea.

THE USE OF CAREGIVER SUPPORT SERVICES AND CAREGIVING IMPACT AMONG DIVERSE CAREGIVERS OF OLDER ADULTS WITH DEMENTIA

Abstract Caregiver support services may improve experiences among caregivers of people with dementia, but racial/ethnic disparities exist in service use. Using data from the 2021 National Study of Caregiving, we measured caregiver service use and caregiving impacts among 470 Black (n=187), Hispanic (n=37), and White (n=246) caregivers of older adults with possible/probable dementia from the National Health and Aging Trends Study. We classified caregivers as using at least one or none of the following services in the past year: caregiver support group, training, or respite care. We calculated the weighted proportion of caregivers reporting caregiver burden (at least one: physical, emotional or financial difficulty), exhaustion, and feeling overwhelmed within each racial/ethnic group. Caregiver service use varied by race/ethnicity (47% of Hispanic, 29% of Black, and 32% of White caregivers). Black and White caregiver service-users were significantly more likely to report a burden than their peers using no service (59% versus 36% of Black, p=0.04, and 90% versus 41% of White, p<0.001, caregivers). There was no significant difference in burden among Hispanic caregivers (59% versus 69%, p=0.65). In each racial/ethnic category, caregivers reported similar prevalence of exhaustion and feeling overwhelmed from caregiving whether they used a service or not. Based on these cross-sectional data, we hypothesize that Black and White caregivers who feel burdened use services more often, and that service use mitigates caregivers’ feelings of being exhausted or overwhelmed by caregiving, despite burden. Racial/ethnic differences highlight the need to understand contextual factors that influence caregiver burden and service use.

USING COMMUNITY ENGAGEMENT TO DEVELOP, TEST, AND IMPLEMENT INTERVENTIONS FOR DEMENTIA CARE PARTNERS

Abstract Interventions for caregivers to persons living with dementia are numerous and target a wide array of outcomes. One challenge limiting the dissemination of research-based interventions is the complexity of translating the intervention models for a variety of community environments and situations. Interventions that plan for future translation and scalability during the development stages have a better chance of quickly and efficiently being adopted by community partners. This symposium describes the methods used and the lessons learned from five research projects that used various forms of community engagement to develop, adapt, and assess feasibility of caregiver interventions, while simultaneously preparing for their translation and scalability: 1) Eaton et al., present the process and benefits gained from partnering with dementia caregivers to iteratively develop the Enhancing Active Caregiver Training (EnACT) intervention. 2) Utz et al., discuss ways to use the RE-AIM implementation framework to guide the development and pilot-testing of the Time for Living and Caring (TLC) respite intervention. 3) Dassel et al., explore the use of community-based participatory methods to adapt a paper-based advance care planning guide to an interactive web-based LEAD (Life-Planning in Early Alzheimer’s and other Dementias) intervention. 4) Cotton et al., report on the lessons learned from a formative analysis of their processes used to culturally adapt an intergenerational respite program for older adults within the Latine community. 5) Supiano et al., describe how they engaged and trained nursing home social workers to develop and implement the PreLoss Group Support intervention for dementia family care partners.

DEVELOPING A CONCEPTUAL MODEL TO ASSESS ACTIVE ENGAGEMENT WITHIN A DEMENTIA CAREGIVER INTERVENTION

Abstract Active engagement is identified as an effective component of psychoeducational interventions for caregivers of persons living with dementia. There are many approaches to active engagement; however, limited assessment of this component within interventions reduces optimization and standardization. To fill this gap and increase transparency, we aimed to strengthen active engagement by developing Enhancing Active Caregiver Training (EnACT), an arts-based intervention designed to help caregivers address the behavioral symptoms of dementia. The intervention uses multi-sensory activities, including interacting with caregiver-informed vignettes, to foster engagement and process caregiving experiences. We partnered with caregivers of persons living with dementia (n=9) to iteratively refine EnACT through six focus groups. The purpose of this presentation is to report the process we took to identify how intervention participants actively engaged with EnACT. Focus group data were analyzed using process coding to identify the patterns of participant engagement with 17 intervention activities. The process codes were mapped to create a diagram of participant engagement for each activity. These diagrams were used to develop the EnACT Cycle of Engagement, a conceptual model illustrating how participants engaged with the intervention. The three-step model illustrates that: 1) antecedents (personal and intervention) contribute to 2) interaction with EnACT through participation, contribution, and application, which leads to 3) EnACT’s hypothesized proximal outcomes (capacity to adapt and appraisal of caregiving demands) and distal outcomes (perceived stress and caregiver well-being). The EnACT engagement model will be tested in the forthcoming randomized control trial assessing feasibility and acceptability.

RECRUITMENT AND BASELINE RESULTS FOR THE STAR CAREGIVERS VIRTUAL TRAINING AND FOLLOW-UP PRAGMATIC TRIAL

Abstract The STAR-Caregivers program is efficacious in reducing the behavioral and psychological symptoms of dementia (BPSD). In this pragmatic trial, we are testing a 6-session, self-directed, online version of the program that leverages secure email, an online learning management system, and brief coaching telephone calls to expand access to training. This paper reports on issues related to recruitment and baseline levels of psychosocial measures collected. Caregivers and persons living with dementia (PLWD) were randomized to intervention or usual care. Baseline measures were collected via REDCap and included standardized measures for PLWD dementia severity and functioning and caregiver measures for anxiety, stress, depression, and caregiving mastery. The study recruited 67 dyads. Recruitment increased greatly when we removed the inclusion that subjects be on antipsychotic medications. Baseline clinical showed the average score on the Dementia Severity Rating Scale was 22.2 (mild) and 28.8 on the Revised Memory and Problem Behavior Checklist (mild). The average Functional Activities Questionnaire was 22/30. Caregivers reported low levels of stress (KCSS), depression (PHQ8), and anxiety (GAD2) with mean and standard deviation: KCSS = 22.8 (6.6), PHQ8 = 4.9 (4.65), and GAD2 = 1.3 (1.4). The mean Caregiver Mastery Score was moderate at 20.4 (3.28). Virtual delivery of the STAR Caregiver training program is feasible. Caregivers of PLWD with mild to moderate cognitive and functional decline seem most amenable to intervention. We are currently analyzing outcome date to determine the efficacy of this program and plan to investigate the optimal timing of caregiver outreach and support programs.

ON THE FRONTLINES: TRAINING A DEMENTIA CAREGIVING WORKFORCE IN CALIFORNIA

Abstract Direct care workers who provide in-home care – such as caregivers hired by consumers of California’s Medicaid-funded In-Home Supportive Services (IHSS) program – are well positioned to observe changes in their consumer’s cognition, health, or behaviors. This proximity to consumers better allows for reporting to healthcare partners, which may reduce risk of emergency department visits, hospitalizations, and other adverse outcomes that are disproportionately high among people living with Alzheimer’s disease and related dementias (ADRD). Despite their vital role in supporting people living with ADRD, IHSS caregivers receive minimal formal training for their unique position. To address this training gap, the IHSS+ ADRD Training Project is a five-year effort funded by the California Department of Public Health to train 720 IHSS caregivers in Alameda and Los Angeles counties, with classes in English, Spanish, Cantonese, and Mandarin. To date, 582 IHSS caregivers have been trained. Using a pre-posttest design, our preliminary findings indicate statistically significant increases in dementia knowledge and self-efficacy that could bolster caregiver’s skills. These results also reveal that IHSS caregivers value training opportunities to better support their consumers. Correlations between caregiver training outcomes and healthcare utilization patterns of their consumers were further examined by evaluating administrative data before and after the training. The results need to be further understood in the context of COVID-19 and the ADRD illness trajectory. Implications include expanding long-term funding for multi-week training programs, which aligns with the California Master Plan for Aging’s goal to support and create one million high-quality caregiving jobs by 2030.

WHAT MATTERS MOST? REACTIONS TO THE RAISE ADVISORY COUNCIL’S NATIONAL STRATEGY TO SUPPORT FAMILY CAREGIVERS

Abstract This presentation reports on feedback from advocates and researchers, those working in organizations serving family caregivers, and family caregivers themselves regarding the 2022 National Strategy to Support Family Caregivers. The Strategy was issued by the RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018). A Request for Information (RFI) published in the Federal Register garnered nearly 600 responses from a wide range of individuals and organizations, providing feedback about top priorities for action, topics or populations that were not adequately addressed, and recommendations for actions that could help meet stated objectives; these comments will prove critical in implementing the National Strategy, as well as in updating and revising it. This presentation sets the progress of the National Strategy in context, reports on the RFI analysis, and describes next steps, highlighting key areas of focus for the federal government, states, and other entities. Priorities included expanding the direct care workforce and increasing access to caregiver training and supports, particularly respite. Other top comments pertained to financial and workplace security for family caregivers - encouraging caregiver-friendly workplaces, paying family members to provide care, and strengthening the Family and Medical Leave Act. Respondents broadly endorsed the Strategy and noted the need for campaigns promoting greater awareness of family caregiving. The findings suggest that there is strong consensus among caregiver advocates regarding the most critical areas for action and the most favored strategies to achieve caregivers’ priority goals.

A CRITICAL EXAMINATION OF AAA SERVICES AND SUPPORTS FOR CAREGIVERS IN MICHIGAN: POLICY AND PRACTICE IMPLICATIONS

Abstract To identify the service gaps for family caregivers in Michigan, this study examined the perceptions of stakeholders from the 16 area agencies on aging (AAA). An online questionnaire was administered to assess a point-in-time picture of current caregiver assessments and services in 2020. Fifteen AAAs responded to see definitely or probably an increase in the number of caregivers in their catchment areas. Fifteen AAAs currently purchase or contract for respite care services. Fourteen provide some type of direct caregiving resources. Twelve utilize staff to develop and monitor care plans. While some provided caregiver training, none directly provided supportive services. AAAs anticipated rapidly increasing needs for caregiver supports and services. While each provided a different array of services, they anticipated that demand would continue to increase given a rising aging population in Michigan. Results were used to craft a proposal to establish a network of regional caregiver resource centers. Recommendations in the study include creating a task force of stakeholders to identify standardized service definitions, measures and reporting requirements; create a no-wrong-door, multi-prong approach for caregivers to access programs; provide respite care through contracts and referrals to community-based organizations; create a network of trainers to disseminate evidence-based best practices to AAAs and contractors; use untapped resources such as AARP and Alzheimer’s Association; explore forming local healthcare systems and provider collaborations to identify caregivers and triage them. Next steps are to pursue funding from the legislature and other sources to create regional caregiver resource centers across the state.

ALASKA NATIVE DEMENTIA CAREGIVERS AND THE INCREASING NEED FOR CULTURALLY SAFE RESOURCES

Abstract With the rate of dementia increasing among Alaska Native people and the tribal health system ill-equipped to meet the challenges associated with dementia care, there is an urgent need to better understand cultural perspectives on dementia caregiving and what states and communities can do to support their caregivers. Despite the fact caring for others is a value and cultural practice for Indigenous communities, and caregivers tend to report fewer challenges and barriers related to care, they still experience barriers and challenges. Guided by Kleinman’s explanatory model of illness, a qualitative, the aim of this study was to gain insight on Alaska Native caregiver experiences in caring for someone living with dementia in communities across Alaska. 21 interviews with Alaska Native dementia caregivers in rural and urban communities were completed. Despite being innovative and resourceful in providing care, caregivers reported the high cost of care, inadequate training of health care providers, and the paucity of culturally safe caregiver training, education, and resources are especially concerning and need to be addressed in a timely fashion. Caregivers in this study recommended the development of basic educational materials to be aware of dementia, its stages, and the available supports, as well as caregiver support and respite services. The recommendations from this study focus on outreach and education for caregivers to improve their access to education, training, and support to reduce isolation, increase their dementia knowledge, expand their awareness of ancillary resources, and inform help-seeking decisions.

LEVERAGING A BEHEMOTH: TRANSLATING VA FAMILY CAREGIVER RESEARCH TO POLICY AND PRACTICE

Abstract The VA has been a pioneer in research, practice and policy that supports the needs of caregivers. The VA HSR&D funded Elizabeth Dole Center of Excellence in Veteran and Caregiver Research, of which Dr. Trivedi is a site PI and part of the core leadership, is a testament to this investment in research, as are several scientific projects. The VA also provides support for caregivers by providing an array of services (e.g., hotline; caregiver training programs; stipends) and has deployed 2000+ staff nationally to connect caregivers to VA and non-VA services. The VA has also invested in rigorous evaluations of existing practice and policy with the eye on refining and improving. Dr. Trivedi will provide an overview of her work within the VA that focuses on developing behavioral intervention to target the collective stress coping needs of Veteran-caregiver dyads. With the lens of implementation science, she will share her work identifying barriers and facilitators of accessing home and community-based services, and describe how these insights are being used to inform VA practice and policy.

Exploring the Barriers and Facilitators to Caregiver Engagement in Postural Management Training for Children with Complex Neurodisabilities: a qualitative study

Twenty-four-hour postural management (PM) is widely recognised as being important for children with cerebral palsy (CP) and other complex neurodisabilities. Training for caregivers involved in delivering PM is essential. However, engagement with PM training by caregivers is variable. Little research has been conducted to date to establish how to engage caregivers in PM training. Karen Crozier*1, Kay Cooper1,2, Sharon Blair3, Rachel McDermott3, Irene Croal1 1 NHS Grampian Physiotherapy Department, Royal Aberdeen Children’s Hospital, Westburn Road, Aberdeen, UK 2 School of Health Sciences, Robert Gordon University, Aberdeen, UK. 3 NHS Grampian Aberdeen City Central Child Development Team, Mile End School, Midstocket Road, Aberdeen, UK *Corresponding author: karencrozier@hotmail.co.uk

Extending Classroom Learning Borders

Through the provision of education and training, the Caregiver Training Workshop (CTW) pilot study aimed to advance knowledge about in-person educational interventions for primary family caregivers aiding ill adults (18 years of age and over) at home. The target population was community-dwelling chronic disease caregivers, fourteen of whom participated in the workshop/pilot study in September and October 2019. The sessions were offered once a week, over five weeks—each session lasting two hours. The goal of the CTW pilot study was to measure any relationship between caregiver burden levels and the study’s multi-component curriculum and course design, and to obtain participant feedback about the content and structure. Curricular topics were selected based on a review of the literature. The methodology selected was mixed-methods and convergent pretest–posttest design. Data was collected at three points in time. The pre-workshop data collection instruments consisted of the Burden Scale for Family Caregivers (BSFC) in long form and a mixed demographics form. Post-workshop instruments consisted of the BSFC (second time) and open-ended questions evaluating the program. Three-months post workshop conclusion, the instruments consisted of the BSFC (final time) and a mixed questionnaire regarding the program’s impact. The reduction in caregiver burden was not statistically significant; however, burden scores from three of the 14 caregivers improved over the study period. Analyzing the qualitative data, as well as viewing caregiver burden through self-efficacy theory, offer insights as to why. Many caregivers expressed interest in maintaining contact with each other post workshop completion. This supports research indicating that some caregivers are interested in maintaining social connections throughout their care recipients’ illness trajectories.

Implementation of community physiotherapy in primary care: one-year results of an on-call physiotherapy service

BackgroundPrimary health care systems have a key role in meeting health needs of community, including function. The aim of this paper is to describe the population involved in the Community Physiotherapist project and their health outcomes over a one-year period.MethodsThe Community Physiotherapist is an on-call service which requires a request by general practitioners or medical specialists. Reason for prescription, waiting time for service delivery, diagnostic categories, provided intervention, number of interventions and outcomes were recorded for everyone included in the project. Possible differences in characteristics between individuals referred by medical specialists and general practitioners were also investigated.ResultsFrom January to December 2022, 409 individuals were referred to the Community Physiotherapist pathway. Functional goals were achieved in 79.5% of interventions, without reported adverse events. In most cases physiotherapists provided counselling or caregiver training and 3.3% of individuals needed a full rehabilitation program. The groups of individuals referred by the two types of prescribers showed no significant differences, apart, as expected, from their median age.ConclusionsThe introduction of the Community Physiotherapist model within the primary care setting allows to provide appropriate, effective and safe interventions. Sharing the project among all the health professionals helped to support its appropriateness and effectiveness. Results also indicate that a new organizational model, such as the Community Physiotherapist, will take a long time to be implemented.

RELEVANCE OF THE TYPE OF ACCOMMODATION IN THE EMOTIONAL STATE AND HEALTH STATUS OF THE ELDERLY

The study aimed to explore differences between the elderly who lived in the institutions and those who lived with their family in terms of emotional state, generativeness, integrity, and psychophysical health. The sample included respondents (N=101) with an average age of 67 years, ranging from 65 to 85. The Current Emotional State Scale, the Adapted Loyola Scale of Generativity, the Integrity Scale and the RAND-36 Health Survey, were used. Higher scores on the scales of happiness, relaxation and pride as well as on the scale of generativeness and integrity were found in respondents living with family. In comparison, higher scores of anger, unhappiness, humiliation and fear/anxiety were found in elderly living in institutions (nursing homes). Statistically significant differences were confirmed in emotional well-being (U=586,000; p=0.001), social functioning (U=803,500; p=0.024), physical functioning (U=557,500; p=0.001), limitations in physical functioning (U=825,000; p=0.016) and general health (U=827,000; p=0.040). The findings of this study suggest the need to maximise the inclusion and participation of the family as a caring and long-term partner in the geriatric organisation of nursing homes, as well as to introduce the activities that would be feasible and adjusted to family members of the elderly in the residential accommodation. Improving such care would contribute to the current inquiries dealing with emotional state and health in the elderly. The assessment of the incidence of chronic morbidities in relation to the functional health of the elderly, along with continuous training of professional caregivers, who are in regular contact with the elderly, remain some of the crucial factors in establishing future preventive and long-term policies of care by the government.

P183: Online support and training for informal caregivers of people with dementia: usability and feasibility of iSupport for Dementia

Introduction:Internet-based interventions have been explored for their potential to minimize the negative outcomes of caring, accounting for their convenient delivery, ubiquity, potential scalability and presumed (cost) effectiveness. A new online training and support programme for dementia caregivers was recently created by the World Health Organization and culturally adapted to European-Portuguese. The programme (iSupport) was developed to prevent or minimize the negative psychological effects of providing informal care to a person with dementia and relies on problem-solving and cognitive behavioural therapy techniques.Objective:To study the usability and feasibility of the European-Portuguese version of iSupport (iSupport- Portugal).Methods:The usability study was aimed at collecting data on user satisfaction and requirements on the programme's contents and interface. A mixed-methods design consisted of focus groups discussion and usability test sessions with informal caregivers (N=17) and health/social support professionals (N=13). The pilot study followed a mixed-methods experimental parallel between-group design with two arms (iSupport, N=21 and e-book, N=21).Results:The usability tests show a success rate superior to 80% in completing tasks within the platform and an excellent perception of the program's usability (M= 89.5 on the System Usability Scale). The feasibility study allowed to explore usage data for iSupport-Portugal (e.g., lessons visited, time on sessions) and explore how the intervention and control arms compare over time (baseline, 3 and 6 months after) on well-being outcomes. For a per-protocol analysis, significant group-by-time interaction effects favouring the intervention were found for anxiety (Wald χ2=6.17, p=.046) and for environmental QoL (Wald χ2=7.06, p=.029). Interviewees with the intervention arm (N=12) revealed positive impacts of iSupport on knowledge and on experiencing positive feelings.Conclusion:The usability and feasibility studies of iSupport-Portugal suggest that this is a promising resource to support informal dementia caregivers. Lessons were learned on the ethical, technological, and research-related challenges for online interventions.

P181: Outreach initiative to promote healthy ageing: Experiences from a Geriatric Psychiatry Unit in India

Aim:To describe the experience, challenges and solutions in implementing an outreach initiative to promote healthy ageingBackground:Prevalence of mental health conditions in older adults is increasing rapidly in developing countries like India due to population ageing. UN Decade of Healthy Ageing (2021-2030) has been launched with focus on combatting ageism, promoting age friendly environment, integrated care and providing access to good quality long term care. Implementing interventions to promote healthy ageing in the Indian context has significant challenges in the background of limited availability dedicated elderly friendly health and social care systems.Methods:Description of the outreach initiatives launched by the Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences a tertiary care academic unit for old age psychiatry in India.Results:A systematic and comprehensive outreach initiative for healthy ageing has been implemented over 2 years. The main objectives for the initiative includes promoting awareness about ageing and mental health, promoting age friendly environment, training of caregivers, volunteers and other stakeholders, psychosocial intervention in old age homes, promoting integrative medicine for healthy ageing and providing geriatric tele-psychiatry services. The important strengths of this initiative has been collaboration with non-governmental organizations, promoting active participation from older adults and volunteers, mobilizing resources through corporate social responsibility funding and effective use of technology.Conclusion:The experience of implementing this outreach initiative has contributed to important learnings for the team. The proposed solutions to address the challenges in sustaining this initiative and scaling up to reach a larger population will be discussed.

Day hospital for psychogeriatric patients: implementation of best practice

AbstractBackgroundPsychogeriatric day hospitals best practices deliver integrated patient and family centered care by multidisciplinary teams, providing a safer transition between acute psychogeriatric units to rehabilitation services and outpatients clinical care. This reduces inpatient length of stay and rehospitalization rates, favoring a successful daily routine care at home. We implemented in 2022 an elderly day hospital service at the Institute of Psychiatry USP Medical School, Brazil. This case report illustrates how day hospitals can contribute to a better clinical outcome.Case report64 year‐old male patient with bipolar disorder (BD), recurrent readmissions in our psychogeriatric unit due to either complications from bipolar disorder or clinical conditions and family burden (2020 for 90 days due to rapid cycling BD and 2021 to treat clinical conditions 4 days). When he was at home his family reported increased burden and difficulty in daily care. They asked for readmissions in this period .The cognitive impairment and functional decline were associated with neuroprogression in BD.The lack of adequate treatment worsened psychiatric, cognitive symptoms and the capacity to maintain his activities of daily living (ADL).In 2022 he was admitted due to behavior symptoms (irritability and aggressivity) in our inpatient unit for 19 days. Transitioned to day hospital, he attended activities for two months, twice a week. The intervention provided cognitive and functional stimulation, caregivers training and psychoeducation. It was performed in groups and individually (patient and family).We observed improvement in cognition, basic daily life activities and social support. Admission and transition to outpatient care were CGI‐04‐04, MMSE 20‐23 and Katz 02‐04. We observed reduction in family burden and management of psychiatric and behavior symptoms.ConclusionPatient and family needs were identified and cared for, and we achieved an improved health outcome by creating a safe transition, reducing length of stay and preventing readmission. This present intervention demonstrates a clinical example of the coordinated approach in order to provide transitional care and enable rehabilitation (cognition, basic daily life and bipolar symptoms).The benefits of the patient‐ family centered care provides consistent recovery and decreased length of hospital stay and risk of readmission.

Family Caregiving in a Great Lakes Native American Community: A Mixed Methods Study of Service Utilization

AbstractBackgroundNative Americans are disproportionately impacted by ADRD, and family caregiving is uniquely significant within Indigenous communities. Caregiving services can improve outcomes but are underutilized, and increasing use of caregiver services is key to addressing the dementia care crisis. Indigenous populations are underrepresented in the ADRD caregiving literature, resulting in a significant gap in understanding of how to improve engagement with services. We examine perspectives on service utilization among caregivers in a large tribal nation in the US Great Lakes region.MethodWithin a community‐based research partnership between the Wisconsin ADRC and the Oneida Nation of Wisconsin, N = 481 completed a survey on use of seven common caregiver resources, including support groups, respite, caregiver training, household help, transportation for care recipient, nursing home, and financial assistance. Drawing on the Andersen model of utilization, multiple regression models examined correlates of positive attitudes toward use of services among caregivers (N = 207), defined as past, current, or intended future use of services. Follow‐up in‐depth interviews with 10 caregivers of elders with ADRD (Table 3) explored decision‐making regarding service utilization using qualitative content analysis.ResultThere were few demographic differences between caregivers and non‐caregivers in the sample (Mage = 52 and 54 yrs; 75% female; Table 1). Over half (54.6%) of caregivers were employed; most (64%) cared for someone with ADRD. In the final regression model in the caregiver subsample, only level of belief that traditional Oneida values and practices support caregivers in using caregiver services predicted positive attitudes toward service utilization (p<.001; Table 2). Interviews revealed barriers to service use include low awareness, complexities of service funding structures, and Elder preferences. Perceptions of alignment of traditional cultural values with service use were complex and nuanced.ConclusionUsing mixed methods in a Native American community sample, we identified unique barriers to access resources to support elders with ADRD and their families, including perceived cultural support for service use. Our findings contribute to the scant literature on ADRD caregiving among Native Americans and provide support for tailored interventions (e.g., Savvy Caregiver in Indian Country). Results can inform public health initiatives to address ADRD disparities and improve outcomes for Indigenous persons with ADRD.