Savvy Caregiver Research Articles

Examining cultural adaptations of the savvy caregiver program for Korean American caregivers using the framework for reporting adaptations and modifications-enhanced (FRAME)

BackgroundThe Framework for Reporting Adaptations and Modifications–Enhanced (FRAME) is a tool that systematically guides decision-making and reporting of adaptations made to evidence-based interventions. Using FRAME, we documented the process and outcomes of adapting the Savvy Caregiver Program (SCP) for Korean American dementia caregivers.MethodsSequential adaptation was initiated with linguistic attunement, followed by pilot implementation and full adaptation. Our data-driven adaptation with multiple data sources and a feedback loop among multiple stakeholders yielded a total of 32 modifications, and each was coded according to the eight domains of FRAME: (1) what was modified, (2) who participated in recommending and deciding the modification to be made, (3) when the modification occurred, (4) whether the modification was planned, (5) whether the modification was fidelity-consistent, (6) whether the modification was temporary, (7) at what level of delivery, the modification was made, and (8) why the modification was made.ResultsThe areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The primary reasons for modification were for engagement (62.5%), followed by fit with recipients (43.8%) and outcome improvement (31.1%). About 66% of the modifications were applied to the entire target group, and all modifications were fidelity-consistent.ConclusionsThe FRAME categorization provided a detailed understanding of the process and nature of adapting the SCP and served as a foundation for further implementation and scale-up. FRAME not only serves as a guide for adapting evidence-based interventions but also promotes their replicability and scalability.

CREATING STRUCTURES FOR SUSTAINABILITY OF EVIDENCE-BASED DEMENTIA CAREGIVER PROGRAMS

Abstract Ensuring sustainable impact for broad-based evidence-based programs (EBPs) serving caregivers for persons living with dementia in the U.S. requires systemic maintenance of programmatic fidelity. This symposium aims to assist decision makers, aging and public health networks, and intervention developers to anticipate and deploy effective strategies and resources required to implement EBP interventions and sustain them. A series of four papers describes precursor studies and activities leading to the development of a structure aimed at ensuring that one such EBP, the Savvy Caregiver® (Savvy), can be faithfully sustained by sponsoring organizations. The first paper presents results from in-depth qualitative interviews of key staff (n=25) in nine organizations delivering Savvy. Findings highlight organizational, structural, and regional collaborations that contributed to sustained EBP implementation with fidelity. The second paper describes an online program to train Savvy interventionists. Informed by the first paper’s findings a fully asynchronous multi-media professional continuing educational interventionist training program was developed in collaboration with the educational design team at Emory’s School of Nursing. The third paper presents results of the online trainer program evaluation conducted among 76 interventionists from 32 organizations in eight states. High scores on content comprehension (95-99%) and participant feedback document benefits of self-paced learning, interactive materials and quizzes, and self-reflective exercises. The final paper describes a platform (Savvy Systems, LLC) created to ensure Savvy’s long-term dissemination, programmatic integrity and sustained use. The single platform provides for authorized content dissemination, leader training, enhanced referrals, and copyright compliance through licensing. Discussant will offer policy and practice implications. This is a collaborative symposium between the Alzheimer’s Disease and Related Dementias and Family Caregiving Interest Groups.

SOCAL SAVVY CAREGIVER: FOCUS GROUP INSIGHTS

Abstract Dementia due to Alzheimer’s disease (AD) is a public health crisis in our nation. More than 1.6 million Californians provide unpaid care for a person with AD. Qualitative data from focus group discussions were obtained from unpaid/informal/family caregivers in a clinical trial testing the efficacy-effectiveness of Savvy Caregiver Express compared to the Savvy Caregiver Program. Objectives: 1) explore class participation motivations, 2) perceived class benefits, and 3) class improvement recommendations. Methods: We randomly selected and invited participants who had completed the class intervention cycle. Focus group subsample (n=25) was 84% female, mean age 54.48 years (28 to 80 years); 36% non-Latino white, 20% Latino, 8% African American, 4% Asian and American/Pacific Islander. 60% cared for a parent (44% mother and 16% father), 16% cared for a spouse/partner, 20% other relatives, and 4% friends. Focus group were transcribed, coded, and themes were created using inductive analysis. Findings: Themes identified for discussion topic #1: seeking to gain knowledge about AD and stages, peer support, and caregiver competence; #2 knowing AD stages, management of meaning, caregiving mastery, and self-care; and #3 audiovisuals improvements, class structure changes, printed materials, and ongoing virtual sessions. Implications: Participation in caregiving classes are critical to the improvement of quality of life for the person with dementia and caregiver. These findings offer actionable changes to improve the transformation of classes and adjust future materials or provide additional resources to help participants fully understand the course and better understand the motivations for increasing engagement with caregivers.

INITIAL EFFICACY OF THE SAVVY CAREGIVER PROGRAM IN KOREAN AMERICAN DEMENTIA CAREGIVERS

Abstract Dementia caregivers in ethnic minority communities have often been excluded from access to caregiver interventions and their benefits because of linguistic and cultural barriers. In pursuit of equal treatments for all, it is imperative to make evidence-based interventions available and accessible to ethnic minority dementia caregivers, and linguistic and cultural adaptation is indispensable for reaching out to them. In the present study, we adapted the Savvy Caregiver Program for Korean American dementia caregivers and tested its initial efficacy for reducing depressive symptoms. This pilot intervention was delivered to 13 Korean American dementia caregivers by two Savvy-certified Korean-speaking trainers. Over the 6-week period of program implementation, there was no attrition (session completion rate = 98%). All participants’ depressive symptoms were reduced at completion of the program, and the level of reduction was statistically significant, with a large effect size (t = 8.64, p < .001, Cohen’s d = .89). Although patterns of change did vary among participants, the score difference between post-intervention and 6-month follow-up was not statistically significant (t = .74, p = .47). The program played a significant role in reducing depressive symptoms in this pilot sample of Korean American dementia caregivers, and this benefit was sustained at the 6-month follow-up. Along with the program’s notably high retention rate, its efficacy suggests strong unmet needs for psychoeducational programs among Korean American dementia caregivers. The study offers promise for sharing the therapeutic benefit of the Savvy program with linguistic minorities when delivered in a linguistically, culturally appropriate manner.

STRATEGIES FOR MAINTAINING FIDELITY AND SUSTAINABILITY IN EVIDENCE-BASED PROGRAM DELIVERY

Abstract Federal agencies and advisory councils emphasize the need to expand delivery of evidence-based programs (EBPs) to meet the needs of the increasing millions of family members and friends providing long-term, complex care to persons living with dementias in the U.S. (Alzheimer’s Association, 2022). Achieving lasting value and impact of such implementations requires systematic and replicable programmatic fidelity and sustainability to ensure caregivers’ broad access and positive outcomes, and the significant investments of providers, stakeholders, and funders are maintained. Unfortunately, a paucity of reported evidence on such strategies continues to limit the full benefit of most intervention efforts. (Hailemariam, M., Bustos, T., Montgomery, B. et al. 2019). To inform the larger RO1 effort described in the previous two papers, we recruited nine organizations from diverse regions that deliver Savvy Caregiver® to discern the key strategies employed to ensure program fidelity and sustainability. Semi-structured interviews were conducted with organization directors (n=9) and Savvy coordinators and group leaders (n=23). Thematic content analyses of transcribed transcripts yielded salient findings on fidelity best practices, including: Assuring EBP coherence with an organization’s mission; proactively integrating fidelity into interventionists’ training; and integration of fidelity monitoring strategies. Regarding structural practices supporting sustainability, findings included: Engaging leadership buy-in of Savvy as an anchor program; establishing succession plans for seamless program delivery; creation of local collaborative partnerships for long-term recruitment or in-kind contributions; establishment of infrastructure to secure ongoing state and federal financial support. Findings highlight effective, accessible, and achievable strategies for ensuring long-term benefits for all EBP implementation efforts.

BUILDING AN ONLINE TRAINING PROGRAM FOR SAVVY FACILITATORS

Abstract Scaling evidence-based interventions to implementing organizations not linked to the development source poses difficulties in maintaining program fidelity. Program facilitator training must ensure consistency of training approach and content material across organizations. A training program must be able to certify that trainees can demonstrate a detailed understanding of the basic curriculum intent, learning objectives, core principles, mechanism of action, and operational details of the intervention. This presentation will describe the development of an online program to train interventionists to facilitate the Savvy Caregiver Program (SCP), a multi-session, group-based psychoeducational intervention grounded in Social Cognitive Theory that helps family caregivers develop the knowledge, skills, and sense of competency and confidence (mastery) important for effective caregiving. In collaboration with the educational design team at the Emory School of Nursing, we developed a prototype, fully asynchronous professional continuing educational interventionist training program. In seven components, the program employed embedded video, text, interactive interfaces, and short self-correcting quizzes to teach core principles, essential facilitator skills, and the dynamics of each of the six SCP sessions. At the end of each segment, learners were required to provide reflections on segment content; they were required to attain a score of at least 80% in order to advance to the next segment (retries were allowed). Based on feedback from the 35 interventionists who participated in the prototype training program, we added additional video assets to further illustrate methods for facilitating the program, further developed the internal quizzes and improved course navigation mechanisms.

TELE-SAVVY@HOME: PRODUCING AND TESTING A FULLY ASYNCHRONOUS ONLINE TELE-SAVVY PROGRAM

Abstract Group-based psychoeducational programs like the Savvy Caregiver program and its synchronous/asynchronous online adaptation, Tele-Savvy, have demonstrated that the acquisition of skills, knowledge, and caregiving mastery can ameliorate caregiving stress and enhance the quality of life for persons living with dementia. Many factors, including the constant presence of care recipients, preclude caregivers attending such programs, including synchronous online programs, and limit programs’ accessibility and availability. This presentation describes the development of a fully asynchronous online Savvy program (Tele-Savvy@Home; TS@H) and the feasibility, acceptability, and preliminary efficacy of the online program. TS@H employed online continuing education methods to present ~16 hours of content in 46 short interactive segments of 8-15 minutes each. TS@H pilot program participants had no interaction with other participants and didn’t engage with a live instructor. Pilot results provided preliminary confirmation of the pilot study’s primary and secondary hypotheses regarding positive benefits to caregivers and care recipients. Results from the 29 participants who completed the pilot program and provided follow-up data indicated the program produced moderate to large effects by end of study on enhancing caregiving mastery (d=0.645) and decreasing reported care recipient behavior (d=-0.834) and reduced caregiver reactivity to that behavior (d=-0.732). The program also produced small to moderate benefits (d = -0.25 to -0.49) in the areas of caregiver depression, anxiety, and burden. Caregivers reported the program helped them be less resentful of their caregiver role and to accept the changes in relationship dynamics with their person. These results will inform the next iteration of Tele-Savvy@Home.

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.

Changes in Depressive Symptoms of Korean American Dementia Caregivers After Attending the Savvy Caregiver Program: Preliminary Findings with a Pilot Sample.

Language accommodation is indispensable in making evidence-based interventions available and accessible to ethnic minorities with limited English proficiency. As part of the larger effort to culturally adapt the Savvy Caregiver Program for Korean American dementia caregivers, we first conducted linguistic adaptation, and the present study reports the preliminary findings on participants' changes in depressive Symptoms. The linguistically adapted program was delivered to two small groups of Korean American dementia caregivers (total n = 13) by two Savvy-certified Korean-speaking trainers. Participants' depressive symptoms were assessed at three time points (pre-intervention, immediate post-intervention, and 6-month follow-up). Following the intervention, participants exhibited lowered depressive symptoms (t = 8.64, p < .001, Cohen's d = .89). This benefit was sustained at 6-month follow-up. Findings suggest that the therapeutic benefit of the Savvy Caregiver Program could potentially be shared with linguistic minorities when delivered in their native language. Although limited in its scope and nature, the pilot study with linguistic adaptation sheds light on efforts to close the gap in the evidence-based intervention delivery.

Caregiver Preparedness: A Therapeutic Mechanism and Moderating Factor on Outcomes for the Savvy Caregiver Program

ABSTRACT Objectives Evidence-based interventions for dementia caregivers, such as the Savvy Caregiver Program (SC), seek to address skills and knowledge deficits, caregiver burden, depressive symptoms, and grief. Little research has examined mechanisms by which these interventions accomplish their goals. Caregiver preparedness may be a possible mechanism by which caregiver interventions may confer benefits. Methods The sample included 76 dementia caregivers who completed the 6-session SC. Participants completed the Anticipatory Grief Scale, Center for Epidemiological Studies-Depression Scale, the Preparedness for Caregiving Scale, and the Zarit Burden Interview-Short Form. Results A repeated measures ANOVA was utilized to determine the interaction between baseline scores and pre-post change in caregiver preparedness. Analysis significantly predicted caregiver burden, (F (1) = 6.68, p=.012, partial η 2 =.10), depressive symptom endorsement, (F (1) = 6.41, p=.014, partial η 2 =.09, and anticipatory grief, (F (1) = 6.22, p=.02, partial η 2 =.1), post-treatment. Conclusions Pre-post change in caregiver preparedness significantly predicted pre-post change across measures of caregiver burden, depressive symptom endorsement, and anticipatory grief. Findings suggest that caregiver preparedness may be one mechanism by which the SC confers positive outcomes. These findings provide an empirical and theoretical basis for tailoring future dementia caregiver interventions. Clinical Implications Clinical Interventions may seek to improve caregiver preparedness and subsequent outcomes through utilization of programs like SC.

METAMORPHOSES: THE CONTINUING EVOLUTION AND ADAPTATION OF THE SAVVY CAREGIVER PROGRAM

Abstract This symposium traces the nearly 30 years of development projects, trials, and transformations that continue to occur in efforts to make an evidence-based psychoeducation program (Savvy Caregiver) available to family members and friends who provide care to community-dwelling persons living with dementia illnesses. Savvy seeks to enhance caregivers’ knowledge and skills for providing care and to enhance their competence and confidence (sense of mastery) in being able to guide their persons through days that are as safe, calm, and pleasant as possible. Over this period of time, Savvy has clarified its target participant group (focusing on primary caregivers rather than larger family groups), moved from having concurrent sessions for caregivers and persons living with dementia, continued to develop strategies that enable broad implementation while maintaining program fidelity, demonstrated the effectiveness of a synchronous/asynchronous online version that extends program reach (Tele-Savvy), and is currently exploring in an ongoing pilot how best to deliver a fully asynchronous version of the program that employs continuing education principles (Tele-Savvy@Home). The individual presentations will describe the main developmental milestones (investigator led to protocol-trained to online trained interventionist; in-person to synchronous/asynchronous to fully asynchronous) and the structural adaptations that enabled them. Particular emphasis will be placed on design decisions linked to maintaining a psychoeducational orientation and to program emphasis on developing or strengthening caregivers’ self-efficacy for providing effective day-to-day care. Savvy’s experience may help investigators in designing new interventions, particularly online interventions or in considering augmentation or delivery platform change of established interventions.

TELE-SAVVY: CHALLENGES AND OPPORTUNITIES OF A SYNCHRONOUS/ASYNCHRONOUS PROGRAM

Abstract This presentation will trace the development of the Savvy Caregiver program from its beginnings as the Center for Nursing Research-supported Minnesota Family Workshop (1993; PI: Sharon Ostwald) through a further test as the Partners in Caregiving Program (1997; PIs: Hepburn 1RO1NR04517-01) to the Alzheimer’s Association-supported Savvy program (1997; PIs Hepburn &amp; Lewis). Three main developments occurred over this period: the program solidified its identity as a caregiver training program and its mechanism of action as that of self-efficacy development through an active learning approach; it sharpened its focus by concentrating on the principal family caregiver (moving away from a broader family approach and eliminating concurrent care recipient programming); and it developed interventionist training materials and programs to enable broader reach. Since 2002, Savvy has enjoyed wide dissemination as an evidence-based in-person psychoeducation program, fostered by support to sponsoring organizations by the Administration on Community Living.

HISTORY: MINNESOTA FAMILY WORKSHOP TO SAVVY CAREGIVER: CENTRALITY OF SELF-EFFICACY

Abstract This presentation will trace the development of the Savvy Caregiver program from its beginnings as the Center for Nursing Research-supported Minnesota Family Workshop (1993; PI: Sharon Ostwald) through a further test as the Partners in Caregiving Program (1997; PIs: Hepburn 1RO1NR04517-01) to the Alzheimer’s Association-supported Savvy program (1997; PIs Hepburn &amp; Lewis). Three main developments occurred over this period: the program solidified its identity as a caregiver training program and its mechanism of action as that of self-efficacy development through an active learning approach; it sharpened its focus by concentrating on the principal family caregiver (moving away from a broader family approach and eliminating concurrent care recipient programming); and it developed interventionist training materials and programs to enable broader reach. Since 2002, Savvy has enjoyed wide dissemination as an evidence-based in-person psychoeducation program, fostered by support to sponsoring organizations by the Administration on Community Living.

Evaluation of an Online Training Program for Savvy Caregiver Program Leaders

AbstractBackgroundThe Savvy Caregiver® program (SCP) is widely disseminated evidence‐based in‐person psychoeducation program that enhances family caregivers’ knowledge, skills, and mastery for effectively performing the caregiver role. SCP is led by one or two trainers who have been trained in the role by one of the SCP developers, usually in in‐person group sessions. To ensure the fidelity of train‐the‐trainer workshops, facilitate SCP dissemination, and relieve the need for in‐person training, our educational design team, with support from NIH (RO1AG061971), produced a fully online, text and video SCP train‐the‐trainer program. The program contains four modules with sections, the first describing SC purpose, core principles, mechanism of action and role of the trainer; the remaining three cover the content and dynamic of each of the six weekly SCP sessions. Seven assessment exercises, scored by the authors, determined trainees’ ability to move forward in training. Following course revisions based on prototype testing, the training program was offered to agencies in six U.S. states. Additional online events allowed debriefing interaction between learners and course developers. A post‐course evaluation was sent to learners.MethodThe evaluation sought Likert‐type assessments (5 highest; 1 lowest) of the overall course, individual elements within it (e.g., on SCP principles, trainer role, and individual sessions), course materials (videos and slides), and assessments. We sought open‐ended comments throughout. Analysis was based on quantitative and qualitative evaluations.ResultForty‐five trainees completed the SCP training course, and 29 completed course evaluations. The course received a score of 4.21 (high/very high) on learners’ assessment of overall preparedness to lead SCP. The average score across all 8 individual segment evaluations was 4.425 and that across evaluation of 4 categories of video materials was 4.54. Comments reflected overall satisfaction with the program and its elements and provided suggestions for improvement (e.g., more illustration of how SCP segments are lead; how to adapt to COVID‐driven online SCP program delivery). The interactive debriefing sessions were deemed helpful for clarifying training questions.ConclusionEarly results indicate this new online SCP train‐the‐trainer program can successfully prepare individuals to lead SCP programs, affirming the potential of virtual training for intervention practitioners.

Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

BackgroundLimited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers’ access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues’ (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability.MethodsPreliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation.ResultsFindings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance.ConclusionsThe adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development.

Feasibility of the Savvy Caregiver Program for LGBTQ+ Caregivers of People Living with Alzheimer's Disease and Related Dementias.

Nearly 350,000 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) adults in the U.S. are currently living with Alzheimer's disease and related dementias (ADRD). Informal caregivers face challenges impacting their ability to access and receive adequate and inclusive care for LGBTQ+ persons living with ADRD. The purpose of this study was to determine the feasibility and acceptability of the Savvy Caregiver Program for caregivers of LGBTQ+ individuals living with ADRD. Data for this secondary analysis come from caregivers (n = 17) who completed 6 sessions of the Savvy program. Caregivers were very satisfied with tailored program activities. Analyses of trends suggest non-significant increases in positive aspects of caregiving and decreases in caregiver burden and depressive symptoms. This is the first known study assessing the feasibility of the Savvy Caregiver Program for caregivers of LGBTQ+ individuals living with ADRD. Future research on the Savvy Caregiver Program for caregivers of LGBTQ+ people living with ADRD is needed.

Focus Group Findings of Trial Participants in a Caregiver Psychosocial Intervention: Savvy Caregiver Program

Previous work highlights the importance of sociobehavioral interventions to address dementia caregiving health and wellbeing outcomes. By empowering caregivers to become objective managers of their loved one’s illness, and own self-care, they are less likely to exhibit negative outcomes. We are conducting a mixed-method, randomized trial to test manualized, multi-family psychoeducational group interventions: Savvy Caregiver Express, and Savvy Caregiver Program. This poster describes the qualitative findings of four focus group interviews recently conducted to elucidate the study participation experiences of family caregivers enrolled in the parent study. Twenty-five racially and ethnically diverse participants (21 women, 4 men) caring for a family member with cognitive decline participated in focus group interviews conducted via videoconferencing methods. We captured more nuanced experiences from the perspective of study participants with regards to the caregiver interventions and their research participation. Interviews were conducted by trained research personnel, lasted 60-75 minutes, and followed an open-ended questioning route. Based on thematic analyses, we identified the following themes: 1) Changing one’s mindset: Seeing life through their shoes; 2) Getting information in one place; 3) Expanding the personal experience; 4) Fears and vulnerability; 5) Time constraints vs. wanting more; 6) Not everyone is at the same place; 7) Technology: It’s going to be part of our lives; and 8) Research: Not always in sync. Our findings indicate high satisfaction with most components of the program while specific recommendations were offered to improve the intervention and study experience such as tailoring materials to stage-specific needs.

Training Savvy Caregiver Program Group Leaders Through an Online Course

A significant factor limiting organizations’ implementation of the Savvy Caregiver program, a widely disseminated dementia caregiver psychoeducation course, is the need to provide training to program leaders to ensure their understanding of Savvy core principles and strengthen their teaching and coaching skills. Such training has typically been provided through in-person group sessions led by the Savvy developers. To facilitate broader availability, we have embarked on an NIA-supported program to develop a fully online self-paced Savvy train-the-trainer course. The course, delivered individually on a widely used teaching platform, is in seven sections: the first introduces Savvy principles and the trainer role; the next six cover the content and teaching strategies of each of Savvy’s six sessions. In the first development phase, 33 individuals from 13 organizations across the country took part in training (average age 49.5; almost all college level or professional women). Qualitative interviews with 11 trainees and debriefing sessions with others yielded consistently positive responses: the training enhanced their own appreciation for caregiving; they endorsed the self-paced learning and; and it established expectations for positive benefits of Savvy for caregivers. Trainees’ feedback has led to several improvements, including resolving reported technical glitches (e.g., navigating the course). New videos illustrating group delivery methods have been added. Fidelity monitoring strategies are supported as organizations have been encouraged to augment the online training by convening meetings of trainees while in training to enable role playing, and greater personalization is achieved via post-training Zoom meetings with trainees and the Savvy training team staff.

Evaluation of the Savvy Caregiver Program for LGBTQIA Adults Living With Alzheimer's Disease and Related Dementias

Approximately 350,000 LGBTQIA+ older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing 1 million by 2030. LGBTQIA+ older adults face challenges in receiving adequate and inclusive care and caregiving support due to the inability to rely on traditional family networks, greater disability, and discrimination when seeking aging services. Working with the Los Angeles LGBT Center Aging in Community Initiative, we evaluated the: 1) Adaptation of the Savvy caregiver training program for care providers of LGBTQIA+ persons living with ADRD; and 2) Feasibility and acceptability of the program. Care providers were very satisfied with the program, strategies, information, and activities of the tailored Savvy program. For psychosocial outcomes, there were trends in greater care planning, increases in asking friends/family for support, and decreased loneliness. Additional research is needed on culturally-relevant aging services and behavioral interventions for care providers of LGBTQIA+ persons living with ADRD.

LGBTQIA+ Caregiving and Care Needs of Persons Living With Alzheimer’s Disease and Related Dementias

Lesbian, gay, bisexual, transgender, queer, intersex, and/or asexual (LGBTQIA+) older adults are a growing population. LGBTQIA+ persons living with Alzheimer’s disease and related dementias (ADRD) face unique challenges in terms of accessing care and support compared with their non-LGBTQIA+ counterparts. The care challenges faced by LGBTQIA+ people living with ADRD may be compounded by the fact they are more likely to be single, more likely to live alone, and less likely to have children. Several studies have started to explore the unique needs of LGBTQIA+ caregivers and persons living with ADRD. In this symposium, we highlight current research addressing the psychosocial and health-related needs of LGBTQIA+ caregivers and persons living with ADRD. Two presentations address psychosocial factors and health among LGBTQIA+ caregivers of persons with ADRD. Krystal Kittle will present analyses using population-based data on LGBTQIA+ caregivers in terms of caregiving burden and mental health. Shana Stites will present results from the Health and Retirement Study highlighting differences among same-sex spouses in terms of caregiving patterns and research participation. Next, Ethan Cicero will present prevalence estimates of care needs and challenges among diverse transgender adults living with memory problems. Finally, we will highlight a promising intervention for LGBTQIA+ caregivers of persons with ADRD. Jason Flatt will describe the adaptation and feasibility of the Savvy Caregiver program for LGBTQIA+ caregivers. Joel Anderson, an expert in LGBTQIA+ caregiving for persons with ADRD, will facilitate a conversation about these results and place them in the context of current LGBTQIA+ and ADRD research.