RESULTS FROM RESEARCH ON A HEALTH-COACHED WALKING PROGRAM IN FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

Abstract Caregivers of persons with dementia demonstrate increased levels of stress, anxiety and depression, placing them at increased risk for poor health-related outcomes. Walking is widely supported as a cost-effective, accessible exercise and way to maintain physical fitness and mitigate stress levels. There is a critical gap in addressing health promotion strategies in caregivers. The specific aims of this health-coaching (HC) walking study using wireless pedometers in family caregivers of persons with dementia were to: 1) establish the feasibility of HC and wireless pedometer use, 2) examine outcomes of well-being, stress and activity level and 3) understand the experience of participation. This 2-group comparative study used a repeated measure design and mixed methods approach. We enrolled 27 females and 5 male caregivers (n=32), μ age 57 years: with both 16 in the control in the intervention arm. Pre-post measures of general health (body mass index [BMI], blood pressure, heart rate, cognition, well-being, stress and perceived activity level) were obtained from caregivers at baseline and again at 12 weeks. Results indicate that those who received HC had a statistically significant improvement in BMI (p = .01). There were no other statistically significant improvements in outcomes in either group. Qualitative findings suggest that participants reported many stresses that made self-care challenging. In summary, this was a feasible intervention that resulted in improved BMI in the HC group. Work is needed to understand the long-term impact of this outcome. Further exploration of other health-promoting interventions that may be beneficial for this population is essential.

Tech, Blacksburg,Virginia,United States,3. VA Boston Healthcare System,Brockton,Massachusetts,United States Few interventions for family caregivers of persons with dementia (PwD) focus on both dementia care skill-building and the enhancement of acceptance and compassion towards oneself and the PwD. We designed a multicomponent, mindfulness-based 4-session caregiver intervention (Practice of Acceptance, Awareness, and Compassion in Caregiving, or "PAACC") to reduce burden in caregivers of family members with Alzheimer's disease and related dementias (AD/ADRD) and TBI-related AD. A prospective, randomized trial design is being implemented to compare the effectiveness of PAACC to the well-known, evidencebased REACH-VA intervention. Seventeen family caregivers (Mean Age = 68.71 years; 82% women; 30% had high school or less education) have participated in the trial thus far and provided qualitative responses to acceptability questions. High acceptability was noted for all intervention components of PAACC. Participants completed 95% of mindfulness homework during the study period. A majority also reported practicing spontaneous, informal mindfulness while engaged in daily activities (e.g., going for a walk, cooking). One participant noted incorporating mindfulness in her daily spiritual practice. The majority remarked that PAACC taught them to be more aware and accepting of the PwD's illness. Others mentioned becoming more aware of which stressors triggered them, and that they were able to avoid arguments with the PwD because of this increased awareness. Overall, our results suggest that this mindfulness-based multicomponent intervention is a promising method for promoting stress reduction for family caregivers of persons with dementia regardless of age, stage of dementia, education level, or rurality. Implications for research and practice will be discussed.

ACTIONS TAKEN BY STROKE FAMILY CAREGIVERS TO POTENTIALLY PREVENT SURVIVORS' HOSPITAL READMISSIONS IN CHINA
Hairui Yu, 1 Jennifer Perion, 1 Victoria Steiner, 1 and Linda Pierce 1 , 1. University of Toledo, Toledo, Ohio, United States Stroke is a leading cause of death in China; its level of burden on the Chinese population is greater than the global average. Family caregiving plays an essential role in prevention and management of stroke. The purpose of this qualitative descriptive study was to identify actions family caregivers of stroke survivors in China take to prevent hospital readmissions. Using purposive sampling, adult family caregivers (n=10) were enrolled from Huai'an city in Jiangsu province who provided care for a survivor in community settings for six months or longer. Caregivers were asked questions in a face-to-face, semi-structured interview with content validity established by experts in the field. Audiotaped interviews were transcribed/translated into English and the narrative data analyzed using Colaizzi's approach to content analysis. Seven female and three male caregivers with an average age of 55 years indicated actions that comprised six themes. These themes are: 1) Encouraging care recipients to be physically active, 2) Balancing a healthy diet with pleasurable foods, 3) Monitoring the physical health of care recipients and preventing injuries, 4) Developing personal and intimate strategies to motivate care recipients, 5) Providing emotional support and maintaining optimism, and 6) Gaining knowledge through relationships with doctors but desiring communication with other caregivers. Recognizing these actions taken by stroke family caregivers may improve education programs aimed at preventing hospital readmissions and be applicable throughout the world. Findings may also guide healthcare professionals who can advocate with Chinese local, provincial, and central health commissions on stroke survivors and their family caregivers' behalf.

FEASIBILITY OF CARRES MODULES TO REDUCE POTENTIALLY AVOIDABLE HOSPITALIZATIONS IN PERSONS WITH COGNITIVE DEFICITS
Victoria Steiner, 1 Linda Pierce, 1 and Carol Bryan 1 , 1.

University of Toledo, Toledo, Ohio, United States
Family caregiving is an essential, yet understudied, factor that can hasten, delay, or prevent hospital readmissions in individuals with cognitive deficits. This 3-month feasibility study examined 18 Internet-based educational CARREs (Communicate, Assist, Recognize & Report Events) Modules for family caregivers that address care recipients' potentially avoidable hospitalization (PAH) conditions, e.g. UTI. This study determined: 1) caregivers' perceptions about the use of the CARREs Modules, 2) caregivers' self-reported value of the Modules, and 3) potential outcomes for caregivers and care recipients. Communitydwelling family caregivers were recruited from local support/education programs and assigned 6-8 Modules based on their care recipients' needs. Links to online surveys were emailed at baseline, and 30 and 90 days postenrollment. Descriptive statistics were performed on these data. Twenty potential subjects were screened but five were ineligible and three refused to participate. The remaining 12 subjects were primarily White females caring for a husband or parent. Subjects completed all the Modules they were assigned and did not experience any difficulties answering the survey questions. Subjects reported completing the Modules at least moderately increased their knowledge (67%), not being burdened by completing the Modules (67%), and very likely to participate again (58%). Many subjects stated the Modules taught them new things about preventing hospital readmissions in their care recipient (75%) and improved their well-being as a caregiver (83%). In collaboration with a home care agency, the investigators plan to implement and test a sustainable, "real-world" educational intervention incorporating the CARREs Modules that reaches a wide audience of family caregivers. them at increased risk for poor health-related outcomes. Walking is widely supported as a cost-effective, accessible exercise and way to maintain physical fitness and mitigate stress levels. There is a critical gap in addressing health promotion strategies in caregivers. The specific aims of this health-coaching (HC) walking study using wireless pedometers in family caregivers of persons with dementia were to: 1) establish the feasibility of HC and wireless pedometer use, 2) examine outcomes of well-being, stress and activity level and 3) understand the experience of participation. This 2-group comparative study used a repeated measure design and mixed methods approach. We enrolled 27 females and 5 male caregivers (n=32), μ age 57 years: with both 16 in the control in the intervention arm. Prepost measures of general health (body mass index [BMI], blood pressure, heart rate, cognition, well-being, stress and perceived activity level) were obtained from caregivers at baseline and again at 12 weeks. Results indicate that those who received HC had a statistically significant improvement in BMI (p = .01). There were no other statistically significant improvements in outcomes in either group. Qualitative findings suggest that participants reported many stresses that made self-care challenging. In summary, this was a feasible intervention that resulted in improved BMI in the HC group. Work is needed to understand the long-term impact of this outcome. Further exploration of other health-promoting interventions that may be beneficial for this population is essential. This article examined the personal and household characteristics influencing the quality of life (QoL) of grandparents caring for grandchildren in Skipped Generation Households in Nigeria with a sample of 2, 144 grandparents in Imo, Lagos and Kano. Chi square and multinomial logistic regression were employed to understand the relationship between the dependent variable (QoL) and independent variables (personal and household characteristics). The level of the QoL of the grandparents almost spread evenly among low (34.3%), average (34.3%) and high (31.4%). Five domains of QoL were examined including level of independence (LI), psychological well-being (PW), social relation (SR), physical health (PH), environment (ENV) and engagement in income generating activities (IGA). Personal characteristics including; state of residence was significantly associated with all the domains except LI and PW, age was associated with IGA, LI and ENV, sex was associated with SR and ENV and level of education was associated with all the domains except IGA and ENV while religious affiliation was associated with IGA. Household characteristics including; sex of household head was significantly associated with PH, SR and ENV, age of household head was associated with IGA and LI and wealth index was associated with all the domains while the number of household members was significantly associated with ENV. The regression analysis shows that only state of residence and wealth index significantly influence the QoL of the grandparents (P≤0.05). The state of residence and wealth index are therefore important in any policy intervention for this category of elderly persons in Nigeria.

SUPPORTING FAMILY CAREGIVERS: HOW DOES RELATIONSHIP STRAIN OCCUR IN CAREGIVING DYADS? A QUALITATIVE STUDY
Elizabeth S. Avent, 1 Laura Rath, 2 Kylie Meyer, 3 Donna Benton, 1 and Paul Nash 4 , 1. University of Southern California,Los Angeles,California,United States,2. Archstone Foundation,Long Beach,California,United States,3. University of Texas Health Science Center San Antonio,San Antonio,Texas,United States,4. University of Southern California,LA,California,United States Family members and spouses are usually the primary caregivers for older adults. Providing direct care can be stressful, strenuous, and time-consuming for caregivers, potentially leading to frustration and anger towards care recipients. This can be detrimental to the relationship quality of the caregiving dyad. Though caregiver strain and burden have been extensively studied, there is limited information on the development of relationship strain. To explore how relationship strain occurs between caregivers and care recipients, 8 focus groups (N=62) and 8 semi-structured telephone interviews were conducted with caregivers in Los Angeles, inquiring about relationship quality with their care recipients and when frustration and anger occurs. Inductive coding was used to create coding schemas. Findings showed that most caregivers reported relationship strain occurring after taking on the caregiving role, and frustration and anger arose when providing ADLs, especially during bathing and toileting. Although these caregivers had initially experienced strain in their relationships, a recurring theme that emerged was that they developed strategies to decrease frustration and anger and improve the quality of their relationships with their care recipients. Direct communication with caregivers is important in designing a structured and effective intervention. These findings help inform an intervention for new caregivers to help them identify what can lead to relationship strain, as well as teach them reliable strategies to manage frustration and anger towards their care recipients. Falls constitute a multitude of injuries irrespective of age. To combat these challenges, older adults are