Psychosocial Interventions for People With Dementia and Their Caregivers in Primary Care

Abstract Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing. However, psychosocial interventions do not seem to have found their way into routine care yet. We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy. In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies. In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions. Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation. It became obvious that psychosocial interventions are not conveyed sufficiently within medical school. A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions. Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group. General retentions to invest in people with dementia were expressed. These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.

Evidence indicates family caregivers of individuals living with dementia (ILwD) are at risk for diminished physical and mental health; which may decrease their quality of life and directly impact their ability to provide care.An interdisciplinary approach to self-care and skill-building for caregivers is provided in a virtual support group offered by Council on Aging in Sonoma County, CA.As part of the nonprofit's Adult Day Program, the group is offered to client caregivers and has two goals: First, creating a communitybased, long-term support system for ILwD who are agingin-place; second, fostering a safe and supportive community for family caregivers, by providing opportunities to collaborate with peers and an interdisciplinary team that includes a Marriage and Family Therapist (MFT), an Occupational Therapist (OT), and a Recreation Therapist (the day program manager).The closed group model established through eight weekly sessions builds trusting relationships in a frame that combines: the OT client-centered and collaborative approach to problem-solving everyday challenges of caregiving, the MFT skills of creating a safe space for discussion and deeper exploration, and program staff insights regarding the ILwD's current interests and abilities exhibited during Day Program activities.Sessions include an emotional check-in by group members; a brief overview of best-practices and common caregiving concerns related to a weekly topic; and an opportunity for caregivers to explore the integration of best-practices into daily routines, while also attending to their well-being as caregivers.Program evaluation and results related to the program's effectiveness and implications for scalability will be discussed.

PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH DEMENTIA AND THEIR CAREGIVERS IN PRIMARY CARE
Lou Frankenstein, and Georg Jahn, Chemnitz Technical University, Chemnitz, Sachsen, Germany Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing.However, psychosocial interventions do not seem to have found their way into routine care yet.We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy.In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies.In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions.Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation.It became obvious that psychosocial interventions are not conveyed sufficiently within medical school.A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions.Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group.General retentions to invest in people with dementia were expressed.These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.Caregivers of patients with dementia experience high levels of emotional distress.mHealth interventions have the potential to feasibly address some needs of caregivers and reduce stress.This qualitative research study of (n = 15) caregivers of patients with dementia explored caregivers' experience using a mindfulness meditation mobile application.The qualitative interviews were guided and structured to allow participants to share their perceived benefits, drawbacks, likes, and dislikes of using mHealth strategies to manage stress and anxiety.We asked about the caregivers' experience with mindfulness before the study, use of the app, their positive/helpful and negative/unhelpful app experiences, the perceived value of the app, and potential enhancements of the app.Caregivers reported that the app was easy to use, engaging and that there were many perceived benefits.They also noted multiple barriers to using the app including time constraints and implementation of mindfulness techniques outside of direct app use.Most of the caregivers recommended using the app to increase knowledge of mindfulness and to reduce stress.Our findings support the growing body of literature on the practical use of mHealth strategies for caregivers.Future work should address the perceived barriers caregivers encounter when using mHealth strategies.

SELF-EFFICACY IN THOUGHT CONTROL , NOT POSITIVE GAINS, MEDIATES EFFECT OF BENEFIT-FINDING INTERVENTION FOR CARERS Sheung-Tak Cheng, Education University of Hong Kong, The Education University of Hong Kong, Not Applicable, Hong Kong
This study examines the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers.42 caregivers received BFT whereas 87 received psychoeducation as control.Both interventions were held in groups.Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4-and 10-month follow-up.Mediators considered included PAC and three self-efficacies-controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite.Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers' PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally.Path analyses with bootstrapped confidence intervals showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups.No mediation effects were found for PAC and the other self-efficacies.As a conclusion, The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT.The therapeutic mechanism for the effect on burden remained unknown.The study sheds light on the importance of actively promoting positive caregiver functioning.

SUPPORTING OLDER FAMILY CAREGIVERS OF YOUNG ADULTS WITH IDD: A PILOT PROGRAM WITH SOCIALLY ASSISTIVE ROBOTICS
Ling Xu, 1 Julienne Greer, 2 Noelle Fields, 1 Priscila Tamplain, 2 John Bricout, 3 Bonita Sharma, 4 and Kristen Doelling, 5 1.University of Texas at Arlington, Arlington, Texas, United States, 2. The University of Texas at Arlington, Arlington,Texas,United States,3. University of Minnesota,twin cities,Minnesota,United States,San Antonio,Texas,United States,5. UTA,Arlington,Texas,United States Introduction: The need for caregiver respite is welldocumented for the care of persons with IDD.Social Assistive Robotics (SAR) offer promise in addressing the need for caregiver respite through 'complementary caregiving' activities that promote engagement and learning opportunities for a care recipient (CR) with IDD.This study explored the acceptability and usefulness of a SAR caregiver respite program responsive to feedback from both the CRs and their older family caregivers (age 55+).Methods: Caregiver-CR dyads (N =11) were recruited.A mixed methods research design was deployed in three phases: Phase I with four focus groups to inform the program design; Phase II for program demonstration and evaluation with pre-and post-surveys; and Phase III with post-program interviews for feedback and suggestions.Results: Quantitative data analysis in Phase II showed both caregivers and their CRs scored favorably the social presence of the robot (Pepper) and social engagement with Pepper.Caregivers also reported positive perceptions of Pepper in terms of anthropomorphism, animation, likeability, intelligence, and safety.Content analysis from Phase III interviews suggested that the SAR may offer physical/emotional respite to caregivers by providing companionship/friendship as well as promoting independence, safety/monitoring, and interactive engagement with children.Discussion: SAR has potential in providing respite for older family caregiver demonstrated by the levels of CR engagement and learning with Pepper.Future studies need a longer program design and larger sample size to test the feasibility and efficacy of the intervention.

THE IMPACT OF SOCIAL SUPPORT ON DEMENTIA CAREGIVERS' PSYCHOLOGICAL WELL-BEING: IS ONLINE COMPARABLE TO OFFLINE? Eun-Hye Yi, Indiana State University, United States
Along with the groundbreaking development of communication technology, caregivers have migrated to online platforms to seek help.Social support theory, including main effect and moderation effect models, has provided a