Improving care for those living with dementia

With a mission to promote healthy aging and reduce preventable negative health consequences and costs, the Texas A&M Center for Population Health and Aging takes a life-course approach to improve the lives of Texans and others throughout the nation and world. The center’s research promotes the belief that healthy aging involves everyone, at every age, every day.

In the past couple of years, the center’s faculty and staff have focused on an extremely vulnerable population: persons with dementia and their caregivers. With the population aging, Texas is expected to have escalating caregiver demands. The latest 2018 statistics indicate an estimated 1.4 million unpaid caregivers provided care to Texans with dementia. This translates to 1.6 billion hours of unpaid care at a cost of over $20 billion per year.

Regents and Distinguished Professor and Center Co-Director Marcia Ory, PhD, of the Texas A&M School of Public Health, was invited to present expert testimony to the Texas House Committee on Public Health on “Addressing Burdens of Care for Alzheimer’s Disease and Related Disorders.” She summarized what was known and what still needs to be known, especially in terms of the implementation and dissemination of innovative interventions that help caregivers better manage daily dementia care demands while simultaneously promoting maximum independence and quality of life for persons with dementia.

With a variety of state and national funding sources, including the Texas Alzheimer’s Research and Care Consortium, the Administration for Community Living and the National Institute on Aging, the center is embarking on several interrelated research projects to better understand the need for and impact of various behavioral, technological, environmental or social service organizational interventions. “Technology can help older adults maintain independence and reduce the burdens of care,” said Center Co-Director Matthew Lee Smith, PhD, associate professor at the School of Public Health, “but it is important to test the acceptability and usability among older adults.”

The center is working on several research projects that will advance knowledge of how technology and the environment impact dementia-related behaviors and care needs.

Helping caregivers through a web-based delivery system

This National Institute on Aging-funded research applies technology to an existing evidence-based intervention, Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II). The goal is to create a scalable and sustainable online family caregiver support systemto be accomplished through advancing the current proof-of-concept into a viable delivery system for the REACH II intervention and comparing the relative impact of a minimal or more extensive intervention strategy on a wide range of family caregiver outcomes. The delivery system, GamePlan4Carea novel multifaceted intervention concept tested in a previously funded Texas Cares grant. It will provide electronic delivery of skill-building exercises and flexible tailoring of services based on the unique needs of each family caregiver. Working collaboratively with Alan Stevens, PhD, a center affiliate, and others at Baylor Scott & White Health Center for Applied Health Research who are designing and implementing GamePlan4Care, center investigators are responsible for the evaluation.

Assessing dementia patient-monitoring technology

Persons living with dementia who wander due to disorientation and underlying agitation are at increased risk for harm due to being in an unsupervised environment, which can increase the burden of care for caregivers. This pilot study funded by the Texas Alzheimer’s Research and Care Consortium aims to test the feasibility of a multi-component intervention that integrates a technology-based approach to decrease caregiver burdens while at the same time enhancing safety and quality of life for persons with dementia. The center is examining the usability of a specially programmed watchthat provides location information and two–way communication between caregivers and care recipients.

Promoting active living through dementia-friendly communities

Little is known about the role of different environments (including built, natural and social) on physical activity, social activity and overall independence for persons with dementia. Funded through the National Institute on Aging, this project is centered on advancing the understanding of various housing and neighborhood environments for persons with dementia. By identifying the significant barriers and facilitators in the environments in which people with dementia live, and by collaborating with dementia experts and built environmental professionals, the center is working to identify environmental strategiesto promote physical activity, social interaction and independence of people with dementia and reduce burdens on their caregivers. This project will be utilized to refine study protocols and obtain pilot data for more extensive research in this understudied area.

What’s next for dementia care

There are several other projects on the horizon. Center investigators are working with a small business to examine how the placement of household sensors can help detect small changes in functioning among persons with dementia that signal the need for more care services. Similarly, the center is working with a large nonprofit organization to understand the need for and effectiveness of coordinated case management and referral to services to enable persons with dementia to remain in their homes longer.

Dementia is a complex issue that impacts the lives of older adults, their families and the health professionals and volunteers who give them care. With the aging of our global society, this problem is not going away. “Translational research efforts like these are needed to ensure the dissemination and implementation of effective interventions that can reach the growing numbers of Americans who will need them,” Ory said. “Mutually beneficial interventions are essential to maximize quality care while ensuring caregiver stress and burden are alleviated and managed.”