Learning Skills Together: A Randomized Controlled Trial of a Complex Care Skills Intervention to Improve AD/ADRD Caregiver Self-Efficacy

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Project Summary/Abstract __________________________________________________________ Two-thirds (67%) of family caregivers to persons living with Alzheimer’s disease and related dementias (AD/ADRD) provide complex care tasks, such as medical/nursing tasks (e.g., managing medications, transferring from bed to chair, managing swallowing difficulties). Yet, only 53% of AD/ADRD caregivers receive any training to prepare them to conduct complex care. Consequently, AD/ADRD caregivers experience high levels of worry about making a mistake. Most responses to caregivers’ need for complex care training are not specific to AD/ADRD caregivers, though complex care is exponentially more challenging in the context of AD/ADRD. Provision of complex care to this population is complicated by the presence of behavioral symptoms of dementia (BPSD), difficulty with communication due to cognitive changes, and greater likelihood of multimorbidity than found amongst cognitively intact older adult care recipients. Another limitation of current responses to caregivers’ need for complex care training is current resources do not fully integrate principles of psychoeducation known to be effective at improving caregiver self-efficacy. High levels of self-efficacy, a person’s belief in their ability to accomplish a specific task, are associated with more positive perceptions of caregiving (e.g., meaningfulness), while low self-efficacy contributes to emotional distress, including depression. To build caregivers’ self-efficacy in the performance on complex care, Learning Skills Together (LST) was developed in 2017 at the UT Health San Antonio Caring for the Caregiver program by a multidisciplinary team with expertise in nursing, occupational therapy, speech-language pathology, nutrition, dental hygiene, and gerontology. In its most recent rendition, LST was delivered online over 4 synchronous videoconferencing sessions and program content integrated principles of Self-Efficacy Theory, such as peer-learning, modeling, and assignments so caregivers could practice skills and access feedback. In a single-arm pre- and post-test pilot study of LST, we observed statistically significant increases in self-efficacy at 4-weeks post-intervention (p=0.003). Near significant effects persisted 8-weeks post- intervention (p=0.057). To rigorously test the efficacy of participation in LST on caregiver self-efficacy, we propose to test the hypothesis that caregivers to persons living with mid-stage AD/ADRD who participate in LST will report greater improvements in self-efficacy compared to a randomized active control group (N=200). We will also test for secondary outcomes we anticipate will be affected by improvements in self-efficacy, including caregiver depression and appraisal of BPSD. Subgroup analyses will be conducted with African American/Black, Latinx, and women caregivers; race, ethnicity, and gender will be tested as intervention effect modifiers given prior research demonstrating differences in the effects of self-efficacy intervention according to these characteristics. If findings demonstrate the efficacy of Learning Skills Together, the next step will be to examine effectiveness when delivering this program in community settings (e.g., Area Agencies on Aging).