Caregiver Training to Manage Inappropriate Behaviors in Individuals with Alzheime

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DESCRIPTION (provided by applicant): Alzheimer's Disease and related dementias (ADRD) combine to form an urgent healthcare challenge facing the aging population of 21st Century America. In the U.S. during 2008, one person receives an ADRD diagnosis every 71 seconds; by 2050, that number will be one every 33 seconds. Authorities cited in the body of this proposal report ADRD are the third most costly disease sets in the U.S. In spite of ongoing research efforts, at present there is no way to prevent onset of ADRD, and death is the only certain cure. Caregiving options are complicated because the cognitive and physical declines of those with ADRD differ for each person, and no single care routine or protocol is predictably effective. Further, inappropriate behaviors are seen in more than 80% of individuals with ADRD, causing immense stress and increased burden to Certified Nursing Assistants (CNAs). Although behavior management strategies have dominated the ADRD literature since the 1980s, many medical directors and other ADRD facility professionals often lack either the preparation or the time to respond to CNAs' requests for help in managing problematic behaviors. Various authorities experienced in ADRD care, however, suggest measurable positive effects result when CNAs receive ongoing education and skill training in this area. This Phase I effort aims therefore to educate CNAs in the knowledge and skills they need to effectively mediate problematic behaviors of those afflicted with ADRD and to do so through an innovative, Internet based prototype presenting a challenging, informative, application- based curriculum. This product exceeds traditional passive methods of CNA education and in-service training and provides instead multi-media features such as interviews, care models, streaming videos, and online interaction. Through this prototype, CNA testers gain convenient, 24/7, private access to a whole team of intervention consultants and therapeutic support specialists experienced in managing ADRD-related problem behaviors. The dispersed effects of improved practice resulting from this prototype may also facilitate a multi-level intervention with power to affect in many positive ways the care recipients themselves as well as their loved ones. In addition to its strong commercial potential, the proposed Phase I training product has the capacity to benefit public health in venues as diverse as community education, military and veterans' hospitals and services, medical offices, healthcare agencies, church-based outreach programs, and workplace settings. During Phase II, a randomized control trial will test the completed product, and commercialization will be undertaken during Phase III. One of the parallel benefits of all phases of this effort may well be the reduction of both direct and indirect costs of ADRD to U.S. health care systems. PUBLIC HEALTH RELEVANCE: The proposed effort is relevant to the nation's public health because during 2008, 5.2 million Americans of all ages have Alzheimer's Disease and Related Dementias (ADRD), which translates to one ADRD diagnosis every 71 seconds (Alzheimer's Disease Facts and Figures, 2008, p. 8). The economic cost of ADRD includes $148 billion in direct costs to Medicare and Medicaid (not including the costs paid for by the Department of Veterans' Affairs, private health care, and long-term care insurance), and an estimated $267 billion savings to the national healthcare system because 9.8 million family members deliver at least 70% of the care for those with ADRD at home without reimbursement instead of in nursing homes. Further, ADRD care is strongly associated with psychosocial costs to caregivers, who must respond directly to the inappropriate behaviors exhibited by those in the cognitive declines of ADRD (Alzheimer's Disease Facts and Figures, 2008).