Background characteristics and treatment-related factors associated with treatment success or failure in a non-pharmacological intervention for dementia caregivers.

BACKGROUND: Non-pharmacological interventions for persons with dementia often rely on family caregivers for implementation. However, caregivers differ in their readiness to use strategies. This study examines dyadic characteristics and treatment-related mechanisms associated with treatment success (high readiness to use strategies) and failure (low readiness to use strategies) at the conclusion of the Advancing Caregiver Training (ACT) intervention. METHODS: Caregiver and person with dementia characteristics and treatment-related variables (treatment participation, number and type of strategies introduced and enacted) were examined in 110 caregivers in intervention. Interventionists rated readiness (1=precontemplation; 2=contemplation; 3=preparation; 4=action) of caregivers to use strategies at the final ACT session. Univariate analyses examined dyadic characteristics, and Multiple Analysis of Covariance (MANCOVA) and Analyses of Covariance (ANCOVA) examined treatment-related factors associated with readiness to use strategies at treatment completion. RESULTS: At treatment completion, 28.2% (N=31) scored in pre-action and 71.8% (N=79) at action. Caregivers at pre-action readiness levels were more likely than those at action to be a spouse, report greater financial difficulties and be managing fewer problem behaviors. Although both groups were introduced an equivalent number of non-pharmacological strategies, caregivers at pre-action were less likely than those at action to report enacting strategies. CONCLUSIONS: Certain dyadic characteristics and treatment-related factors were associated with treatment failure including financial strain and lack of strategy integration. Findings suggest that developing intervention components to address financial concerns and increase opportunities for practicing strategies and then using them between treatment sessions may be important for caregivers at risk of treatment failure.

Readiness to use compensatory strategies among older adults with functional difficulties.

BACKGROUND: Compensatory strategies (behavioral/environmental modifications) can reduce the difficulties of performing daily living activities, fear of falling, and mortality risk. However, individuals vary in their readiness to use strategies. We examined characteristics associated with readiness to use compensatory strategies, the extent to which level of readiness changed from participation in an intervention (Advancing Better Living for Elders (ABLE)) providing compensatory strategies, and factors predictive of change in readiness level. METHODS: Data from a randomized trial were used. Participants were 148 older adults assigned to the ABLE intervention designed to enhance daily function through compensatory strategy use. Baseline measures included demographic characteristics, functional difficulty level, presence/absence of depressive symptoms, compensatory strategy use, and social support. At initial (2 weeks from baseline) and final (6 months) ABLE sessions, interventionists rated readiness (1 = precontemplation; 2 = contemplation; 3 = preparation; 4 = action/maintenance) of participants to use strategies. Ordinal logistic regression was used to identify baseline characteristics associated with initial readiness rating. A McNemar-Bowker test of symmetry was used to describe change in readiness, and binary logistic regression was used to identify baseline predictors of change in readiness (from initial to final intervention session). RESULTS: At the initial intervention session, 70.3% (N = 104) scored in pre-action (precontemplation/contemplation, preparation), and 29.7% (N = 44) in action/maintenance. Depressive symptomatology (χ2(2) = 9.08, p = 0.011) and low compensatory strategy use (F(2, 147) = 8.44, p = 0.001) at baseline were associated with lower readiness levels at initial ABLE session. By final ABLE session, most participants demonstrated greater readiness: 72% (N = 105) in action/maintenance, 28% (N = 41) in pre-action (two participants dropped out). A significant baseline predictor of positive change in readiness (from initial to final session) was higher social support levels (b = 0.10, SE = 0.05, Wald = 4.98, p = 0.026). CONCLUSION: Whereas presence of depressive symptomatology and lower use of compensatory strategies at baseline were associated with lower readiness at initial intervention session, neither predicted change in readiness level. Thus, mood and prior compensatory strategy use do not effect enhancements in readiness to use strategies provided in an intervention. Baseline social support was the strongest predictor of change in readiness suggesting that interventions may need to involve older adults' social networks to enhance acceptability of compensatory strategy use.