Psychometric Evaluation of Kingston Caregiver Stress Scale.

OBJECTIVES: Standardized measurement of caregiver stress is a component of Medicare's new health care benefit supporting care planning for people with dementia. In this article we identify existing measures of caregiver stress, strain and burden and propose specific criteria for choosing tools that may be suitable for wide use in primary care settings. We reviewed 22 measures and identified one, the Kingston Caregiver Stress Scale (KCSS), which met all the proposed criteria but had not been studied in a U.S. SAMPLE: We conducted a psychometric evaluation of KCSS to determine its potential usefulness as a care planning tool with a U.S. METHODS: We examined the internal consistency, test-retest reliability, component structure, and relationship to depression and anxiety in 227 dementia caregivers at two U.S. sites. RESULTS: The KCSS has high internal consistency and test-retest reliability, a strong factor structure, and moderate to high correlations with caregiver depression and anxiety. CONCLUSION: KCSS is a good candidate for use as part of comprehensive care planning for people with dementia and their caregivers. CLINICAL IMPLICATIONS: Routine assessment of caregiver stress in clinical care may facilitate timely intervention and potentially improve both patient and caregiver outcomes.

Now where was I going? The challenge of care transitions for the cognitively impaired.

Transitions in care settings can be disconcerting to anyone, but they can be particularly difficult for people with cognitive impairment. MemoryCare's design of integrated clinical and care management services is well suited to minimizing the preventable morbidity that can accompany transitions in health care for cognitively impaired older adults at high risk for poor outcomes.

Efficacy of a Virtual Education Program for Family Caregivers of Persons Living with Dementia.

BACKGROUND: Family caregivers of people with dementia often experience negative impacts including stress and burden. Psychoeducational programs can reduce these negative outcomes. OBJECTIVE: To evaluate whether this virtual caregiver education program changes caregiver confidence, self-efficacy, and burden relative to controls. METHODS: This was a pre-post comparison of a five-week, synchronous, virtual caregiver education program delivered by a clinician and caregiver support specialist covering aspects of dementia, including changes in cognition, behavior, functional abilities, caregiver-care recipient roles, communication, and caregiver self-care. Caregivers (n = 90) were surveyed at baseline, at completion of intervention, and three months thereafter; controls (n = 44) were surveyed at two points six weeks apart. We compared validated measures of caregiver confidence, self-efficacy, and burden using generalized estimating equations. RESULTS: Participants' confidence and self-efficacy increased over follow-up compared with controls (p < 0.01 for intervention*time in regression models). There was no difference in burden. All participants (100%) reported perceived increased knowledge, 97% perceived increased confidence, and 95% perceived increased ability to manage dementia-related behaviors after the course. CONCLUSION: This virtual caregiver education program was effective in improving caregiver confidence and self-efficacy and participants' self-reported impact was equivalent to those who had taken previous courses in person. Caregivers with greater confidence and self-efficacy have been shown to have better health outcomes and decreased stress and depressive symptoms. Health professionals, health care organizations, and public health agencies should consider using efficacious virtual caregiver education programs in rural and other community settings, during public health crises, or in standard practice as an alternative to in-person programs.

Quality Dementia Care.

Absent a cure or effective disease modifying treatment for dementia, developing cost-effective models of care that address the needs of caregivers alongside the medical management of the disease is necessary to maximize quality of care, address safety issues, and enhance the patient/caregiver experience. MemoryCare, a community-based non-profit organization, has 15 years of experience delivering a medical and care management model for persons with Alzheimer's disease and other types of dementia. Designed to supplement primary care services, the average annual cost-per-patient is US$1,279. Observational data on 967 patients and 3,251 caregivers served by the program in 2013 reveal high levels of satisfaction, increased dementia-specific knowledge, improved perceived ability to manage challenging behavioral aspects of dementia, and lengthened perceived time in the home setting. Data suggest lower hospitalization rates and related cost savings. These findings warrant a further study of broader integration of caregivers into clinical care models for persons with dementia.