A Telehealth-Adapted Dementia Caregiver Skills Training Intervention (TeleCARE): Single-Arm Pre-Post Intervention Study

TL;DR

A telehealth version of a dementia caregiver training program was found to be feasible and acceptable, with some improvements needed for technology use.

Contribution

The study introduces TeleCARE, a telehealth adaptation of an in-person dementia caregiver skills training program, and evaluates its feasibility and acceptability.

Findings

TeleCARE had a recruitment rate of 22% and high session attendance (83% completion rate).

Participants reported adequate satisfaction with the telehealth intervention despite needing technological support.

Small effect sizes were observed for reduced caregiver depression, anxiety, and care recipient neuropsychiatric symptoms.

Abstract

Dementia caregivers often want to support aging at home, but as neuropsychiatric symptoms (NPS) become more severe, caregiver challenges increase, often resulting in negative outcomes for both the caregiver and care recipient and institutionalization. Project CARE is a manualized in-person group intervention for dementia caregivers designed to reduce negative caregiver outcomes by teaching skills to manage NPS in care recipients in the home environment. Interventions that occur in person, however, can be difficult for caregivers to attend. Telehealth-based interventions are possible alternatives that reduce barriers to attendance.

The primary objective of this pilot study was to evaluate the feasibility and acceptability of offering CARE via telehealth (TeleCARE). The secondary objective was to explore quantitative outcome trends and effect sizes postintervention outcomes of TeleCARE for both caregivers and care recipients.

Rates of recruitment, attendance, and completion were used to assess the feasibility of TeleCARE. Data on technology use and telehealth-based adaptations were also collected. Acceptability was measured using participants’ rated satisfaction with the intervention immediately postintervention. Questionnaires were administered at baseline and immediately and 3 months postintervention. Primary outcomes for exploratory analysis included NPS presence, severity, and caregiver NPS-related distress. Secondary outcomes included caregiver depression, anxiety, stress, self-efficacy, positive aspects of caregiving, and meaning and purpose in life.

Of the 109 caregivers contacted for recruitment, 24 (22%) caregivers enrolled in TeleCARE, and 20 (83%) caregivers, predominantly female spouses, completed the study. Feedback from participants in the TeleCARE test group 1 (n=3) was used to modify the intervention to improve the telehealth experience, including adding procedures to improve safety, encourage rapport building, address etiquette, and ensure privacy. The final version of TeleCARE included 7 weekly synchronous video sessions. Ten out of 17 participants (59%) attended all 7 sessions, and all participants attended at least 5 sessions. Satisfaction ratings suggested adequate intervention acceptability. Most participants (11/17, 65%) required technological support, which was needed throughout the intervention. Quantitative trends were observed toward postintervention decreases in care-recipient NPS severity (Cohen d=0.16), caregiver depression (d=0.15), anxiety (d=0.23), and caregiver self-efficacy (d=0.21), as well as increases in positive aspects of caregiving (d=0.18) and meaning and purpose in life (d=0.09). Most improvements were not sustained at the 3-month follow-up.

In this pilot feasibility study, dementia caregivers were successfully recruited and engaged in TeleCARE. Overall, TeleCARE was deemed feasible and acceptable. The current findings suggest that offering interventions via telehealth requires modifications and technological support for older caregiver engagement but is a feasible and acceptable means of offering services.

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