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The Internet of Health Things (technologies for exchanging data) is crucial in helping promote health and wellbeing. Family caregivers of people with Alzheimer's can significantly benefit from the Internet of Health Things by enabling caregivers to participate in programs from home to help manage their stress and distress in their caregiver role. This paper reports the results of a techno-economic analysis and a life cycle assessment comparing a video-communication delivered intervention designed to decrease the stress and distress of caregivers of people with Alzheimer's and related dementias to a hypothetical in-person delivery of the same intervention. Results indicated that the virtual intervention, compared to the hypothetical in-person intervention, was associated with lower participant costs yet, potentially more expensive from an organizational/provider perspective. Environmentally, the virtual intervention had lower carbon emissions than the hypothetical in-person delivery of the intervention. Furthermore, video-communication delivery of the intervention has the potential to reduce some of the hassles of looking for respite to attend caregiving interventions and allow caregivers to join from their preferred location across the country. [ABSTRACT FROM AUTHOR]

To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization. Longitudinal. San Francisco Bay area, California. Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers. Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization. Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas. Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia. [ABSTRACT FROM AUTHOR]

The Northern California Chronic Care Network for Dementia brings together Northern California's major providers of managed care, community-based care, consumer education, and advocacy in new partnerships to improve the care of persons with dementia enrolled in managed care plans and their family caregivers. These partnerships are part of a national initiative entitled the Chronic Care Network for Alzheimer's Disease (CCN/AD) sponsored by the National Chronic Care Consortium and the Alzheimer's Association. This initiative selected eight promising provider-consumer partnerships across the country to implement and evaluate a new model of coordinated care for people with dementia and their families. This paper describes the Northern California network's partnerships and its intervention and challenges. The intervention is grounded in the key components of the CCN/AD model: “identification of patients with possible dementia, diagnostic assessment, care management and family caregiver information and support.” These components, in turn, are translated into protocols and pathways designed to create timely, comprehensive, appropriate, and effective systems of care services that address the unique needs of dementia patients and their caregivers over the course of the disease. [ABSTRACT FROM AUTHOR]

Some individuals with mild cognitive impairment (MCI) experience not only cognitive deficits but also a decline in motor function, including postural balance. This pilot study sought to estimate the feasibility, user experience, and effects of a novel sensor-based balance training program. Patients with amnestic MCI (mean age 78.2 yr) were randomized to an intervention group (IG, n = 12) or control group (CG, n = 10). The IG underwent balance training (4 wk, twice a week) that included weight shifting and virtual obstacle crossing. Real-time visual/audio lower-limb motion feedback was provided from wearable sensors. The CG received no training. User experience was measured by a questionnaire. Postintervention effects on balance (center of mass sway during standing with eyes open [EO] and eyes closed), gait (speed, variability), cognition, and fear of falling were measured. Eleven participants (92%) completed the training and expressed fun, safety, and helpfulness of sensor feedback. Sway (EO, p = 0.04) and fear of falling (p = 0.02) were reduced in the IG compared to the CG. Changes in other measures were nonsignificant. Results suggest that the sensor-based training paradigm is well accepted in the target population and beneficial for improving postural control. Future studies should evaluate the added value of the sensor-based training compared to traditional training. [ABSTRACT FROM AUTHOR]

The original validation study for the Montreal Cognitive Assessment (MoCA) suggests a cutoff score of 26; however, this may be too stringent for older adults, particularly for those with less education. Given the rapidly increasing number of older adults and associated risk of dementia, this study aims to provide appropriate age- and education-adjusted norms for the MoCA. Data from 205 participants in an ongoing longevity study were used to derive normative data. Individuals were grouped based on age (70–79, 80–89, 90–99) and education level (≤12 Years, 13–15, ≥16 Years). There were significant differences between age and education groups with younger and more educated participants outperforming their counterparts. Forty-six percent of our sample scored below the suggested cutoff of 26. These normative data may provide a more accurate representation of MoCA performance in older adults for specific age and education stratifications. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia. DESIGN: This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems. SETTING: Community-dwelling dementia caregiving dyads from the Memphis REACH II site. PARTICIPANTS: Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired. INTERVENTION(S): Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two “check in” phone calls. MEASUREMENTS: Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care). RESULTS: At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care ( P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day. CONCLUSION: The intervention provided that most scarce of caregiver commodities—time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost. [ABSTRACT FROM AUTHOR]

The Resources for Enhancing Alzheimer's Cargiver Health (REACH) project was designed to test promising interventions for enhancing family caregiving for persons with dementia. The purpose of this article is to describe the research design, interventions, and outcome measures used in REACH and to characterize the sample recruited for the study. Nine interventions and 2 control conditions were implemented at 6 sites; 1,222 dyads were randomly assigned to an intervention or a control condition. The caregiver sample was 18.6% male with an average age of 62.3 years (56% Caucasian, 24% Black, and 19% Hispanic). Caregivers reported high levels of depressive symptoms and moderate burden. Care recipients were older, with a mean age of 79, and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30. [ABSTRACT FROM AUTHOR]