BACKGROUND/RATIONALE:
Caregiving for individuals with dementia is an extremely stressful task that exposes caregivers to high levels of physical, mental, and financial strain. Over the past 40 years, a variety of psychosocial interventions have been developed to help caregivers cope with caring for family members with dementia. One of the most studied and effective interventions for caregivers of individuals with dementia is REACH II which served as the basis for its adaptation: REACH VA which is currently being rolled out within the VA. However, studies of even the most effective interventions suggest that a large proportion of caregivers continue to experience significant symptoms post treatment. There is no known research exploring potentially mutable factors that predict treatment outcome, nor are there interventions tailored to the needs of treatment non-responders.

OBJECTIVE(S):
The current study has two primary objectives: (1) identify predictors of response to REACH VA (2) develop and pilot a new intervention designed to address the unique characteristics of those who do not respond to REACH VA.

METHODS:
Participants in the study will be family members who serve as the primary caregiver of an individual with dementia. Participants will undergo an initial interview and will be asked to fill out questionnaires to obtain baseline information about themselves and the individual with dementia.
Phase I: 30 participants will receive REACH VA. Following the 3-4 month REACH VA protocol, preliminary analyses will be conducted to identify variables correlated with magnitude of treatment response. The identified predictors will guide development of the new intervention and non-responders from this phase will also serve as the first group of participants to pilot the new intervention.
Phase II: Non-responders from Phase I will be provided with the newly developed intervention protocol. Furthermore, an additional 20 newly recruited participants will be provided with REACH VA and non-responders will be provided with the new intervention.

FINDINGS/RESULTS:
No results/findings from the study are available.

IMPACT:
This research was the first to attempt to understand and identify factors associated with treatment non-response to REACH VA. It provided data necessary to clarify the ways caregiver factors impact capacity to be positively affected by REACH VA. Identifying these factors will help clinicians to provide the most appropriate services to caregivers. However, it is challenging for clinicians to identify these factors in an efficient manner, as the baseline assessment for caregivers in this study consisted of a battery of measures requiring nearly 4 hours to complete. The next project based on these data will develop a targeted assessment tool that clinicians can use to identify relevant interpersonal predictors of response and intervene on those predictors through a family intervention.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX000783-01
Link: https://reporter.nih.gov/project-details/8205251

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PUBLICATIONS:

Journal Articles

1. Denckla C, Bailey RW, Jackson C, Tatarakis J, Chen CK. A Novel Adaptation of Distress Tolerance Skills Training Among Military Veterans: Outcomes in Suicide-Related Events. Cognitive and behavioral practice. 2014 Apr 1; 22(4):doi:10.1016/j.cbpra.2014.04.001. [view]
2. Chen CK. Defiance, denial, and defining limits: Helping Family Caregivers of Individuals with Dementia Distinguish the Tap-out from the Cop-out. Journal of psychotherapy integration. 2016 Dec 1; 26(4):353-365. [view]
3. Chen CK, Uzdawinis D, Schölmerich A, Juckel G. Effects of attachment quality on caregiving of a parent with dementia. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry. 2014 Jun 1; 22(6):623-31. [view]
4. Chen CK, Bailey RW. Episodic memories of relationship quality, procedural knowledge of attachment scripts, and the experience of daughters caring for a parent with dementia. Dementia (London, England). 2018 Jan 1; 17(1):61-77. [view]
5. Nehrig N, Chen CK. How to address the needs of non-responders to REACH VA: a qualitative analysis. Aging & mental health. 2019 Sep 1; 23(9):1203-1208. [view]
6. Chen CK, Nehrig N, Abraham KS, Wang B, Palfrey AP, Baer AL. Predictors of Symptoms Remission Among Family Caregivers of Individuals With Dementia Receiving REACH VA. American journal of Alzheimer's disease and other dementias. 2019 Sep 1; 34(6):376-380. [view]
7. Nehrig N, Shifrin M, Abraham K, Chen CK. The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study. Cognitive and behavioral practice. 2019 Aug 1; 26(3):562-574. [view]
8. Chen CK, Clayton K, Chodosh J. The Relationship Between "What We Believe" and "How We Care" Among Daughters Caring for a Parent With Dementia. American journal of Alzheimer's disease and other dementias. 2017 Mar 1; 32(2):90-95. [view]
9. Nehrig N, Gillooly S, Abraham K, Shifrin M, Chen CK. What is a non-responder: A qualitative analysis of non-response to a caregiver behavioral intervention. Cognitive and behavioral practice. 2019 May 1; 26(2):411-420. [view]

DRA: Neurodegenerative Diseases, Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems Science
DRE: Treatment - Observational
Keywords: none
MeSH Terms: none