Health Services Research & Development

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Davis ML, Hendrickson J, Wilson N, Shrestha S, Amspoker AB, Kunik M. Taking Care of the Dyad: Frequency of Caregiver Assessment Among Veterans with Dementia. Journal of the American Geriatrics Society. 2019 Aug 1; 67(8):1604-1609.
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Abstract: OBJECTIVES: This study assessed frequency of caregiver identification and needs of a sample of persons with dementia (PWDs) and their caregivers to determine whether needs were addressed and whether documentation increased with growing levels of self-reported relationship problems and burden. DESIGN: Cross-sectional design using data from electronic medical record (EMR) review and baseline research assessments (Burden Interview and Mutuality Scale). Items from a caregiver assessment tool were used to identify documentation of important factors in clinical guidelines. SETTING: Michael E. Debakey VA Medical Center, Houston, TX. PARTICIPANTS: A total of 211 PWDs from a randomized controlled trial testing a psychosocial intervention for preventing aggression in PWDs. MEASUREMENTS: EMRs for 12 months before participation in the original study were abstracted, using a tool created by the authors to assess documentation of information deemed important to caregiver assessment in clinical guidelines (eg, caregiver needs, caregiver well-being, and caregiving context). The first two authors reviewed the EMRs, adjusting the tool, based on questions that arose. RESULTS: Of 211 EMRs of PWDs reviewed, 177 (89%) identified caregivers. Of these, 88% identified the caregiver by name or relation to the PWD, 28% assessed caregiver well-being, and 41% assessed caregiver needs. All EMRs assessing caregiver needs showed provision of caregiver support (including psychoeducation, skills training, or referrals for additional aid). Levels of self-reported caregiver burden were not associated with documentation of assessment; however, higher levels of self-reported relationship problems were positively associated with increased caregiver contact documentation and negatively associated with caregiver need documentation and Alzheimer Association referrals. CONCLUSION: Healthcare providers identified caregivers in most of the sample, but less than 50% assessed their well-being and needs. J Am Geriatr Soc 67:1604-1609, 2019.