Advisory Council January 2019 Meeting Presentation: Tele-Savvy

01/28/2019

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Monday, January 28, 2019

Printer Friendly Version in PDF Format (7 PDF pages)

 

Tele-Savvy: A Fully On-Line Version of The Savvy Caregiver Program

Ken Hepburn, PhD
Emory University School of Nursing
Goizuetta Alzheimer's Disease Research Center

Patricia Griffiths, PhD
Emory University School of Nursing
School of Medicine
Atlanta Veteran Administration Medical Center (4)

Development and Testing Support

  • Pilot Project Support:
    • VA Office of Geriatrics and Extended Care Transformational Pilot Program (T2TA-ILCA160)
    • Goizuetta ADRC Pilot Grant (AG025688)
  • Support for current Randomized Trial
    • Testing Tele-Savvy, an On-line Psychoeducation Program for Informal Alzheimer's Caregivers (R01AG054079 -- Hepburn/Griffiths)

The Savvy Caregiver Program

  • Six-Week, In-Person Group Psychoeducation program (generally 6-12 caregivers)
    • Focused on developing knowledge, skills, outlook, and mastery for the newly acquired caregiving role
    • Targeted to help caregivers promote meaningful engagement in tasks and activities
  • Evidence-Based: reductions in caregiver distress; increased caregiving mastery
  • Draws on multiple disciplines
  • Widely available, largely through ACL grants
    • ~ 20,000 participants nationwide over past 15 years
  • Limitation: In-Person Attendance
    • Distance and transportation
    • Care for person living with Alzheimer's

Tele-Savvy: A Virtual Group Program

  • Deconstructed Savvy Curriculum Reconfigured
  • Maintain group format
  • Seven weekly on-line group sessions (75-90 minutes)
  • 36 daily "video lessons" -- daily emails provide links to videos on a Canvas platform

Weekly Videoconferences

  • Led by an experienced Savvy facilitator
  • Focus on portions of Savvy that benefit most from interaction
    • Homework debriefing
    • Exercises
    • Key talks
      • Illness-produced erosion of strengths
      • Staging framework
      • Practicing engagement strategies
  • Technical Support Provided (Navigator)

Daily Video Lessons

  • Every day between live sessions
  • Interdisciplinary faculty
  • Focus on content:
    • Dementia 101
    • Cognitive losses in dementia
    • Progressive losses of behavioral self-control
    • Models of behavior and behavior guidance
    • Caregiver self-care
    • Family Issues in caregiving
    • Strategies for decision making

Tele-Savvy Faculty

  • Dr. Angela Amar
  • Dr. Carolyn Clevenger
  • Dr. Clinton Dye
  • Dr. Patricia Griffiths
  • Dr. Kenneth Hepburn
  • Dr. James Lah
  • Ms. Susan Peterson-Hazan
  • Ms. Ivory Shields

Pilot Test Results

64 Participants from 14 StatesPre-Post, No Control Design

  • Significant Reductions:
    • Caregiver Burden (Zarit)
    • Caregiver Depression (CES-D)
    • Average frequency of BPSD (RMBPC)
Average Caregiver Age: 63.3 yr.
Average Care recipient Age: 70.0 yr
% Female Caregiver 91%
Caregiver Ed > H.S. 59%
% African American 33%
Attrition 11%
  • Significant Increase:
    • Caregiver Mastery (Pearlin)
Increased Caregiving Mastery significantly linked To reductions in post-program Caregiver Burden

Griffiths PC, Kovaleva M, Higgins M, Langston AH, Hepburn K (2018). Tele-Savvy: An On-Line Program for Dementia Caregivers. American Journal of Alzheimer's Disease & Other Dementias, 33:5; 269-76.

Current Tele-Savvy Trial

  • Emory Study Center
  • Three collaborating ADCs (Northwestern, OHSU, Rush) -- national recruitment
  • Three study conditions:
    • Immediate Tele-Savvy
    • Healthy Living attention control (uses NIA Go4Life and CDC Health Promotion Materials)
    • Usual Care
  • Cohorts of 10 or 15 time-matched participants randomized at a 2:2:1 ratio
  • Following baseline, data gathered at 3, 6, 9, and 12 months
  • Data gathered in 45 minute video calls by interviewers blind to condition
  • 45 minute data gathering
  • After 6 month data point, those in Healthy Living or Usual Care receive Tele-Savvy

Kovaleva, M. A., Bilsborough, E., Griffiths, P. C., Nocera, J., Higgins, M., Epps, F., Kilgore, K., Lindauer, A., Morhardt, D., Shah, R. C., & Hepburn, K. (2018). Testing Tele-Savvy: Protocol for a randomized controlled trial. Research in Nursing & Health. Advance on-line publication. doi: 10.1002/nur.21859

Focus of Study Aims:

  • Caregiver psychological well-being
  • Caregiver mastery
  • Care recipient quality of life
  • Exploring salience across racial groups

What We Know so Far

  • We built it, and they are coming
    • Caregivers attend and participate
      • Observers and facilitators report "groupness"
      • Attrition is about 15%
  • Tele-Savvy participants are "good students"
    • High rate of viewing of asynchronous video lessons
  • Wide geographic distribution of participants
    • Maine to Hawaii

Challenges

  • Cohort Formation
    • Finding 15 -- or even 10 -- who can meet at the same time (across time zones) means some have to wait a long time to begin
      • Probably ideal for a statewide organization or a health system
  • Technical Problems
    • Surprisingly few -- principally linked to bandwidth or old equipment

Still Recruiting

  • Informal (family) caregivers of community-dwelling persons living with Alzheimer's or similar illnesses
    • No firm plan for institutionalization within next six months
  • Averaging at least 2 hours of care per day
  • Access to a computer with internet connection (can provide webcam)
  • Able to participate in English

Contact: Ken Hepburn, Emory University 404-712-5797


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