This clinical trial will test the FamTechCare intervention that uses multidisciplinary professional guidance based on in-home video monitoring to support family caregivers in managing behaviors of persons with dementia (PWD). Families provide the majority of care for PWD at home. However the stress of caregiving is so significant that it increases caregiver morbidity and mortality. Stress is magnified by disruptive behaviors that frequently lead to nursing home placement. In-home video monitoring allows experts to assess behaviors of PWD and to identify antecedents, recommend specific interventions, and subsequently evaluate caregiver outcomes. FamTechCare uses new technology to link family caregivers to experts for guidance in managing disruptive behaviors, supporting continued care at home while reducing the negative effects of caregiving. Caregiver-PWD dyads (N=88) from the University of Iowa Hospital and Clinics and the University of Kansas Alzheimer's Disease Center will be randomly assigned to intervention or control groups. Both groups will record behaviors during daily care for 3 months using a home monitoring unit. Notably, this new technology captures 15 minutes prior to the behavior, thus recording behavior triggers and precursors. Intervention group videos will be auto-uploaded to a HIPAA-secure Internet site for weekly team review with in-home feedback to caregivers in behavior management. The time and attention equivalent control group will receive a weekly phone call from a nurse, but their recorded videos will be held for review and feedback after 3 months. This study builds on the PI's CTSA study that verified feasibility for using in-home monitoring and professional observation of behaviors to guide caregivers in managing care at home. Our team found the video-data essential to identify antecedents, recommend specific interventions, and subsequently evaluate responses. Caregivers were highly satisfied with reductions in disruptive behaviors and their own stress and burden. This study expands the IRB-approved protocols, procedures, HIPAA-secure software interface, and protocols for internet-based team meetings and caregiver feedback.
Study aims are to identify interventions, based on in-home observations, to assist caregivers in behavior management. Between-group effects on outcomes, including PWD disruptive behaviors and caregiver burden and other negative outcomes will be compared using linear mixed modeling. We will evaluate ease of use and satisfaction, cost-efficiency, and factors influencing likelihood of translation into practice. Thi is the first study to test new technology for direct observation and immediate feedback to empower families to manage PWD behaviors at home while reducing caregiver stress and morbidity. Technology links caregivers to individualized expert guidance, acknowledging the importance and burden of their role. This study addresses NIH missions and the 2012 National Plan to Address Alzheimer's disease goals, integrating strategies to promote adoption and use of aging services technologies in interventions that will reduce negative caregiver outcomes, a growing public health problem.
This study tests FamTechCare, a new telehealth intervention that uses in-home monitoring to link family caregivers to experts for guidance in managing disruptive behaviors, to support continued care for the PWD at home with reduced caregiver stress, burden and negative outcomes. Family caregivers currently provide $375 billion in home care for 35.6 million persons with dementia, a population that will grow to 115.4 million by 2050.
|Williams, Kristine; Pennathur, Priya; Bossen, Ann et al. (2016) Adapting Telemonitoring Technology Use for Older Adults: A Pilot Study. Res Gerontol Nurs 9:17-23|
|Bossen, Ann L; Kim, Heejung; Williams, Kristine N et al. (2015) Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technol Telehealth 3:49-57|