Introduction and Objective: The primary objective of the proposed four-year randomized, controlled trial is to document that providing a hands-on skills training and assistive technology (AT)/environmental modification program for older veterans who are dependent in activities of daily living (ADLs) and their informal caregivers will result in improvements in caregiving processes (i.e., caregiving skills) and outcomes (i.e., safety during tasks) compared to the current standard of care and have beneficial direct and indirect effects for both members of the dyad. Secondary objectives are to determine the effects of the program on veteran and caregiver subjective well-being (depression, quality of life) and to compare the relative effectiveness of two validated implementation modalities the traditional in-person approach and real-time interactive tele-video conferencing. Research Plan. The study will be conducted with older veterans (>60yrs) with mobility impairments who live in the community and are dependent on an informal caregiver for ADL assistance involving mobility, transfer or positional change. The study will utilize a modified randomized controlled cross-over design with four study arms and three outcome assessment periods. Prior to the first home visit, participants will be randomized to an immediate intervention (IIG) or delayed intervention/control group (DICG) then randomized within those groups to intervention modality (in-person vs. tele-video). Methods. In-home interviews will be completed with 180 veteran caregiving dyads to obtain baseline, self-reported measures of caregiving needs, processes and outcomes using standardized, validated instruments. In-home visits by an assistive technology specialist (ATS) will mirror the interview visits (within 1 week) to independently and objectively assess needs through observation of functional tasks. Dyads will be re-evaluated one (T2) and two (T3) months later to ascertain change. Following T1 assessments, those in the IIG will receive 2 additional home visits from the ATS to (1) deliver the intervention and (2) reinforce the intervention. A 2nd blinded ATS will conduct the T2 outcome assessments which will also serve as a repeat baseline for the DICG. The intervention schedule will then be repeated for dyads in the DICG followed by T3 final assessments for both groups. Intervention. The Caregiving Assessment of Skill Sets & Individualized Support Thru Training or CG Assist program has recently undergone feasibility testing in a VA RR&D pilot study. The intervention consists of (a) provision of assistive technology (AT) and simple home modifications to facilitate ADLs and (b) dyad training on the appropriate use of the devices and proper task execution using standardized protocols individualized to the needs and preferences of the dyad and environmental features of the home. Clinical Relevance. Supporting and assisting caregivers in providing care for veterans to help them age in place has important implications for the VHA system and the safety, dignity and quality of life of the veterans we serve.
This study will lead to a better understanding of activities of daily living (ADL) dependency needs in older veterans and their informal caregivers and is both preventive and 'promotive' in nature as challenges with ADL assistance can lead to injuries, falls, strain, distress and premature institutionalization. Sustaining caregivers and their ability to provide care at home is crucial to our health and long-term care systems. The CareGiving Assessment of Skill Sets and Individualized Support thru Training or CG ASSIST program is designed to help veterans and their caregivers with these fundamental activities of daily living thus enabling them to maintain independence and dignity and to remain safely within their own homes for as long as possible.
