The physical and emotional toll faced by the approximately 15 million Americans serving as family caregivers for persons living with dementia (PWDs) is well-established, and the challenges posed by care provision during COVID-19 related distancing and shelter-in-place orders likely intensify experienced burdens. The NIA-funded parent K01, ?Style and Substance: Characterizing Dementia Caregiving Styles and Associate Biopsychosocial and Health Services Utilization Outcomes? (K01AG056557, PI: Amanda Leggett), characterizes distinctions in how various caregiving styles react to internal care challenges (i.e. behavioral and psychological symptoms of dementia, activities of daily living, etc.). This administrative supplement builds off that parent K01 by examining how various defined caregiving styles cope and manage differently in the face of a global pandemic (COVID- 19) and associated shelter-in-place orders. To better understand care styles at higher risk for negative care outcomes and facets of care styles that may be targeted and modified in future caregiving interventions, this supplement aims to 1) Identify the association between external COVID-19 care challenges (pandemic-related stress, social distancing, and shelter-in-place regulations) on caregiver distress and well-being; 2) Characterize how identified cognitive-behavioral care styles uniquely perceive and behaviorally manage care in the face of COVID-19 care challenges; 2a) Explore caregiving styles as a moderator between COVID-19 related external care challenges and outcomes (care-related distress, well-being, informal and formal support seeking, and healthcare utilization), and 3) Delineate caregiver?s perceptions of barriers and facilitators to care during COVID-19 and what services and supports they would have found beneficial to pinpoint targets for social distancing relevant caregiving interventions. To accomplish these aims we will conduct in-depth mixed- methods interviews with 100 primary family caregivers for PWDs (as many as possible from our original sample with refill recruitment to maintain a total sample of 100 participants). All participant contact will be conducted virtually by phone, web-based survey, and videoconferencing methods. This work extends the career development of the PI by expanding the caregiving styles model to incorporate cognitive-behavioral care management across typical care and pandemic care contexts and offering additional training related to a major public health concern which has critical implications for PWDs and their caregivers. Moving forward, insight from this research can inform us on how caregiving styles respond to internal and external stressors allowing for the development of more efficient and effective caregiver-focused interventions tailored to the individual?s caregiving style.

Public Health Relevance

The COVID-19 pandemic is dramatically changing daily routines (e.g. physical and social distancing, fractured care and social support networks, reduced access or change in modality for healthcare utilization) in ways that may have dramatic impact on the care management practices and well-being of family caregivers for persons living with dementia. This supplement builds off of its parent K01 (K01AG056557) by exploring how caregivers? cognitive-behavioral care styles influence how they adapt and respond to the external care challenges resulting from the COVID-19 pandemic and associated social distancing measures in ways that impact care outcomes, accounting for internal care challenges (e.g. cognitive impairment, activities of daily living impairment, behavioral and psychological symptoms of dementia). Such goals are at the heart of NIA and the National Plan to Address Alzheimer?s Disease?s priorities to optimize care quality and efficiency and improve health outcomes for both care partners and PWDs in midst of the normal challenges presented by dementia care and in pandemic and physical distancing contexts.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
3K01AG056557-04S1
Application #
10180489
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Gerald, Melissa S
Project Start
2017-08-01
Project End
2022-05-31
Budget Start
2020-09-04
Budget End
2021-05-31
Support Year
4
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Xiang, Xiaoling; Leggett, Amanda; Himle, Joseph A et al. (2018) Major Depression and Subthreshold Depression among Older Adults Receiving Home Care. Am J Geriatr Psychiatry 26:939-949
Leggett, Amanda N; Kales, Helen C; Gitlin, Laura N (2018) Finding fault: Criticism as a care management strategy and its impact on outcomes for dementia caregivers. Int J Geriatr Psychiatry :
Leggett, Amanda N; Sonnega, Amanda J; Lohman, Matthew C (2018) The association of insomnia and depressive symptoms with all-cause mortality among middle-aged and old adults. Int J Geriatr Psychiatry :
Leggett, Amanda; Polenick, Courtney A; Maust, Donovan T et al. (2018) ""What Hath Night to Do with Sleep?"": The Caregiving Context and Dementia Caregivers' Nighttime Awakenings. Clin Gerontol 41:158-166
Leggett, Amanda N; Conroy, Deirdre A; Blow, Frederic C et al. (2018) Bright Light as a Preventive Intervention for Depression in Late-Life: A Pilot Study on Feasibility, Acceptability, and Symptom Improvement. Am J Geriatr Psychiatry 26:598-602
Meyer, Oanh L; Leggett, Amanda; Liu, Siwei et al. (2018) Prevalence and correlates of subjective memory complaints in Vietnamese adults. Int Psychogeriatr 30:1039-1048
Pepin, Renee; Leggett, Amanda; Sonnega, Amanda et al. (2017) Depressive Symptoms in Recipients of Home- and Community-Based Services in the United States: Are Older Adults Receiving the Care They Need? Am J Geriatr Psychiatry 25:1351-1360
Maust, Donovan T; Kales, Helen C; McCammon, Ryan J et al. (2017) Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs. Am J Geriatr Psychiatry 25:1074-1082
Polenick, Courtney A; Leggett, Amanda N; Kales, Helen C (2017) Medical Care Activities Among Spouses of Older Adults With Functional Disability: Implications for Caregiving Difficulties and Gains. Am J Geriatr Psychiatry 25:1085-1093
Polenick, Courtney A; Leggett, Amanda N; Webster, Noah J et al. (2017) Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains. J Gerontol B Psychol Sci Soc Sci :