The goal of this study is to test the efficacy of a mealtime intervention (Partners at Meals) in respite care centers (RCCs) that provide a social model of care for people with dementia living in the community and support for their caregivers. Largely staffed by long-time volunteers, these centers support caregivers? ability to maintain their loved one in the home. Outcomes include improvements in: a) quality of life (QOL) and nutritional outcomes for people with dementia (PWD) and QOL outcomes for family caregivers (CGs); b) self- efficacy training outcomes for assessing and managing meals for the CGs and the RCC volunteers; and c) sustainability outcomes as determined by directors of the RCCs. Two large RCCs with a total of 5 sites of care in suburban and rural areas of SC will be the sites of this project; and 60 PWDs and 60 CGs will be recruited for this cluster-randomized trial, as well as potentially 60 staff and volunteers. Caregiving for PWDs is increasingly occurring in the community by persons who are often not prepared to assume this responsibility. Fortunately, RCCs evolved as a vital community-based resource that provide socialization, meaningful activities, respite for caregivers and at least one meal daily. Mealtime is a particular problem for PWDs because as this life-limiting disease progresses, they lose the functional ability to manage meals and display a variety of challenging behaviors all of which will eventually affect their ability to consume adequate calories and continue the social aspects of meals that connect them to others. A HIPAA-compliant telehealth system using simple ?tablets? will allow CGs to capture behaviors and environmental aspects of meals in the home at the time behaviors occur so that plans of care can be tailored to PWD needs. Using a train-the-trainer model, volunteers will be taught to assess the environment (Place), the interactions between the PWD and others (People), and the actions of the PWD (Person). They will then train the CGs to make those observations so they can tailor and change mealtimes in the home ? the telehealth component supports this. Thus this project could be used in the community as a model for behavior modification for other dysfunctional behaviors in the home. This study proposes to examine the following aims: (Primary) Compared to participants in ?enhanced usual care? sites, PWD participants in the intervention sites will demonstrate improvement in nutritional status and dysfunctional behaviors, and QOL; (Secondary) a) CGs will report improve QOL and self-efficacy for managing meals, and decreased depression and burden; c) RCC volunteers will report improved self-efficacy for training and management of feeding issues; and d) Directors will report satisfaction with the program and willingness to continue the program post-funding. Additionally, hospitalizations and discharges related to nutrition-related issues among PWDs will be collected for future work.
The goal of this study is to test the efficacy of a multi-level, mealtime intervention in respite care centers for people with dementia and their caregivers. Mealtimes become more challenging as dementia progresses eventually causing nutritional and behavioral issues in the affected individuals. Using a train-the-trainer program built on the Partners at Meals model, volunteers in respite centers partner with caregivers and develop a mealtime plan that builds on the strengths of the person with dementia, and develop a supportive environment for change.
