This is an application for a VA Rehabilitation Research and Development (RR&D) Small Projects in Rehabilitation Research (SPiRE) Award submitted by Blake K. Scanlon, Ph.D. He is currently a Clinical Research Associate (Assistant Professor equivalent) at the Stanford/VA Aging Clinical Research Center with a pending 8/8ths VA appointment subsequent to receipt of a RR&D CDA-2 (Dementia caregiver rehabilitation: enhancing Veteran and family-centered care, 1 IK2 RX001240-01A1; JIT process complete, start date pending). Dr. Scanlon is establishing himself as a clinician-scientist who conducts patient- and family-centered clinical research on dementia and neurodegenerative disease. This award will provide Dr. Scanlon and his team with the resources necessary to develop a novel project aiming to expand the reach of the CDA-2 intervention study by utilizing mobile media devices (i.e., tablets) to serve additional family caregivers of Veterans with dementia in the comfort of their own homes. To accomplish this goal, he has gathered a team that includes three Co-Investigators: Dr. Jerome Yesavage (a geriatric psychiatrist and renowned expert in cognitive and psychiatric functioning across the lifespan); Dr. Joy Taylor (a cognitive psychologist and expert in the trajectory of cognitive decline); and Dr. Lisa Kinoshita (a clinical neuropsychologist with expertise in the assessment and treatment of cognitive and behavioral symptoms in dementia); a Senior Researcher: Dr. Mary Mittelman (an internationally renowned expert in dementia caregiver intervention) and a consultant: Dr. Booil Jo (a biostatistician with expertise in design/analysis of clinical trials, longitudinal data analysis, and missing data analysis). The proposed project studies the effects of an education and skill-building rehabilitation (ESBR) intervention, designed to be low-cost and clinically scalable using mobile media devices, on family caregivers of Veterans with dementia. A total of 40 caregivers caring for a Veteran with dementia will be randomized to mobile media ESBR intervention (ESBR-m; n=20) or to usual care plus paper educational materials (UC; n=20). Intervention effects will be examined at three months post-intervention. The Primary Aim of this study is to establish the feasibility of delivering a group-based intervention to family caregivers of Veterans through mobile media devices (e.g., tablets such as the iPad). Dr. Scanlon will also use advanced statistical techniques (e.g., mixed-effects modeling) to evaluate the impact of the intervention on: quality of life (Specific Aim 1); perceive stress and depressive symptoms (Specific Aim 2); and socialization and engagement in pleasant activities (Specific Aim 3) in caregivers of Veterans with dementia. This award will create an ideal environment where Dr. Scanlon and his team can establish the necessary pilot data to pioneer the development of low-cost, pragmatic and clinically translatable methods for improving rehabilitation and management of neurodegenerative disease and dementia within VHA.
There is currently no cure for dementia. Ultimately, dementia will have a large impact on quality of life in Veterans and families, lead to expensive nursing home placement, and decrease life expectancy for patients and family caregivers. The experience of high burden in a caregiver for a Veteran with dementia increases the likelihood of nursing home placement and can separate Veterans from their families. To address the high burden of caring for a Veteran with dementia, we propose to study the effect of a low-cost, rehabilitative intervention delivered via tablets (e.., iPad) customized with educational and skill resources direct to the homes of family caregivers. Our novel approach will use mobile media technology that can reach caregivers in rural areas who do not have easy access to major VA medical centers. If this rehabilitative intervention proves successful, it may represent an approach to Veteran- and family-centered dementia care that can be used throughout VA with low staff, resource, and cost burdens.
