Target Population
Older adults whose age exceeds 60 years are often affected by chronic conditions and require caretakers. In particular, this population of older adults is prevalently affected by dementia. Dementia is a term that is used to refer to the loss of memory, language, problem-solving, and other thinking capabilities that are severe enough to affect daily activities. The prevalence of this condition in older people increases with age. Dementia is identified as more popular in people who are older than 60 years, have educational attainment, have an annual income below 200% of the 2015 federal poverty level, and come from an ethnic minority group (de Almondes et al., 2016). As many as 7% of adults who are 60 years and older suffer from dementia. More than half (63%) of older adults with dementia are 80 years and older (Valkanova et al., 2017). Along with memory loss, and decision-making capabilities, dementia can result in other symptoms such as heightened irritability and depression. They also involve shifts in personality and behavior.
Literature Review and Rationale for CDSM group
According to Bentwich et al. (2018), dementia is not only overwhelming to the individuals who have it but also to their caretakers and families. Individuals with dementia typically face shifts in their emotional attitudes. They may possess a lower level of control when it comes to their feelings and their reactions. These shifts are often difficult for their caregivers to handle and often require an effective identification of needs. Valkanova et al. (2017) state that dementia may increase feelings of insecurity in the adults affected and a lower level of confidence. Older adults may begin to feel that they are not unable to control their surroundings and begin to doubt their judgment. These adults may also be stigmatized and receive differential treatment from others due to their diagnosis. In this way, de Almondes et al. (2016) state that dementia can have an indirect impact on the self-esteem of an individual by affecting various aspects of their lives.
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Hepburn et al. (2007) established a savvy caregiver program conducted a trial on a transportable psychoeducation program for individuals who serve as caretakers for persons living with dementia. Based on the findings, it was clear that the program could be applied in several environments and was beneficial to caregivers. Quinn et al. (2016) conducted a study to investigate whether the ability of family caregivers to communicate empathically can be strengthened, their emotional attitude towards the patient can be enhanced, and their perceived burden can be minimized through a special communication-oriented psychoeducation intervention. Based on the findings obtained, the study established that family caregivers of people with dementia did not benefit from direct information transfer through the extensive offer of self-help literature to a similar degree as the psychoeducational group intervention. Presently, the evidence base for self-management in older individuals with dementia is very low. Hence, there is a need to set up self-management groups for older individuals with dementia.
Desired Outcomes and Measurement of Outcomes
There will be three desired outcomes for the individuals that will be engaged in the six-week chronic disease self-management (CDSM) curriculum. These desired outcomes will include increased cognitive functioning, decreased anxiety and depression, and an increase in the patients' well-being. An increase in cognitive function will be measured through Addenbrooke's Cognitive Examination- III. This is a tool that can be applied at the different stages of dementia (Beishon et al., 2019). It evaluates cognitive capability in a variety of areas, including attention and memory. Lower levels of depression and other mental issues will be examined using HADS. HADS is a self-report tool that evaluates and assesses symptoms of depression and is especially appropriate to older individuals that experience other conditions (Annunziata et al., 2019). The last desired outcome is increased well-being in dementia patients and caregivers. The CORE-OM, which is a self-reporting tool that evaluates the level of severity of a challenge and is effective for showing sensitivity to changes, will be used to determine the well-being of patients.
6-Week Psychoeducational Curriculum
The CDSM group will specifically cater to individuals with dementia aged more than 60 years and their caregivers. Participants to the CDSM group will be recruited from various sites. The implementation sites for the group will be two different community centers. The CDSM group will involve education sessions that are given at prearranged times during the day, afternoon, and evening. The DSM group will include six one-hour sessions conducted every week at a local clinic. It will be controlled by two individuals working in the clinical team that will have the training required to provide the content to the participants while providing increased access to additional support. The DSM group will take on about twenty patients. The caregivers of these patients (a relative of every participating individual with dementia) will be requested to engage in the first and final sessions (Hepburn et al., 2017). These caregivers will also be requested to be involved in the group at the completion of every meeting to obtain a general summary of the theme that was addressed.
Each participant will be asked to share personal information. However, they will only be requested to share information that they are comfortable disclosing. Every participant will be provided with a booklet that will include the content of every session. This is expected to provide an opportunity for the participants to write down additional notes and comments while sharing the resource with their caregivers between sessions. Participants that attend the group will also receive all the services that they need. A flexible approach will be taken to the structure and organization of every session within six weeks. Every session will address a specific subject, and the individuals involved will explore the subject with the others around them and the facilitators of the group. Within every theme, participants will be provided with the ability to focus on components that are essential to the participants (Quinn et al., 2016). The themes to be explored for every week will include;
Week 1- Managing unexpected symptoms
Week 2- Maintaining meaningful roles
Week 3- Building and maintaining relationships
Week 4- Maintaining a sense of self
Week 5- Keeping connected to the community
Week 6- Keeping physically well
The facilitation of the group will take on an informal approach, and there will be time set aside for a greater number of social processes. The facilitators will document the number of sessions that every participant attends. There will also be an outlined summary of every session with an incorporation of the impressions of the involvement of participants in the meeting. Follow-up evaluations will take place at 2 and 4 months and will be used to evaluate the effectiveness of the program. The main outcome to be evaluated will be the self-efficacy of the older adults who suffer from dementia.
There will be important adaptations to the psychoeducation program to initiate a goodness-of-fit that considers the diversity factors of individuals, families, and/or caregivers who will participate in the group. One of the adaptations that will be utilized will be the application of visuals during different sessions. Visuals such as pictures, objects, and videos will be used to ensure that the participants have a better understanding of the content presented in the group. The instructional arrangement of each session will also be altered in accordance with the existing needs of the individuals and families that take part in the group. The participants will be provided with the opportunity to alter their physical or social environment based on choices such as where to sit and what they are willing to express.
References
Annunziata, M. A., Muzzatti, B., Bidoli, E., Flaiban, C., Bomben, F., Piccinin, M., Gipponi, K. M., Mariutti, G., Busato, S., & Mella, S. (2020). Hospital Anxiety and Depression Scale (HADS) accuracy in cancer patients. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer , 28 (8), 3921–3926. https://doi.org/10.1007/s00520-019-05244-8
Beishon, L. C., Batterham, A. P., Quinn, T. J., Nelson, C. P., Panerai, R. B., Robinson, T., & Haunton, V. J. (2019). Addenbrooke's Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment. The Cochrane Database of Systematic Reviews , 12 (12), CD013282. https://doi.org/10.1002/14651858.CD013282.pub2
Bentwich, M. E., Dickman, N., & Oberman, A. (2018). Autonomy and dignity of patients with dementia: Perceptions of multicultural caretakers. Nursing Ethics , 25 (1), 37-53. https://doi.org/10.1177/0969733016642625
De Almondes, K. M., Costa, M. V., Malloy-Diniz, L. F., & Diniz, B. S. (2016). Insomnia and risk of dementia in older adults: systematic review and meta-analysis. Journal of Psychiatric Research , 77 , 109-115. https://doi.org/10.1016/j.jpsychires.2016.02.021
Hepburn, K., Lewis, M., Tornatore, J., Sherman, C. W., & Bremer, K. L. (2007). The Savvy Caregiver Program: the demonstrated effectiveness of a transportable dementia caregiver psychoeducation program. Journal of Gerontological Nursing , 33 (3), 30-36. https://doi.org/10.3928/00989134-20070301-06
Quinn, C., Toms, G., Jones, C., Brand, A., Edwards, R. T., Sanders, F., & Clare, L. (2016). A pilot randomized controlled trial of a self-management group intervention for people with early-stage dementia (The SMART study). International Psychogeriatrics , 28 (5), 787-800. https://doi.org/10.1017/S1041610215002094
Valkanova, V., Ebmeier, K. P., & Allan, C. L. (2017). Depression is linked to dementia in older adults. The Practitioner , 261 (1800), 11-15.
