Journal of Applied Gerontology

Objectives: This article describes the translation and evaluation of STAR–Community Consultants program (STAR-C), an evidence-based dementia caregiver training program, within the Oregon Department of Human Services. Method: Staff from two regional Area Agencies on Aging (AAAs) were trained to implement all aspects of STAR-C, including screening, recruitment of caregiver/care-receiver dyads, and treatment delivery. Mailed assessments of caregiver depression, burden, and care-receiver mood, behavior, and quality of life were collected at pre-treatment, post-treatment, and 6-month follow-up. Results: One hundred fifty-one dyads entered the program; 96 completed the 8-week intervention. Significant positive post-treatment effects were obtained for caregiver depression, burden, and reactivity to behavior problems, and care-receiver depression and quality of life. At 6-month follow-up, improvements in caregiver reactivity and care-receiver depression were maintained. Caregivers reported high levels of satisfaction with the program. Discussion: STAR-C was successfully and effectively implemented by participating AAAs. Recommendations for replication, including training, recruitment, and assessment procedures are provided.

This study examines whether the delivery of three components, (a) exercise training, (b) behavior management skill building, and (c) dementia-related education, in an evidence-based program are differentially associated with changes in outcomes for individuals with dementia (IWDs) after 3 months. Data come from 508 IWDs participating in the community replication of the evidence-based “Reducing Disability in Alzheimer’s Disease” program. Regression results indicate that after 3 months, more exercise sessions are associated with improvements in physical functioning, mobility, minutes exercising, and symptoms of depression; more dementia education sessions are related to fewer restricted activity days; and more behavior management sessions are related to more symptoms of depression. As resource-strapped agencies look to best serve participants, further analysis and consideration is needed to determine the ideal balance of program efficacy, feasibility, and resources, as well as program benefits for IWDs and caregivers.

We used a randomized controlled trial to test the implementation of Strong for Life (SFL), a resistance exercise intervention, using 32 home care aides (HCAs) as exercise leaders with their 42 homebound older adult clients enrolled in the Community Care Program, a Medicaid 1915(c) waiver program. Mixed-methods were used to analyze outcomes of program satisfaction rates, training session evaluations, program fidelity, and job descriptive index scores. Results indicate that it is feasible for HCAs to implement SFL safely with clients. Participants viewed SFL as highly satisfactory and HCAs were able to adapt SFL for their clients. HCAs have high job satisfaction, and leading SFL enhances work achievement and pride. Our results show it is possible to train HCAs to implement SFL with their clients in addition to providing usual care services, participation positively affects both care partners, and this is a feasible and practical delivery model to provide exercise for adults receiving home- and community-based services.

This study describes engagement of veterans with dementia in an evidence-based care coordination intervention called Partners in Dementia Care (PDC). PDC uses a person-centered approach that encourages participation by individuals with dementia (IWDs), despite their cognitive impairment. PDC also targets primary family or friend caregivers, who often are the main user of the program. Of the total 316 IWDs, 202 passed a mental status screening and were considered to have engagement potential. The study of actual engagement was based on data from IWDs’ PDC records, combined with data from structured research interviews. Approximately 80% of IWDs with engagement potential had a minimum level of actual engagement in PDC. A smaller subsample was more actively engaged, as indicated by assigned and/or accomplished action steps. Younger IWDs and those self-reporting more memory difficulties had higher levels of engagement. Results describe one example of the extent and limits of IWD engagement in psychosocial interventions.

Background: Low-income, ethnically diverse, older adults may be at greater health risk owing to their lower activity levels and potential cultural barriers to physical activity (PA) programs. To explore the specific barriers and promoters to enrollment to a 16-week Tai Chi (TC) program, we interviewed 87 lower socioeconomic older adults from multiple ethnic backgrounds before the initiation of a TC program. Method: Semistructured qualitative focus group interviews were conducted with questions focused on themes of barriers and promoters to enrollment in a TC program that might or might not be culturally or gender related. Results: Important issues emerged that covered six categories. Categories included physical and mental health, time of day, socialization, program pairing, accessibility, and appropriate leadership/teacher. Conclusion: This information may have value for tailoring future PA programming in the community that could lead to improved health outcomes through better enrollment and increased participation in PA and exercise.

The number of older adults residing in assisted living facilities (ALF) and utilizing adult day care services is expanding with the increasing population of older adults. Currently, there are no standardized requirements for continuing education for assisted living and adult day care service staff at a national level. Given that 62% of states within the United States require continuing education for ALF staff and/or administrators, a more formalized system is needed that provides evidence-based gerontological training to enhance the quality of care and services provided to older adults. This article describes the challenges and lessons learned from conducting a program evaluation of a Statewide Training and Continuing Education Program for Assisted Living Facility and Adult Day Care Service staff in Virginia. Survey evaluation data from a 6-year period was examined and a formative program evaluation was conducted. The findings from the survey evaluation and formative evaluation are discussed as are the lessons learned.

The Hawaii Community Living Program was a participant-direction pilot project aimed at rural, multicultural, and community-dwelling older adults at risk of institutionalization. This evaluation examined participant outcomes, and explored the role of culture, health literacy, and rural settings in participant-direction programs. The program enrolled 91 participants and, of these enrollees, helped 84 (92.3%) participants avoid institutionalization and spend down to Medicaid. Findings indicated that Program Coaches needed to be culturally appropriate and creative in arranging for services and the delivery of goods and supplies. Results suggested that participants need to be health literate to direct their care, but further research is needed.