Cho Jinmyoung, Luk-Jones Susanna, Smith Donald R, Stevens Alan B
Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas.
Center for Population Health & Aging, Texas A&M University Health Science Center, College Station.
Innov Aging. 2019 Aug 23;3(3):igz022. doi: 10.1093/geroni/igz022. eCollection 2019 Jul.
Family caregiving interventions have been proven efficacious at reducing dementia caregiver's stress and burden, yet translation of evidence-based interventions into community-based support service programs requires modification to the original intervention protocol. In collaboration with community partners, the REACH-TX program was developed based on the REACH II (Resources for Enhancing Alzheimer's Caregiver Health) intervention. REACH-TX maintains the integrity of the multicomponent skill-based REACH II intervention but requires significantly fewer therapeutic contacts between the family caregiver and the dementia care specialist. This study presents an evaluation of REACH-TX implemented by the Alzheimer's Association North Central Texas Chapter.
REACH-TX was provided to 1,522 caregivers between November 2011 and December 2017. The number of therapeutic contacts scheduled for caregivers was determined by the Risk Appraisal Measure (RAM) and ranged from 1 to 23. The rate of follow-up data on outcome measures collected was 59.0% ( = 898). All five domains of the REACH II quality-of-life measure (burden, depression, social support, self-care, and problem behaviors) were assessed at baseline and at 6 months. Caregivers (3) participating in the program more than once allowed us to investigate the long-term impact of the first exposure to REACH-TX and the value of repeating the program. Generalized linear models were used to assess changes in quality of life after adjusting for covariates.
Caregivers who completed the program showed significant improvements from baseline to 6 months on all five domains of quality of life, as evidenced by the follow-up data. Furthermore, caregivers who enrolled a second time in REACH-TX showed significant improvement in burden and social support scores.
This evaluation of REACH-TX suggests that REACH II evidence-based intervention can be translated into a valuable and sustainable community-based service for family caregivers. Additional translational research is needed to overcome the challenges of conducting standardized outcome assessments of caregiving services.
家庭照护干预已被证明在减轻痴呆症照护者的压力和负担方面有效，但将基于证据的干预措施转化为社区支持服务项目需要对原始干预方案进行调整。与社区合作伙伴合作，基于REACH II（增强阿尔茨海默病照护者健康资源）干预措施开发了REACH-TX项目。REACH-TX保持了基于多成分技能的REACH II干预措施的完整性，但家庭照护者与痴呆症护理专家之间所需的治疗性接触显著减少。本研究对由德克萨斯州中北部阿尔茨海默病协会分会实施的REACH-TX进行了评估。
2011年11月至2017年12月期间，为1522名照护者提供了REACH-TX。照护者的治疗性接触次数由风险评估量表（RAM）确定，范围为1至23次。收集的结局指标随访数据率为59.0%（n = 898）。在基线和6个月时评估了REACH II生活质量量表的所有五个领域（负担、抑郁、社会支持、自我护理和问题行为）。参与该项目不止一次的照护者（n = 3）使我们能够研究首次接触REACH-TX的长期影响以及重复该项目的价值。使用广义线性模型在调整协变量后评估生活质量的变化。
随访数据表明，完成该项目的照护者在生活质量的所有五个领域从基线到6个月都有显著改善。此外，第二次参加REACH-TX的照护者在负担和社会支持得分方面有显著改善。
对REACH-TX的这项评估表明，基于REACH II证据的干预措施可以转化为一项对家庭照护者有价值且可持续的社区服务。需要进行更多的转化研究，以克服对照护服务进行标准化结局评估的挑战。
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