Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners

Marie Boltz; Jacqueline Mogle; Ashley Kuzmik; Rhonda BeLue; Douglas Leslie; James E Galvin; Barbara Resnick

doi:10.1093/geroni/igad083

Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners

Innov Aging. 2023 Aug 16;7(7):igad083. doi: 10.1093/geroni/igad083. eCollection 2023.

Authors

Marie Boltz¹, Jacqueline Mogle², Ashley Kuzmik¹, Rhonda BeLue³, Douglas Leslie⁴, James E Galvin⁵, Barbara Resnick⁶

Affiliations

¹ Ross and Carol Nese College of Nursing, The Pennsylvania State University, State College, Pennsylvania, USA.
² College of Behavioral, Social, and Health Sciences, Clemson University, Clemson, South Carolina, USA.
³ College for Health, Community, and Policy, The University of Texas at San Antonio, San Antonio, Texas, USA.
⁴ Center for Applied Studies in Health Economics, The Penn State College of Medicine, State College, Pennsylvania, USA.
⁵ Miller School of Medicine, Comprehensive Center for Brain Health, University of Miami, Boca Raton, Florida, USA.
⁶ School of Nursing, University of Maryland, Baltimore, Maryland, USA.

Abstract

Background and objectives: Hospitalized persons living with dementia are at risk for functional decline, behavioral symptoms of distress, and delirium, all persisting in the postacute period. In turn, family care partners (FCPs) experience increased anxiety and lack of preparedness for caregiving, compounding existing strain and burden. Family-centered Function-focused Care (Fam-FFC) purposefully engages FCPs in assessment, decision-making, care delivery, and evaluation of function-focused care during and after hospitalization (within 48 hours of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months). The objective of this study was to test the efficacy of Fam-FFC.

Research design and methods: A cluster randomized controlled trial included 455 dyads of persons living with dementia and FCPs in 6 medical units in 3 hospitals. Patient outcomes included return to baseline physical function, behavioral symptoms of distress, depressive symptoms, and delirium severity. Family care partner measures included preparedness for caregiving, anxiety, strain, and burden.

Results: Multilevel level modeling demonstrated that the likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.4, p = .01, 95% CI 1.2-4.7). Family-centered Function-focused Care was also associated with fewer symptoms of distress (b = -1.1, SE = 0.56, p = .05) but no differences in the amount of moderate physical activity, depressive symptoms, and delirium severity. Preparedness for caregiving increased significantly only from 2 to 6 months (b = 0.89, SE = 0.45, d = 0.21, overall p = .02) in the intervention group, with no group differences in anxiety, strain, and burden.

Discussion and implications: Family-centered Function-focused Care may help prevent some of the postacute functional decline and behavioral symptoms in hospitalized persons living with dementia. Further research is needed to promote sustained improvements in these symptoms with more attention to the postacute needs of the care partner.

Keywords: ADRD; Acute care; Dyads; Family engagement; Functional recovery; Transitional care.