Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as with diabetes found improvements in self-management behaviors and glucose control after participating in a CHW-led intervention. Using data from the REACH Detroit Partnership’s cohort 3, this study used descriptive statistics and multiple linear regression analyses to evaluate whether the six-month CHW intervention had a greater effect on older Latino/as (ages 55 and older) than younger participants between baseline and post-intervention follow-up at six months. There were significant intervention effects by age group that varied by outcome. Compared to a control group that received enhanced usual care, there were statistically significant intervention effects demonstrating greater self-efficacy scores 1.27 (0.23, 2.32); p < 0.05, and reductions in HbA1c 1.02 (−1.96,−0.07); p < 0.05, among older participants in the CHW intervention, and increases in diabetes support 0.74 (0.34, 1.13); p < 0.001; and understanding of diabetes management 0.39 (0.08, 0.70); p < 0.01 among younger participants.
The REACH II intervention is the gold-standard in dementia caregiver interventions. The FL-REACH translation is a novel adaptation offered in both English and Spanish to an outpatient memory disorder clinic at an urban, Southeastern healthcare system. This pre-post feasibility trial involves 6 sessions (4 in person at the clinic and 2 by phone) with the identified caregiver and any other family who wish to attend, which may also include the person living with dementia. The program is focused on early stage post-diagnosis, and is structured around building rapport, empowering families to build support networks, and teaching skills and knowledge-based material. Twenty four of the 60-participant target sample have consented to participate in this ongoing study. Change on the Preparedness for Caregiving Scale is significant (t=3.03, p=.001, Cohen’s d=2.49). Means for the Zarit Burden 12-item scale went from 24.5 to 13.17 (t=-6.65, p=.03, Cohen’s d=3.53). Access by care recipients to dangerous objects decreased (67% to 14%). Confidence in ability to use behavioral strategies in caregiving increased from 8% at baseline to 72% at study completion. Satisfaction surveys indicate high satisfaction with all elements of the intervention. These outcomes are consistent with existing data regarding utility of the REACH framework and reflect feasibility of delivering an adapted program model in an outpatient clinic environment. A future randomized controlled trial should examine whether early intervention and training reduces utilization of emergency care over time and improves quality of life for families.
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