Depression and dementia commonly coexist and are associated with higher rates of behavioral and functional problems. Caregivers of these individuals report higher levels of physical and mental distress, as well. Effective treatment, therefore, has the potential to help both the older adult and their caregiver. This article provides an overview of the current literature on treatment of depression in demented older adults, with particular emphasis on providing guidelines for evidence‐based clinical care. Eleven randomized controlled clinical trials were identified following an extensive review of the literature. These studies are reviewed with particular attention to the methodological issues of most relevance to clinicians attempting to use the findings from these studies to guide their practice. Issues of particular relevance when working with this population are also addressed, including (a) for assessment—differential and coexistent diagnosis of depression in dementia, use of collateral informants, self‐report and interviewer‐obtained information; and b) for treatment—the need for caregiver involvement, individualizing of goals, and planning for future deterioration of cognitive function.

Objectives To investigate a protocol for identifying and evaluating treatment fidelity in STAR (Staff Training in Assisted-living Residences), a structured yet flexible program to train direct care staff to improve care of residents with dementia. Design Multi-site feasibility trial. Setting Assisted living facilities (ALFs). Participants 44 direct care staff and 36 leadership staff. Intervention STAR is a comprehensive, dementia-specific training program to teach direct care staff in ALFs to improve care and reduce affective and behavioral problems in residents with dementia. It is conducted on-site over two months via 2 half-day group workshops and 4 individualized sessions. Measures Treatment fidelity was assessed following the National Institute of Health Behavior Change Consortium model utilizing observations and self-report of trainers, direct care staff and leadership. Results Each key area of treatment fidelity was identified, measured, and yielded significant outcomes. For example, significant increases included: direct care staff identifying ABCs (an essential component of training); understanding basics of dementia care; and applying STAR techniques. Conclusions Results support that STAR is ready to be translated and disseminated into practice. Because ALFs will continue to provide care for individuals with dementia, the need for effective, practical, and sustainable staff training programs is clear. STAR offers one such option. Hopefully, this report will encourage others to conduct comprehensive evaluations of the treatment fidelity of their programs and thereby increase the availability of such programs to enhance care.

This article presents issues that affected the implementation and response to STAR (Staff Training in Assisted-living Residences), an on-site training program specifically designed to improve care of persons with dementia in assisted living residences. We discuss how unlicensed assistive personnel responded to this program and how we addressed staff concerns and the challenges that arose during training.

Background Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum—from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings. Objective This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR). Methods A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist. Results Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C. Conclusions We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR.

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