Background and Objectives 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. Research Design and Methods 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% (n = 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 (n = 53) 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. Results 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. Discussion and Implications 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.
Addressing increasing rates of Alzheimer’s disease and related dementias (ADRD) requires public health approaches including prevention, early detection and diagnosis, and outreach to low-income and minority communities facing higher risk and adverse health and economic outcomes. Communities are seeking ways to enhance cross-sector collaboration and overcome underdeveloped relationships and fragmentation that are barriers to effective public health responses. In this exploratory study, we evaluated outcomes of a community-wide effort to mobilize systems-level changes, build public awareness, and increase access to early detection services. A community-based organization, public health department, and academic institution in North Texas partnered to expand ADRD education programs and outreach for underserved communities. Nineteen community health workers were trained to provide brain health and ADRD education programs and refer to financial, legal, and social resources. Through collective action, 371 participants attended 26 education sessions delivered in English and Spanish. Forty-five percent of participants identified as non-white and 61% reported low educational attainment. Participants (n=314) completed post-surveys. As a result of training, 89% of trainees could recognize common warning signs of Alzheimer’s disease, 86% understood the importance of early detection and diagnosis, and 96% knew activities promoting cognitive health. Findings revealed strategies to increase collective action such as sharing data, establishing referral methods, and adopting dementia-friendly and age-friendly frameworks. Results show that collective action has the potential to build a community’s capacity for targeted ADRD education and improve access to early detection and brain health education for at-risk populations.
Of the 254 counties in Texas, 69% are rural, and three out of every four counties are designated as whole or partial Primary Care Health Professional Shortage Areas. Rural counties in Texas have a higher proportion of older adults compared to metropolitan counties, and rural older adults with Alzheimer’s Disease and their caregivers face unique challenges of limited access to healthcare and lower earnings, resulting in more health-related problems. As part of a HRSA Geriatrics Workforce Enhancement Program, an academic medical center, two Area Agencies on Aging in North Texas, and an Alzheimer’s Association Chapter partnered to expand access to evidence-based programs into surrounding rural counties for older adults and caregivers of persons with Alzheimer’s Disease. An interdisciplinary workgroup developed focus group questionnaires for older adults, caregivers, and health care providers in rural areas to identify perceived needs, barriers to accessing services, and strategic partnerships. The North Central Texas Council of Governments conducted 11 focus groups in late 2018 and early 2019. Of these, seven consisted of family members caring for persons with memory loss. Four consisted of professionals who treat persons with memory loss. Transcription and thematic analysis identified key themes of training needs (both providers’ and laypersons’), resource needs, providers’ best practices, barriers to quality care, and other support needs. Practice implications of the findings include cross-sector partners and integrating telehealth platforms for program delivery. Collaboration between academic and community partners can expand access to evidence-based programs for rural and other underserved communities and address areas of need.
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