Satisfaction With a Family-Focused Intervention for Mild Cognitive Impairment Dyads.

As the population ages, the prevalence of mild cognitive impairment (MCI) is increasing. The symptoms of MCI overlap significantly with those of early Alzheimer disease (AD), and no disease-altering treatments for MCI or AD have been found. AD is the second most feared disease among American adults, and most Americans (62%) feel unprepared to care for a loved one diagnosed with AD (MetLife Foundation, 2011). Older adults with memory problems are at risk for physical functional decline, emotional distress, depressive symptoms, falls, and mortality (Panza et al., 2010; Wadley et al., 2009; Yaffe, Petersen, Lindquist, Kramer, & Miller, 2006). Difficulties with memory are often associated with depressive symptoms in persons with MCI (PwMCI) and cause problems with financial or emergency management, dyadic communication conflict, decline in functional performance, decreased engagement in meaningful activities, and loss of sense of control (B' arrios et al., 2013; McIlvane, Popa, Robinson, Houseweart, & Haley, 2008; Roland & Chappell, 2015). Engagement in meaningful activity is essential to the well-being of older adults with cognitive impairment in order to maintain a healthy active lifestyle. Meaningful activities range from small daily rituals to the pursuit of one's overall purpose in life (Roland & Chappell, 2015).Research findings regarding caregivers of PwMCI indicate they experience caregiving burden and negative effects on emotions, and they report needing services related to neurobehavioral symptom management (Paradise et al., 2015; Seeher, Low, Reppemund, & Brodaty, 2013). Caregiving for persons with MCI is challenging given the complexity of living with cognitive decline, the challenges of coping with noncurable cognitive impairment for long periods, and the fact that PwMCI have more awareness of their cognitive impairment and functional performance deficits than those with mild or late-stage dementia. Tailored educational interventions for caregivers designed to be delivered during that MCI window of opportunity before progressing to dementia are sorely needed (Roberts & Clare, 2013; Vogel et al., 2004). Such early prevention interventions may help PwMCI remain engaged or improve engagement in meaningful activities with support from their family caregivers. Additionally, caregivers may be better prepared for possible behavioral disturbances.The Daily Engagement of Meaningful Activity (DEMA) intervention, a family-focused tailored intervention, was based on gerontological theory (Lawton, 1990), the Model of Human Occupation (Kielhofner, 2002), components of problem-solcing therapy (Unutzer et al., 2002), findings from two phenomenology studies of PwMCI and their caregivers, and a three-phase DEMA intervention development study (Lu & Haase, 2009, 2011; Lu, Haase, & Farran, 2007; Lu, Haase, & Weaver, 2013). The purpose of this article is to describe satisfaction with and acceptability of the DEMA intervention for PwMCI and their family caregivers compared to an attention control group. The value of DEMA as an intervention is contingent on evidence of patient and caregiver perceptions of usefulness, ease of use, acceptability, and overall satisfaction prior to evaluating efficacy in a large study.Design and MethodsThe study design was a two-group randomized, controlled pilot of DEMA in a sample of PwMCI-caregiver dyads. Study aims were related to feasibility, acceptability, and effect size of the DEMA intervention compared to an information support (IS) group (Lu et al., 2016). In this article, we report quantitative and qualitative findings specifically related to our research questions: What are PwMCI and their caregivers' perceptions of satisfaction (usefulness, ease of use, acceptability) with the DEMA intervention compared to the IS attention control group? Institutional review board (IRB) approval was received and all participants provided written informed consent prior to enrollment. …