Modifying a Telephone Based Care Program to Assess for Self-Neglect

Study Overview
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Brief Summary
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The purpose of this study is to assess the feasibility of enrollment, attrition, and adherence of Benjamin Rose Institute Care Consultation (BRI-CC) on unmet needs in low-income older adults who screen positive for dementia and their caregiver (CG).

Official Title
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Modifying a Telephone Based Care Program to Assess for Self-Neglect

Conditions
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Self Neglect

Intervention / Treatment
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* Behavioral: Benjamin Rose Institute Care Consultation (BRI-CC)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: able to provide consent and understand English since most of the measures have not been translated into other languages has a CG willing to participate, specifically the CG must provide assistance in personal care, daily living tasks, and/or healthrelated decisions at least 3 hours per day and at least 3 days per week screen positive for dementia. Exclusion Criteria: participant who receives home-delivered meals plans to relocate to long-term care prior to study enrollment reportedly moving out of the catchment area during the proposed study period non-English speaking unable to provide informed consent pre-diagnosed terminal illness non-working telephone visual impairment inhibiting the dyad from reading the instruments

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Benjamin Rose Institute Care Consultation (BRI-CC)<br> | Behavioral: Benjamin Rose Institute Care Consultation (BRI-CC)<br>* The BRI-CC is a telephone-based intervention designed for adults with chronic conditions and has been used in persons with dementia and their caregiver (CG). This assessment is guided by the use of assessment tools with domains that trigger specific and pertinent needs of the dyad such as relationship strain, depression, financial concerns, memory problems, and difficult behaviors. To address unmet needs, the care consultant and dyad develop action plans with specific action steps pertinent to the dyad. The intervention involves maintenance and support where the care consultant (CC) continues the relationship with the dyad through regular telephone contact, email and mail. CC use a web-based reporting system, to maintain and track dyad information, assessments, action plans, completed tasks, and ongoing contacts. At a minimum, the care consultant will contact the dyad by telephone once per month over the duration of the study period (i.e. 6 months).<br>|
| No Intervention: No intervention<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility as assessed by enrollment rate | enrollment rate = # enrolled / # who met inclusion criteria | 6 months | 
| Feasibility as assessed by attrition rate | attrition rate = # not completing the study / # enrolled at baseline | 6 months | 
| Feasibility as assessed by adherence rate | adherence rate = # completing all BRI-CC sessions / # enrolled in intervention group | 6 months | 
| Feasibility as assessed by why subjects were not able to participate in BRI-CC |  | 6 months | 
| Feasibility as assessed by why subjects dropped out of BRI-CC |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unmet needs of participants who receive home-delivered meals as assessed by domains of the Unmet Needs Instrument | Responses will be entered onto a 10-item dichotomous response (need met or unmet) instrument that will be summed across six assessment domains: 1) understanding dementia, 2) accessing healthcare services, 3) accessing community services 4) accessing family services, 5) legal and financial issues, and 6) emotional support. | baseline | 
| Unmet needs of of participants who receive home-delivered meals as assessed by domains of the Unmet Needs Instrument | Responses will be entered onto a 10-item dichotomous response (need met or unmet) instrument that will be summed across six assessment domains: 1) understanding dementia, 2) accessing healthcare services, 3) accessing community services 4) accessing family services, 5) legal and financial issues, and 6) emotional support. | 3 months | 
| Unmet needs of participants who receive home-delivered meals as assessed by domains of the Unmet Needs Instrument | Responses will be entered onto a 10-item dichotomous response (need met or unmet) instrument that will be summed across six assessment domains: 1) understanding dementia, 2) accessing healthcare services, 3) accessing community services 4) accessing family services, 5) legal and financial issues, and 6) emotional support. | 6 months | 
| Self Neglect as assessed by the Elder Self-Neglect Instrument (of participants who receive home-delivered meals) | The Elder Self-Neglect Assessment (ESNA) is a 25-item rating scale to assess for SN. Each item is a 5-point Likert scale to assess the participant and the participant's home. Scores are tallied with the following suggested interpretations: (1) if high scores for social behavioral SN (B) but not environmental SN (E), then there is high risk for SN, (2) if high scores are for both B & E, then severe unintentional SN, and (3) if high E but not B, then intentional SN. An item example asks, Does the older adult wear dirty clothes? | baseline | 
| Self Neglect as assessed by the Elder Self-Neglect Instrument (of participants who receive home-delivered meals) | The Elder Self-Neglect Assessment (ESNA) is a 25-item rating scale to assess for SN. Each item is a 5-point Likert scale to assess the participant and the participant's home. Scores are tallied with the following suggested interpretations: (1) if high scores for social behavioral SN (B) but not environmental SN (E), then there is high risk for SN, (2) if high scores are for both B & E, then severe unintentional SN, and (3) if high E but not B, then intentional SN. An item example asks, Does the older adult wear dirty clothes? | 6 months | 
| Number of participants who receive home-delivered meals who were admitted to the hospital |  | 6 months | 
| Number of participants who receive home-delivered meals who were readmitted to the hospital |  | 6 months | 
| Number participants who receive home-delivered meals who were relocated for long term care |  | 6 months | 
| Psychosocial well-being of the caregiver (CG) as assessed by the Zarit Burden Interview | The Zarit Burden Interview is a 22-item self-rated screen to assess CG burden. This measure uses a 5-point Likert scale to assess direct stress of the CG, specifically caregivers of persons with dementia. It has been shown to be sensitive to change. | baseline | 
| Psychosocial well-being of the informal caregiver as assessed by the Zarit Burden Interview | The Zarit Burden Interview is a 22-item self-rated screen to assess CG burden. This measure uses a 5-point Likert scale to assess direct stress of the CG, specifically caregivers of persons with dementia. It has been shown to be sensitive to change. | 6 months | 
| Caregiver depression as assessed by the Geriatric Depression Scale- Short Form | The Geriatric Depression Scale (Short-Form) (GDS-SF) is a 15-item yes and no self-rated screen to assess depression. Scores range from 0-15 with scores of 5 and greater are indicative of depression | baseline | 
| Caregiver depression as assessed by the Geriatric Depression Scale- Short Form | The Geriatric Depression Scale (Short-Form) (GDS-SF) is a 15-item yes and no self-rated screen to assess depression. Scores range from 0-15 with scores of 5 and greater are indicative of depression | 6 months | 
| Caregiver unmet needs as assessed by domains of the Unmet Needs Instrument | Responses will be entered onto a 10-item dichotomous response (need met or unmet) instrument that will be summed across six assessment domains: 1) understanding dementia, 2) accessing healthcare services, 3) accessing community services 4) accessing family services, 5) legal and financial issues, and 6) emotional support. | baseline | 
| Caregiver unmet needs as assessed by domains of the Unmet Needs Instrument | Responses will be entered onto a 10-item dichotomous response (need met or unmet) instrument that will be summed across six assessment domains: 1) understanding dementia, 2) accessing healthcare services, 3) accessing community services 4) accessing family services, 5) legal and financial issues, and 6) emotional support. | 6 months | 
| Emotional significance of pets to participants who receive home-delivered meals as assessed by the Monash Dog Owner Relationship Scale (MDORS) |  | baseline | 
| Unmet Pet Care needs of participants who receive home-delivered meals as assessed by the Unmet Pet Care Needs (UPCN) scale | The UPCN scale was developed by the researchers which taps a respondent's need for information or help surrounding pet-related issues. It is based on the Benjamin Rose Institute Unmet Needs Scale (see references). Response categories are dichotomous (0=No and 1=Yes). The total score is the sum of the items noted for each measure. Higher scores indicate greater unmet need for information or help. The individual scales may be summed to create a score for total unmet need. | baseline | 
| Barriers to pet caretaking as assessed by structured interviews over the telephone with participants who receive home-delivered meals |  | baseline | 
| Potential resources and services to support unmet pet caretaking needs as assessed by structured interviews over the telephone with participants who receive home-delivered meals |  | baseline |