title: Impact of caregiver readiness on outcomes of a nonpharmacological intervention to address behavioral symptoms in persons with dementia.
abstract: Previous research shows that nonpharmacological strategies may effectively manage behavioral symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. We examine the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.
  
  
  
  Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioral symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviors) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.
  
  
  
  By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviors (β = -.180, p = .041) and higher confidence (β = .27, p = .009). Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.
  
  
  
  By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioral symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioral management but not other caregiver outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Community Public Health, School of Nursing, Joint appointments, Department of Psychiatry, and Division of Geriatrics and Gerontology, School of Medicine, Director, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.affiliation: Department of Psychology, Widener University, Chester, PA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Rose
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001526:Behavioral Symptoms; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000451:nursing / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000628:therapy; D012044:Regression Analysis; D016896:Treatment Outcome; D055816:Wandering Behavior
keywords: behavior change; caregiving; dementia; nonpharmacologic interventions
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