The Aging Brain ANSWERS Program
Abstract
Our nation’s Veterans represent a population at elevated risk for dementia and cognitive decline. Both Alzheimer’s disease (AD) and traumatic brain injury (TBI) pose a tremendous public health burden in the U.S. and to the Veterans Health Administration (VHA). The number of Americans aged 65 years or older with AD is expected to grow to more than 13 million by 2050. Currently, 563,786 Veterans have a diagnosis of AD, similar to the overall population, and this number is expected to increase dramatically in the coming decades. Since 2000, 352,619 Veterans have been diagnosed with TBI. There is growing evidence that TBIs sustained early in life might trigger a cascade of neurodegenerative processes that may later develop into AD or other motor neuron diseases many years or decades later. Once symptoms emerge, patients with AD share many similarities with TBI patients in that they both experience reduced quality of life (QoL) as a result of their disease. In addition, both AD and TBI patients receive the majority of their care in primary care settings and require similar symptom management strategies, care from many types of care providers, and support from family caregivers. Family caregivers of individuals with AD and TBI are critical to the QoL of the care recipients. However, caregivers also experience high rates of depression and burden as well as social isolation, financial hardship, and poor physical health. Although the effectiveness of interventions for AD and TBI patients and family caregivers has been well-studied and hold promise to enhance patient QoL and reduce caregiver burden, very few studies have made these evidence-based interventions scalable and embedded into the existing Department of Veterans Affairs (VA) healthcare system. The proposed intervention, the Aging Brain Care ANSWERS Program (ABC ANSWERS), has elements that have been developed for and tested in AD and TBI patients. We are specifically interested in understanding if the combination these elements, which include collaborative care, cognitive rehabilitation, and strength-based coping interventions for caregivers, can improve the QoL of Veterans and their caregivers and reduce caregiver burden. Most AD or TBI interventions have focused on either the patient or caregiver individually. However, given that AD and TBI seriously impact both the patient and caregiver, our project will simultaneously deliver intervention components to both and provide an opportunity to discuss difficult topics in a supportive environment, which reinforces the skills for managing and coping with disease symptoms in a more consistent manner. The intervention is delivered at the patient’s home or via phone and may be more cost-effective. The impact of the proposed intervention, ABC ANSWERS, on patient and caregiver QoL and caregiver burden will be explored by testing the following primary hypothesis: Veterans with AD or TBI and their caregivers who receive the ABC ANSWERS program will have improved QoL and decreased burden at 1 year compared with the best practice VA primary care. There are two overall project objectives: (1) to measure and compare the real-world effectiveness of the ABC ANSWERS intervention on QoL and caregiver burden and (2) to establish the optimal implementation strategies to make the protocol scalable for wide-spread dissemination through Primary Care PACT (Patient Aligned Care Team) at VA Medical Centers (VAMCs). These objectives will be realized by measuring the impact of ABC ANSWERS on Veterans’ QoL, depressive symptoms, and anxiety. Additionally, we will test the impact of ABC ANSWERS on Veterans’ family caregivers QoL, caregiver burden, depressive symptoms, anxiety, and relationship strain. ABC ANSWERS will be tested in a 1-year randomized controlled trial that includes 200 dyads. The dyads will include a Veteran with AD and/or TBI who receives their primary care from a PACT associated with the Richard L. Roudebush VAMC in
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710574
Entities
People
- Nicole R. Fowler
Organizations
- Indiana University – Purdue University Indianapolis
- United States Army