Biomedical subjects

Sara J Czaja

Publications and source records attributed to Sara J Czaja.

At least 19 recordsLinked to original sources

PubMed2006

Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial.

BACKGROUND: Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to support family caregivers is a major public health challenge. OBJECTIVE: To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups. DESIGN: Randomized, controlled trial. SETTING: In-home caregivers in 5 U.S. cities. PARTICIPANTS: 212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders. INTERVENTION: Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief "check-in" telephone calls during the 6-month intervention. MEASUREMENTS: The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months. RESULTS: Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months. LIMITATIONS: The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups. CONCLUSIONS: A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers. ClinicalTrials.gov identifier: NCT00177489.

Aged↗

PubMed2006

Factors predicting the use of technology: findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE).

The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption.

Adult↗

PubMed2006

The value of telephone support groups among ethnically diverse caregivers of persons with dementia.

PURPOSE: Dementia caregiving is a rapidly growing public health problem. Logistical problems prevent many caregivers from utilizing available interventions. This article provides a demonstration of the usefulness of technology for conducting telephone-based support groups in ethnically diverse dementia caregivers. DESIGN AND METHODS: Participants were 41 White American and Cuban American dementia caregivers participating at the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health (known as REACH) program. Support groups were conducted over the telephone in English and Spanish as appropriate. RESULTS: Eighty-one percent of the participants found the group "valuable," largely because of the social and emotional support and useful information obtained from other group members. The majority of caregivers also reported that their participation had increased their knowledge and skills as caregivers. IMPLICATIONS: The findings demonstrate that telecommunications technology can overcome the often formidable logistical problems faced by both English- and Spanish-speaking caregivers, and it can provide benefits similar to those obtained in face-to-face support groups.

Aged↗

PubMed2006

The role of family functioning in the stress process of dementia caregivers: a structural family framework.

PURPOSE: The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors. DESIGN AND METHODS: One hundred eighty-one family caregivers from the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health project participated in this study. We assessed sociodemographics, burden, depression, anxiety, and perceived health for each caregiver. We measured family functioning by using a multidimensional and observational instrument. We used structural equation modeling to assess the fit of the model for the overall sample and for different caregiver subgroups and to examine whether demographic variables affected the relationships in the model. RESULTS: The results of the study indicated that family functioning significantly contributed to distress in the overall sample and partially mediated the relationship between objective burden and distress. We also found that the stress-process model was adequately fit by the hypothesized relationships between objective burden, family functioning, and distress for the overall sample and all of the subsamples, except for wives. IMPLICATIONS: This study provides support for the structural family approach as an explanatory model for the influence of family functioning on dementia caregivers. Family structural functioning is one contributor to the caregiver stress process. This suggests that interventions targeting structural family problems may reduce caregiver distress.

Aged↗

PubMed2006

Data and safety monitoring in social behavioral intervention trials: the REACH II experience.

BACKGROUND: Psychosocial and behavioral interventions trials targeting a broad range of complex social and behavioral problems such as smoking, obesity and family caregiving have proliferated in the past 30 years. At the same time the use of Data and Safety Monitoring Boards (DSMBs) to monitor the progress and quality of intervention trials and the safety of study participants has increased substantially. Most of the existing literature and guidelines for safety monitoring and reporting of adverse events focuses on medical interventions. Consequently, there is little guidance for investigators conducting social and behavior trials. PURPOSE: This paper summarizes how issues associated with safety monitoring and adverse event reporting were handled in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) program, a multi-site randomized clinical trial, funded by the National Institutes on Aging (NIA) and the National Institutes of Nursing Research (NINR), that tested the efficacy of a multicomponent social/behavioral intervention for caregivers of persons with Alzheimer's disease. METHODS: A task force was formed to define adverse events for the trial and protocols for reporting and resolving events that occurred. The task force conducted a review of existing polices and protocols for data and safety monitoring and adverse event reporting and identified potential risks particular to the study population. An informal survey regarding data and safety monitoring procedures with investigators on psychosocial intervention trials was also conducted. RESULTS: Two categories of events were defined for both caregivers and patients; adverse events and safety alerts. A distinction was also made between events detected at baseline assessment and those detected post-randomization. Standardized protocols were also developed for the reporting and resolution of events that occurred and training of study personnel. Results from the informal survey indicated wide variability in practices for data safety and monitoring across psychosocial intervention trials. CONCLUSIONS: Overall, the REACH II experience demonstrates that existing guidelines regarding safety monitoring and adverse event reporting pose unique challenges for social/behavioral intervention trials. Challenges encountered in the REACH II program included defining and classifying adverse events, defining "resolution" of adverse events and attributing causes for events that occurred. These challenges are highlighted and recommendations for addressing them in future studies are discussed.

Alzheimer Disease↗

PubMed2005

Adapting the structural family systems rating to assess the patterns of interaction in families of dementia caregivers.

PURPOSE: This study adapted the Structural Family Systems Ratings (SFSR), an observational measure of family interactions, for dementia caregivers. This article presents the development of the SFSR-Dementia Caregiver adaptation (SFSR-DC) and examines relationships between specific family-interaction patterns and caregiver distress. DESIGN AND METHODS: The families of 177 Cuban American and White non-Hispanic American caregivers of dementia patients were assessed at baseline, 6, 12, and 18 months. Structural family theory and clinical experience were used to identify family interaction patterns believed to be related to caregiver emotional functioning. Factor analysis was used to refine subscales and develop a multiscale measure. RESULTS: Six reliable subscales were related to caregiver distress and included in the SFSR-DC. There were two second-order factors. The SFSR-DC was provisionally cross-validated and showed invariance across the two ethnic groups. IMPLICATIONS: The SFSR-DC provides a method for examining specific and multiple interaction patterns in caregiver families and thus can advance knowledge regarding the role of the family in the stress processes of caregiving. These findings support the relevance of family interactions in caregiver distress and suggest that a treatment approach aimed at supporting family closeness and conflict resolution and reducing negativity might enhance caregiver well-being.

Aged↗

PubMed2004

Long-term care placement of dementia patients and caregiver health and well-being.

CONTEXT: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. OBJECTIVE: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. DESIGN, SETTING, AND PARTICIPANTS: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. MAIN OUTCOME MEASURES: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. RESULTS: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P =.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P =.21). These effects were most pronounced among caregivers who were married to the patient (P =.02 for depression), visited more frequently (P =.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P =.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P =.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P =.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative. CONCLUSIONS: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.

Aged↗

PubMed2004

A cost-benefit analysis methodology for assessing product adoption by older user populations.

A methodology for assessing perceptions of a product through cost-benefit analysis is demonstrated in an experimental study involving use of one of two products for supporting interaction with telephone voice menu systems. The method emphasizes ratings of constructs related to costs and benefits considered relevant to decisions regarding product adoption, and the use of the analytic hierarchy process technique to derive subjective importance weights associated with those constructs. Twenty-five younger subjects (18-39 years of age) and 27 older subjects (60-82 years of age) interacted with simulated telephone voice menu systems supported by either a screen phone or a graphical device. Although analysis of the benefit-cost ratios revealed that benefits were perceived as more important than costs, the analysis of the constituent item ratings and importance weights provided potentially more useful information for predicting product adoption.

Adolescent↗

PubMed2004

An evaluation of performance by older persons on a simulated telecommuting task.

Telecommuting work represents a strategy for managing the growing number of older people in the workforce. This study involved a simulated customer service telecommuting task that used e-mail to answer customer queries about media-related products and company policies. Participants included 27 "younger" older adults (50-65 years) and 25 "older" older adults (66-80 years). The participants performed the task for two 2-hr sessions a day over 4 consecutive days. Although both age groups showed significant improvement across sessions on many of the performance criteria, in general the improvements were more marked for the older age-group participants. However, the participants from both age groups had difficulty meeting some of the task performance requirements. These results are discussed in terms of training strategies for older workers.

Aged↗

PubMed2003

Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH).

This article provides background information and an overview on Resources for Enhancing Alzheimer's Caregiver Health (REACH) a multisite intervention trial for caregivers of persons with Alzheimer's disease designed to reduce caregiver burden and depression. REACH is the largest randomized controlled clinical trial to date, involving 1,222 caregiver and care recipient dyads recruited from 6 different sites in the United States. The authors describe the design of the study, summarize the interventions implemented at each site, and provide an overview of the 4 articles in this special section.

Aged↗

PubMed2003

Effect of multicomponent interventions on caregiver burden and depression: the REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p = .022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p = .034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored.

Aged↗

PubMed2003

A methodology for describing and decomposing complex psychosocial and behavioral interventions.

This article presents a comprehensive conceptual framework and methodology for characterizing multidimensional psychosocial and behavioral interventions for family caregivers of people with Alzheimer's disease. The methodology involved conducting a detailed task analysis of the interventions, and the application of the analytical hierarchy process. The authors were able to achieve high levels of consistency and reliability using this methodology to decompose and describe the interventions according to a complex conceptual framework comprising 3 dimensions: target domain, functional domain, and delivery system characteristics. Application of this methodology will enhance the ability to describe and measure interventions consistently, make comparisons across studies, isolate causal factors that achieve desired outcomes, and more generally elevate the science of psychosocial intervention research.

Aged↗

PubMed2003

Using a new taxonomy to combine the uncombinable: integrating results across diverse interventions.

Researchers have examined numerous psychosocial and behavioral interventions intended to alleviate distress among family caregivers of persons with dementia. Many of these interventions are complex, combining numerous treatment components. Although some multicomponent interventions have been successful in reducing caregiver distress, the impact of specific elements of these interventions on outcomes is not known. The article presents results of an analytic approach that allows researchers to describe the individual elements of multicomponent interventions and to examine the relationships between those components and outcomes. This approach is successfully applied to interventions being evaluated in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program. The results indicate that actively targeting caregiver behavior is effective in achieving positive outcomes with respect to caregiver depression.

Aged↗

PubMed2003

The effect of a family therapy and technology-based intervention on caregiver depression.

PURPOSE: The majority of persons with Alzheimer's disease (AD) are cared for at home by a family member such as a spouse or daughter. Caregiving places enormous demands on these caregivers, and the negative consequences associated with caregiving are well documented. This paper reports results from the Miami site of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms (according to the Center for Epidemiological Studies Depression scale) among family caregivers of AD patients at 6 months and 18 months follow-up. DESIGN AND METHODS: There were 225 White American and Cuban American caregivers that were randomized into a structural ecosystems therapy, structural ecosystems therapy + computer-telephone integrated system, or minimal support control condition. RESULTS: Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months. The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husband and daughter caregivers. IMPLICATIONS: The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers. The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship.

Aged↗

PubMed2003

Practically relevant research: capturing real world tasks, environments, and outcomes.

PURPOSE: Development of strategies to optimize the functional performance of older adults requires understanding the behavior of older people doing tasks in real-world settings and capturing these interactions in research protocols. This is a major challenge as there is some degree of tension between capturing the contextual variables and constraints that operate in the real world and the scale of research that can be realistically conducted within controlled experimental settings. This article presents a research approach that can be used to help ensure the ecological validity of research protocols. The intent is to demonstrate how an ecologically valid approach affords greater insight into the performance of older adults in real world settings. METHODS: The approach involves techniques such as task analysis and simulation. Examples from two research projects examining aging and the performance of real-world computer-based work tasks are used to demonstrate the application of this approach. RESULTS: The article demonstrates how an ecologically valid research approach yields information about human performance that can be translated into solutions for real-world problems. IMPLICATIONS: Ecologically valid research protocols offer the potential for providing answers to real-world problems and advancing theory regarding aging and functional performance.

Activities of Daily Living↗

PubMed2003

Effects of age, speech rate, and environmental support in using telephone voice menu systems.

Age differences in the use of telephone menu systems were investigated in two experiments. Participants from three age groups (younger: 18-39; middle-aged: 40-59; older: 60+ years) were required to obtain specified information or perform some action using simulated voice menu systems. Measures reflecting task performance, menu navigation, and subjective responses were collected. The focus in Experiment 1 was on examining the effect of speech rate. Data from 196 participants indicated age differences in performance, especially for complex problems. There was no effect of speech rate on any of the performance measures. Experiment 2 examined two types of support devices: a screen phone and a graphical aid. Data from 114 participants indicated that the screen phone provided some benefits in navigational efficiency. In terms of performance, the older participants benefited more from the graphical aid and the younger participants performed better with the screen phone. Actual or potential applications of this research include guidance in the use of support devices that can reduce memory demands and the identification of appropriate speech rates.

Adolescent↗

PubMed2003

Healthcare website design for the elderly: improving usability.

Research shows that the elderly often use the Internet to search for healthcare information. Other studies show that many widely-implemented features of web site design may interfere with elders' ability to access the information they seek. This poster will illustrate principles of elder-friendly web site design by presenting a demonstration web site that provides information about neurological and psychiatric conditions for adults 50 years of age and older

Aged↗

PubMed2002

Differential increases in average isokinetic power by specific muscle groups of older women due to variations in training and testing.

BACKGROUND: As a person ages, leg speed and power decrease. These changes are associated with increased falls and reduced gait speed. It has been shown that upper leg training in younger persons results in increased strength and power at the specific speed at which resistance training is applied, although there are only limited data concerning speed-specific training effects on lower leg activity. However, because both upper and lower leg speed and power influence gait and balance, it is important to determine the training speeds that selectively improve these variables in older persons. METHODS: No studies have examined selective speed-specific changes in performance for the upper and lower leg muscles in older individuals. Therefore, we compared shifts in the power-velocity relationship after high-speed (HS) and low-speed (LS) isokinetic training of knee extensors (KE) and flexors (KF), dorsiflexors (DF), and plantar flexors (PF) in community-dwelling women (ages 61 to 75). Subjects were randomly assigned to a HS training, LS training, or control (C) group. Training occurred three times a week for 12 weeks. HS training occurred at 4.73 rad.s(-1) (knee) and 3.14 rad.s(-1) (ankle); LS training for both joint actions was at 1.05 rad.s(-1). RESULTS: HS training improved KE power at intermediate (3.14 rad.s(-1); p =.0007) and high (5.24 rad.s(-1); p =.0004) testing speeds. Neither the HS nor LS group showed any change in KF as a result of the training. Both LS and HS training improved DF power at all testing speeds; however, PF power improved only with LS training and only at 1.05 rad.s(-1) (p =.0132) and 3.14 rad.s(-1) (p =.0310). CONCLUSIONS: Our results suggest that, in older women, lower leg training should occur at lower training speeds than upper leg training. Additionally, attention to differential speed-specific training of knee and ankle actions could improve power production, mobility, balance, and other functional measures in older persons.

Age Factors↗