A Telehealth-Adapted Dementia Caregiver Skills Training Intervention (TeleCARE): Single-Arm Pre-Post Intervention Study

BACKGROUND: Dementia caregivers often want to support aging at home, but as neuropsychiatric symptoms (NPS) become more severe, caregiver challenges increase, often resulting in negative outcomes for both the caregiver and care recipient, and institutionalization. Project CARE is a manualized in-person group intervention for dementia caregivers designed to reduce negative caregiver outcomes by teaching skills to manage NPS in care recipients in the home environment. Interventions that occur in-person, however, can be difficult for caregivers to attend. Telehealth-based interventions are possible alternatives that reduce barriers to attendance. OBJECTIVE: The primary objective of this pilot study was to evaluate the feasibility and acceptability of offering CARE via telehealth (TeleCARE). The secondary objective was to explore quantitative outcome trends and effect sizes post-intervention outcomes of TeleCARE for both caregivers and care recipients. METHODS: Rates of recruitment, attendance, and completion were used to assess the feasibility of TeleCARE. We also collected data on technology use and telehealth-based adaptations. To measure acceptability, participants rated satisfaction with the intervention immediately post-intervention. Questionnaires were administered at baseline, and immediately and 3-months post-intervention. Primary outcomes for exploratory analysis included NPS presence, severity, and caregiver NPS-related distress. Secondary outcomes included caregiver depression, anxiety, stress, self-efficacy, positive aspects of caregiving, and meaning and purpose in life. RESULTS: Of the 109 caregivers contacted for recruitment, 24 caregivers (22%) enrolled in TeleCARE, and 20 caregivers (83%; predominantly female spouses) completed the study. Feedback from participants in TeleCARE-test Group 1 (n=3) was used to modify the intervention to improve the telehealth experience, including adding procedures to improve safety, encourage rapport building, address etiquette, and ensure privacy. The final version of TeleCARE included 7 weekly synchronous video sessions. Ten participants attended all 7 sessions, and all participants attended at least 5 sessions. Satisfaction ratings suggested adequate intervention acceptability. We found that most participants (65%) required technological support, and that technological support was needed throughout the intervention. We observed quantitative trends toward post-intervention decreases in care-recipient NPS severity (d=0.16), caregiver depression (d=0.15) and anxiety (d=0.23), and, perhaps surprisingly, caregiver self-efficacy (d=0.21), and increases in positive aspects of caregiving (d=0.18) and meaning and purpose in life (d=0.09). Most improvements were not sustained at three-months. CONCLUSIONS: For this pilot feasibility study, we successfully recruited dementia caregivers and engaged them in TeleCARE. Overall, TeleCARE was deemed feasible and acceptable. The current findings suggest that offering interventions via telehealth requires modifications and technological support for older caregiver engagement but is a feasible and acceptable means of offering services.