Using Technology to Support Care Partners for Persons with Alzheimer's Disease: Tele-STELLA

PROJECT SUMMARY The purpose of this NIH Stage 1B mixed methods study is to test the feasibility, acceptability, fidelity and efficacy of a telehealth-based intervention designed to reduce stress for family care partners (CP) for those with Alzheimer's disease and related dementias (ADRD). ADRD extracts physical, mental and financial tolls from CPs caring for affected family members. In the later stages of disease, behavioral and psychological symptoms of dementia (BPSD) can contribute to CP burden, increasing the risk of depression in CPs and long- term care placement for those with ADRD. Interventions that help CPs manage BPSD are available, but access to them is limited by cost, distance, care demands and stigma. Further, most technology-based interventions are not tailored to the later stages of disease, when BPSD are more common. In the proposed study we aim to refine and optimize the multi-site Tele-STELLA (Support via TEchnology: Living and Learning with Advancing ADRD) intervention. Tele-STELLA is a video-conference-based intervention that provides education and peer support for CPs caring for family members in the moderate to late stages of ADRD. The intervention, which CPs access from their own homes, begins with one-to-one training with a Tele-STELLA Guide (a nurse or psychologist), then advances to peer-based education and support modeled on the ECHO (Extension of Community Healthcare Outcomes) template. The intervention is specifically for CPs, no care- recipients with ADRD will be in this study. However, the skills CPs develop in Tele-STELLA will be integrated into the care of the person with ADRD, thus reducing behavioral symptoms. The foundation of this proposal was laid with two pilot studies which assessed early versions of Tele-STELLA. This mixed-methods study will assess the feasibility, acceptability, treatment fidelity and efficacy of Tele-STELLA. We hypothesize that the Tele-STELLA intervention will be feasible and acceptable and will reduce the frequency of behavioral symptoms in persons with ADRD, thus improving CP affective symptoms (burden, depression, grief) and quality of life for CPs and those with ADRD. We will recruit rural, African American and white CPs (n=150) from three sites (Oregon, Kentucky and Georgia). Feasibility will be assessed quantitatively by measuring attendance and completion rates. Qualitative data from focus groups will augment the feasibility quantitative findings and provide feedback on consumer acceptability. Content experts will evaluate treatment fidelity by reviewing a subsample of video-taped sessions. We will measure efficacy of Tele-TELLA on reducing the frequency of behavioral and psychological symptoms in persons with ADRD using pre-post assessments and linear regression strategies. Our long term goal is to reduce the psychological burden CPs experience by providing the Tele-STELLA intervention for any CP who has access to a computer and an internet connection.