Cathleen M. Connell - US grants

Optimal care or people with Alzheimer's disease and related disorders (AD) involves a broad array of health professionals, service providers, and community, government and voluntary organizations that are part of the dementia service delivery network. Typically, dissemination of information to this diverse network is not coordinated or part of a collaborative process and is insufficient to prepare communities to meet the needs of people with AD and their caregivers. An alternative model of outreach education is based on a community development model that involves broad representation from the dementia service delivery network. Involving the entire community in outreach education increases opportunities for understanding cultural values and beliefs, becoming familiar with relevant channels of communication, being responsive to local needs and interests and ensuring the long-term success of the outreach efforts. The overall objective of this project is to disseminate information about the diagnosis, assessment treatment, management, and care of people with AD to health care professionals, service providers, family caregivers, and the staff of community, government, and voluntary organizations in three communities in Michigan. This proposed project represents a replication of our ongoing community outreach program and expansion to selected communities in the northern and western portions of the state. The goals of the project are to increase knowledge and awareness of AD, increase the coordination of the local dementia service delivery network, and foster a network of effective and knowledge community members who work collaboratively to improve care for people with AD and their families. Using a community development model, the Michigan Alzheimer's Disease Research Center (MADRC) will collaborate with the Alzheimer's Association in Michigan to establish community advisory boards that will be involved in all aspects of the project. First, a comprehensive community assessment, involving focus group and key informant interviews, will be conducted at each intervention site. Next, project staff will design, implement and evaluate locally relevant educational interventions in collaboration with advisory board members. The effectiveness of the interventions will be determined by assessing knowledge, awareness, and attitudes of program participants and advisory board members prior to, during, and three months after the intervention in-each site. The number of referrals received by the local information and referral and geriatric assessment centers prior to, during, and three months after the intervention will also be recorded. A detailed program implementation report will be prepared in each community, including a log maintained by the project team of all calls, visits, and meetings, minutes of advisory board meetings, and local media coverage. This report will be invaluable in efforts to replicate the project in other communities throughout the state.

The overall goals of the Education and Information Transfer Core are to disseminate information about Alzheimer's disease and related disorders (AD) through educational materials and community-based outreach programs and to facilitate clinical and research training in dementia. Activities designed to address these goals will ultimately enhance the early detection, assessment, diagnosis, treatment, and long-term care of people with AD. The specific aims are: 1) to increase knowledge and awareness of AD in Michigan through community-based educational outreach efforts conducted in collaboration with statewide organizations targeted to physicians and other health care professionals, service providers, voluntary organizations, and family members and other caregivers, 2) to develop and disseminate educational materials for selected Cores and each of the scientific projects of the Michigan Alzheimer's Disease Research Center (MADRC) and the two Satellite Diagnostic and Treatment Centers that target a minority and rural community, and 3) to facilitate interdisciplinary clinical and research training in AD among physicians and other health care professionals and predoctoral and postdoctoral fellows and undergraduate and graduate students at the University of Michigan. In addition to interacting with each of the Cores and projects, the Education Core directly addresses the two overarching themes of the MADRC. First, the activities proposed for the period of renewal benefit people with AD and related disorders. For example, the proposed educational materials and training programs are designed for a diverse group of health care professionals who provide direct care to patients diagnosed with a variety of dementing illnesses. Second, the proposed activities target the state of Michigan and build on extensive collaborative ties with statewide agencies that the Education Core has cultivated during the current funding period, including the Michigan Council of the Alzheimer's Association, the Michigan Dementia Program, and the Michigan Department of Community Health. To address the challenge of increasing knowledge and awareness of AD and related disorders in Michigan, the Education Core will build on its collaborative ties with these and other related disorders in Michigan, the Education Core has proposed new collaborations with the ADRCs at Case Western Reserve University and Oregon Health Sciences University to address physician training as part of community outreach efforts and managed care plans.

The impact of Alzheimer's disease (AD), in terms of its prevalence and cost to society, is increasingly recognized as a major public health issue. Currently, however, little is known about the public's awareness and understanding of AD. Because individuals with AD are unlikely to seek information or professional help for themselves (due, in part, to their cognitive deficits and the stigma of the disease), the knowledge of and attitudes about AD among family members, friends, neighbors, and society in general will play a major role in the health decisions made on behalf of individuals with dementia. The purpose of the proposed research is to assess the level of knowledge and commonly held myths and misconceptions about the cause, symptoms, perceived risk, assessment, diagnosis, and treatment of AD. The long-term objective is to incorporate findings from this research into the statewide information dissemination and educational outreach interventions of the Michigan Alzheimer's Disease Research Center. Ultimately, efforts to increase societal awareness and understanding of AD will increase acceptance and compassion for patients with AD and their families and lead to greater support for dementia-related research, service delivery, and health care policy initiatives. The two specific aims of the proposed research include: a) to assess knowledge of and attitudes toward AD among adults in Michigan and b) to assess awareness and attitudes toward utilization of the statewide network of dementia services among adults in Michigan. To accomplish these aims, data will be collected via a telephone interview of a systematic random sample of 1,200 Michigan residents aged 18 or older identified by random digit dialing. The telephone interviews will be conducted by the Survey Research Center (SRC) of the Institute for Social Research at the University of Michigan using state-of-the-art procedures and facilities. SRC personnel will complete two focus groups and two pretests to assist in questionnaire development. The broad content areas covered in the survey include: familiarity with AD, knowledge of the attitudes toward AD, health beliefs (e.g., perceived severity, susceptibility, benefits of and barriers to seeking services), awareness of local and statewide services for dementia patients, and demographic and background characteristics. The first stage of data analysis will include the examination of univariate and bivariate statistics. Next, models of health decision making will be estimate using multivariate procedures, including multiple regression analyses.

Caring for a spouse with Alzheimer's disease or a related disorder (ADRD) is an enormous burden that has been linked with a variety of negative physical and mental health outcomes for the caregiver. Preliminary evidence suggests that caregiving demands may lead to adverse health effects by negatively influencing caregivers' self-care behaviors. The broad objective of this research is to design, implement, and evaluate a telephone counseling intervention based on Social Cognitive Theory to promote self-care behaviors of spouse caregivers. The five specific aims of the proposed research are: 1) to conduct six focus group interviews to inform the process of designing a telephone counseling intervention to promote self-care behaviors among caregivers who provide in-home care to a spouse with ADRD, 2) to design the curriculum for a telephone counseling intervention to improve self-care behaviors (i.e., weight management, exercise, sleep patterns, stress management), 3) to conduct a field test of the intervention with 200 randomly selected experimental and control group subjects recruited from spouse caregivers of patients seen at the Michigan Alzheimer's Disease Research Center (MADRC), 4) to evaluate the process of implementing the intervention, including the extent to which the delivered activities fit the original design and factors external to the program competed with program effects., and (5) to evaluate the impact of the intervention of caregiver self-care behaviors, self-efficacy for self-care, physical health, depression, and caregiver burden. Data will be collected by telephone at baseline and 3,6,9, and 12 month follow-up assessments. Experimental group subjects will be contacted once a week throughout the 9-month intervention period to assess progress on self-care goals. In addition, each subject will record their self-cre behaviors in a daily health diary. Analyses will determine the effects of: 1) the intervention on physical health, depression, and caregiver burden, 2) components of the intervention on specific behavioral and self-efficacy changes, and 3) important mediating variables (e.g., patient severity) on the outcomes. The long-term objective of this research is to test the telephone counseling intervention as part of a randomized clinical trial with a large representative and diverse caregiver population.

Education and Information Transfer Core. The overalls goals of the Education and Information Transfer Core of the Michigan Alzheimer's Disease Research Center (MADRC) are to dissemintate information about Alzheimer's disease and related disorders (AD) through community-based outreach efforts, to facilitate clinical and research training, and to assist in the recruitment and retention of subjects. The specific aims are: 1) to increase knowledge and awareness of AD in general and the MADRC in particular through community-based educational outreach efforts conducted in collaboration with statewide organizations targeted to physicains and other health care professionals, service providers, voluntary organizations, and family members and other caregivers, 2) to facilitate interdisciplinary clinical and research training in AD among diverse audiences, including physicians, health care professionals, fellows, and graduate students, and 3) to assist in the recruitment and retention of subjects to the Clinical Core and Minority Satellite Diagnostic and Treatment Center. The activities proposed for the period of renewal target the state of Michigan and build on extensive collaborative ties with statewide organization that the Education Core has cultivated during the current funding period, including the Michigan Department of Community Health, the Michigan Dementia Coalition, and the local chapters of the Alzheimer's Association. In addition, the Education Core has proposed a new collaborative activity with the ADRCS at Washington University in St. Louis and the Oregon Health Sciences University to develop a standardized mechanism to collect, certify, and share clinical tools for dementia diagnosis, treatment and care.

DESCRIPTION (provided by applicant): This application is in response to PA 11-123, Translational Research to Help Older Adults Maintain their Health and Independence in the Community (R01). Using the Replicating Effective Programs (REP) framework, the proposed study will translate a University of Michigan Center for Managing Chronic Disease (CMCD) evidence-based program for older adults with heart disease for a vulnerable older, primarily African American population, in Detroit, Michigan. The study will be conducted in partnership with the Rosa Parks Geriatric Center at the Detroit Medical Center (RPC) and the Detroit Area Agency on Aging (DAAA). The specific aims of the research are to: (1) adapt, pilot test, and implement the take PRIDE heart disease management program as part of a partnership with the DAAA and RPC; (2) conduct a randomized trial of the translated intervention with 590 participants to assess health outcomes including frequency of cardiac symptoms; functional health status; emergency department visits and hospitalizations for heart disease; (3) assess the translation and implementation of the intervention in the target setting and identify factors that help and hinder the process; (4) assess cost savings associated with the intervention and return on investment (ROI) to the RPC and DAAA; and (5) develop guidelines for scaling up, that is, for replicating the intervention in other low-income areas through the national network of Area Agencies on Aging. Given the aging of our population and the disproportionate burden of chronic disease among low income African American communities, the translation of evidence based programs to support disease-management and reduce health care utilization-e.g., emergency department visits and hospital readmissions--is timely and of great public health significance.