Supporting Caregivers through Problem Solving Therapy Mary Chiu, PhD Tim Pauley, MSc Dunstan Pushpakumar, MPH, Joel Sadavoy, MD, FRCPC, Virginia Wesson, MD, MSc, FRCPC Background • Informal carers are essential in keeping persons with dementia at home • However, carers are susceptible to the development of Caregiver Burden, which can impair their ability to provide care • The needs of carers have been overlooked due to the lack of training for healthcare providers and paucity of evidence to guide practice Background (continued) • PST is a systematic approach to problem solving shown to be effective in alleviating emotional distress and improving problem solving skills of carers looking after persons with a variety of conditions Purpose of the Study • To evaluate the effectiveness of a PST training program when delivered to informal carers in the home, by case managers who have received training in PST Hypotheses Hypothesis 1 • By improving the ability to identify and define problems, carers assigned to receive PST will demonstrate improved task and emotional coping Hypothesis 2 • Through a systematic approach to solution creation for identified problems, carers will demonstrate improved self-perceived competence and sense of mastery Hypotheses (continued) Hypothesis 3 • As burden is highly associated with care recipient’s physical condition and disease stage, neither group will demonstrate a change in burden Hypothesis 4 • Carers assigned to receive PST will demonstrate reduced self-perceived stress Methods Methods (continued) • Study design: concurrent, matched cohort design • Outcome measures: – Coping Inventory for Stressful Situations – Mastery Scale – Caregiving Competency Scale – Perceived Stress Scale – Zarit Burden Interview Methods (continued) • Inter-rater agreement was determined – For independent evaluations of whether PST was implemented as intended • Intention-to-treat analysis was utilized • Repeated measures ANOVA were conducted to test study hypotheses • Paired-samples t-tests were used for follow-up pair-wise comparisons – Bonferroni correction was used to reduce likelihood of type I error Results Outcome Measures Score for PST Group 70 60 ** 50 * 40 Score Baseline 30 * * * * 20 ** = p < 0.01 * = p < 0.001 10 0 Task‐Oriented Coping Emotional Coping Competence Post‐intervention Mastery Outcome Measures Burden Self‐perceived Results (continued) Outcome Measures Score for Control Group 70 60 50 40 Score Baseline 30 Post‐intervention 20 ** = p < 0.01 * = p < 0.001 10 0 Task‐Oriented Coping Emotional Coping Competence Mastery Outcome Measures Burden Self‐perceived Discussion & Conclusions • PST can be easily learned and delivered by CCs • PST grounded visits are more effective than usual home visits – Improves carers’ sense of caregiving competence – Increases task-focused coping – Reduces emotion-focused coping – Reduces burden – Reduces stress Discussion & Conclusion (continued) • PST intervention may reduce reliance on primary care, psychiatric services and institutional services • Effective partnerships between interprofessional groups and community agencies can extend the reach of the expertise of specialized healthcare institutions • The project incorporated key elements of a scalable, sustainable model disseminated to diverse groups of professionals, carers and persons with dementia Discussion & Conclusion (Continued) • Limitations – Care recipients were not evaluated so it is not possible to state whether the development of carers’ problem-solving and other caregiving capacities meaningfully improved outcomes – Carers found the number of outcome measures difficult – This pilot was delivered in one location by professionals integral to its development and may be hard to replicate at other sites Future Directions • Development of a more targeted package of outcome measures • Exploration of further collaboration between Mount Sinai Hospital and CCAC to effectively expand the use of the PST intervention in the community • Significant expansion of system capacity for dementia care and contribution to sustained financial viability of the health care system Acknowledgements • This project is funded by the UHN AMO Innovation Fund and is a collaboration between Mount Sinai Hospital and Toronto-Central Community Care Access Centre • A special thanks to the CCAC care coordinators: Belma Agustin, Bozena Kosciolek, Edith Lee, Deanna Oad, Mira Olearczyk, Ann Poon; and to the carergivers who participated.