A $2.2 million, five-year NIA award funds the randomized control Decisions about Cancer Screening in Alzheimer’s Disease study, known as DECAD, to investigate if an evidence-based mammography screening decision aid can improve the quality of medical decision making among caregivers by lowering their decisional conflict and increasing their confidence in making mammography decisions for older women with Alzheimer’s disease.
“Family caregivers are often the ones making tough decisions and facilitating medical care for their loved ones with Alzheimer’s disease,” Dr. Fowler said. “They struggle with decisions about care, especially those that they are not sure will improve their loved ones’ quality of life and may be burdensome. For example, imagine you are a women with Alzheimer’s disease being taken out of your familiar surroundings to get a mammogram and you don’t really know or understand what is going on, what is being done to your body; then imagine how difficult it can be for the caregiver to make the decision to take their confused family member to the imaging facility and keep them calm and comfortable.”
National guidelines on mammography screening in older women vary and some address the need to tailor guidelines for women with serious, life-limiting illnesses such as Alzheimer’s disease. It is estimated that over 800,000 older women with Alzheimer’s disease receive screening mammograms annually in the U.S.
“Additionally findings from this study will help us understand the implications of undergoing follow-up tests and treatment for these women and if they are a significantly greater burden for older women with dementia than those who are not cognitively impaired,” Dr. Fowler said.
To determine if the decision-making quality of caregivers can be improved, half of the 426 caregivers enrolled in the DECAD study will be randomized to receive an evidence-based decision aid and followed for 24 months. The decision aid was developed by Dr. Fowler and colleagues with the support of a Regenstrief Foundation innovation award.
The second new grant to Dr. Fowler, a Department of Defense award of $626,283, supports the first study of a comprehensive collaborative care program for veterans with traumatic brain injury or Alzheimer’s disease and their caregivers designed to be scalable and embedded into the VA healthcare system.
Study participants will be enrolled in Aging Brain Care (ABC) ANSWERS. This study builds upon the ABC collaborative care model, developed by IU Center for Aging Research. ABC ANSWERS expands the bundle of ABC services to veterans with traumatic brain injuries and incorporates strength-based educational and skills training for veterans and their caregivers. A key aspect of the intervention builds upon techniques that currently work for veterans and their caregiver partners adding nuances to compensate for cognitive and behavior changes due to memory loss and other symptoms of dementia or traumatic brain injury.
Since 2000, over 350,000 veterans have been diagnosed with traumatic brain injury, putting them at high risk for dementia. Nationwide more than 564,000 veterans have a diagnosis of Alzheimer’s disease.
The ABC model has been shown to improve care and outcomes for patients and caregivers while decreasing ER visits and hospitalizations for older adults with dementia and ICU survivors, and is currently being studied in trauma victims.
“As are those who care for family members with Alzheimer’s disease, caregivers of individuals with traumatic brain injury are critical to the quality of life of the care recipients,” Dr. Fowler said. “However, these caregivers experience high rates of depression and burden as well as social isolation, financial hardship and poor physical health. There is a great and growing need to address these issues.”
The physical, psychological and cognitive issues of the veteran with traumatic brain injury or dementia and his or her caregiver participating in ABC ANSWERS will be addressed. Study participants will receive comprehensive collaborative care in partnership with their VA primary care team and a series of nine joint sessions with a trained interventionist that will focus on areas known to lead to stress between patient and caregiver, including communication and understanding behaviors of individuals with brain injuries or cognitive impairment.
The study, which will measure the effectiveness of ABC ANSWERS, will initially enroll veterans and caregivers seen at the Richard L. Roudebush VA Medical Center in Indianapolis and will then extend to community-based outpatient clinics throughout Indiana. A total of 200 patient-caregiver pairs will participate.
“We hope to develop evidence-based information on how to improve VA clinicians’ ability to provide high quality primary care to veterans with Alzheimer’s disease and traumatic brain injury by tailoring medical care to match the specific needs of veterans and their caregivers,” Dr. Fowler said.