Bringing Evidence-based Dementia Programs to the Community

By Heather Menne, Elizabeth Gould, and Molly Knowles

The Administration on Aging and National Alzheimer’s and Dementia Resource Center are hosting a session, Caring for Caregivers: Evidence-Based Trainings on Dementia Behaviors, at the Aging in America conference on Wednesday March 25, 2020 from 3:30-5:00 pm. Attendees will learn about AoA’s grants program and grantee experience of translating, expanding, and sustaining two evidence-based dementia interventions at the community level that address response to behavioral symptoms.

Since 2008, the Administration on Aging (AoA) has funded projects to improve community-level supportive services for people living with dementia and their caregivers through evidence-based nonpharmacological interventions. There is mounting evidence that points to the benefits of evidence-based dementia care and services. States and community-based organizations have used AoA funds to translate these interventions to local communities.

A brief review was conducted to understand which evidence-based interventions were implemented by AoA grantees between 2008 and 2019. We reviewed the compendium resource Grantee-Implemented Evidence-based and Evidence-informed Interventions. In addition, we relied on prior literature and translation report reviews by the National Alzheimer’s and Dementia Resource Center (NADRC), which highlighted the outcomes achieved from evidence-based interventions implemented by AoA grantees.

Implementation of Evidence-based Programs through AoA Grants

Between 2008 and 2019, 87 AoA grant projects have implemented or are currently implementing 17 different evidence-based interventions. Grantees have implemented evidence-based interventions that primarily target caregivers of people living with dementia (n=10). The remaining interventions (n=7) focus on the dyad of people living with dementia and their caregivers. None of the implemented interventions exclusively target people living with dementia.

The interventions address various concerns and needs among people living with dementia and their caregivers, focusing on one or more of the following areas:

  • caregiver education and skills to manage behavioral symptoms
  • care management services to help caregivers identify and access needed support services
  • caregiver stress and caregiver well-being
  • modification to living spaces as more supportive environments for people living with dementia
  • exercise and physical activities for people living with dementia.

Evaluations of Evidence-based Programs through AoA Grants

Between 2008-2010, AoA awarded grants to 19 projects to study the impact on communities of nine evidence-based interventions. These specific projects required rigorous evaluation and attention to outcomes. Grantees evaluated a variety of outcomes, with caregiver stress, burden, or coping abilities being the most common domains, followed by caregiver depression. Few grants measured outcomes for people living with dementia, with the exception of the frequency or severity of behavioral symptoms. Various outcomes had statistically significant improvement (set at p < .05) in a number of grants:

  • Improved caregiver stress/burden/coping (16 grants)
  • Decrease caregiver depression (15 grants)
  • Improved caregiver knowledge/competence (10 grants)
  • Improved caregiver health (7 grants)
  • Increased knowledge, use, and satisfaction with services and social supports (6 grants)
  • Reduced frequency/severity of behavioral symptoms (4 grants)
  • Delayed/decreased placement in a facility (1 grant)

Conclusion

AoA advanced the field of dementia care by funding translation and demonstration of effective interventions. To date, AoA grants have implemented 17 evidence-based dementia interventions (Knowles & Gould, 2019). With over two hundred available evidence-based dementia interventions (Gitlin, Marx, Stanley, & Hodgson, 2015), organizations need assistance in deciding the best fit for their local community that accounts for cost, geographic accessibility, delivery method (e.g., in-person, workshop, home-based), target audience, and dementia progression.

Overall, AoA-funded projects produce abundant practical information about how to translate existing evidence-based interventions into effective supportive service programs at the community level, and about ways to reduce problems that interfere with successful implementation. The projects develop new delivery methods that can help to reduce costs and increase the number of persons living with dementia and family caregivers who can be identified and served. Ongoing federal, state, foundation, and local support will continue to expand the delivery of quality dementia care in the community.

Heather Menne, Elizabeth Gould, and Molly Knowles are from RTI International, which is contracted by the Administration on Aging/Administration for Community Living (AoA/ACL) to manage the National Alzheimer’s and Dementia Resource Center (NADRC). This blog is the work of the authors and does not necessarily express the opinions of the Administration on Aging/Administration for Community Living, the U.S. Department of Health and Human Services or RTI International.

For more information, consider attending National Alzheimer’s and Dementia Resource Center sessions at the Aging in America conference on Wednesday March 25, 2020. From 1:30-3:00 pm learn about Reaching Socially Isolated People Living with Dementia, and from 3:30-5:00 pm learn about Evidence-Based Trainings on Dementia Behaviors.