Theoretical Based Case Management Intervention for Dementia Family Caregivers

The primary care physicians in the memory disorder clinics at the participating hospitals (Chang-Gung Memorial Hospital at Lin-Kuo, Chang-Gung Memorial Hospital-Taoyuan branch, Catholic Mercy Hospital at Hukou, Hsinchu county) will receive a written letter to explain the purpose of this project and the eligible criteria of PWDs and their FCGs. Debriefing can be provided upon request. Then the participating physicians will help to identify eligible dyads; while one trained research assistant (RA) is responsible for CM implementation (RA I), and the second RA (graduate students, RA II) will be responsible for data collection in each time point.

To increase the feasibility of this project, the inclusion criteria of PWDs are made to reflect the recruiting site reality, including: (1) age being older than 60 years old; (2) having a primary FCG or a secondary FCG who can provides sufficient information and assistant for the PWD; co-residence is not required; (3) PWDs are those with cognitive impairment confirmed by the primary or secondary FCG or participating neurologists. The exclusion criteria of PWDs include: (1) acute illnesses, impaired sensory symptoms (hearing loss and severe visual problems); (2) acute agitation which requires emergency treatment; (3) chronic alcohol abuse or use of drugs which possibly affect central nervous system functions; (4) presence of major psychiatric disorders within the last 2 years; (5) neurological or systemic illness (e.g. delirium, hypoxia, or unstable thyroid dysfunction); (6) no primary FCG or secondary FCG.

Investigator will screen for FCGs who report and meet the criteria of moderate levels of severity in the following risk areas (Table 1): depressive symptoms, burden, distress to problematic behaviors of PWDs and healthy behaviors. The definition of primary FCG include: (1) age 18 years old or greater; (2) at least providing the most assistance (4 hours a day) to their relatives with dementia for the past three months or those who conduct secondary care to their relatives, meaning that these FCGs supervise the hired care assistants or foreign helpers who actually take care of the patients; co-residency is not required for family caregivers. Exclusion criteria of family caregivers include: (1) documented cognitive or mental disorder, such as severe memory problems or major affective disorders; (2) hearing or visual impairments which are not properly corrected; (3) prescribed drugs known to impair or enhance attention, e.g., antidepressants, barbiturates, or other depressants, amphetamines; (4) insufficient command of Mandarin, Taiwanese; (5) participation in other interventions which may contaminate the results of this study.

In previous project, the satisfactory level of our case management training course was high. All the trainees had the highest regard toward the professional quality of the content and the instructors (Chiu et al, 2013). One of the case managers served as research assistant in the previous project and will continue to work with us as interventionist upon funded. Investigator will conduct a three-year RCT involving repeated measures at four time points: baseline screening (T0), 4th month (the end of the intervention, T1), 6th month (post-treatment follow up, T2), 12th month (T3).

Randomization Randomization takes place after baseline assessment. An external independent person establishes the random order using random number tables.