Dementia Care Training for Dementia

(CfAA Trial)

Overseen By Cerelia Liu

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Disqualifiers: Palliative care, Moderate dementia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 22

120 Participants Needed

Trial Summary

What is the purpose of this trial?

Care for America's Aging is a randomized pilot study investigating whether a home health aide training intervention consisting of enhanced dementia-specific curriculum content will improve: 1) behavioral symptoms of older adult persons living with dementia or cognitive impairment (PLWD/CI) and 2) global health-related quality of life among PLWD/CI and their care partners.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Enhanced home health aide training for dementia care?

Research shows that training programs for dementia carers can lead to increased patient survival at home and reduced psychological stress for carers. Additionally, training home health aides in specific activities, like Montessori-based methods, significantly increases the pleasure experienced by clients with dementia. ^{1 2 3 4 5}

Is the dementia care training program safe for participants?

The dementia care training programs, such as the IHSS + ADRD Training Project and Montessori-based training, focus on improving caregiver skills and have shown positive outcomes like increased knowledge and client pleasure, without reported safety concerns. Additionally, home safety interventions and toolkits have been effective in reducing risks and improving safety for people with dementia, suggesting that these training programs are generally safe for participants. ^{3 6 7 8 9}

How does the dementia care training treatment differ from other treatments for dementia?

This dementia care training is unique because it focuses on enhancing the skills and confidence of caregivers through online and mobile e-learning platforms, incorporating mentoring and social networking. Unlike traditional medical treatments, it aims to improve the quality of care by empowering caregivers with knowledge and practical skills to better support individuals with dementia at home. ^{1 3 9 10 11}

Research Team

Olivia I Okereke, MD, MS

Principal Investigator

Massachusetts General Hospital

Eligibility Criteria

This trial is for individuals aged 60 or above with mild to moderate dementia or cognitive impairment, who are part of the Mass General Brigham healthcare system and have a care partner. They must be referred to home care services after hospital discharge and able to read English. Those with severe dementia, without a care partner, in palliative care, or unable to consent due to cognitive issues cannot participate.

Inclusion Criteria

My cognitive issues are mild to moderate.

My discharge plan includes getting home care services.

All surveys have been validated in English, so participation is limited to potential participants able to read English

Exclusion Criteria

You do not have someone to help take care of you during the study.

Your Montreal Cognitive Assessment (MoCA) score is below a certain level.

I am being discharged to a Medicare-approved short-term rehab.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training Intervention

Home health aides receive either enhanced or standard curriculum training

Approximately 4 weeks

20 instructional days for standard curriculum, 22 instructional days for enhanced curriculum

Follow-up

Participants are monitored for behavioral symptoms and quality of life outcomes

6 months

Questionnaires every 2 weeks, occasional phone calls

Treatment Details

Interventions

• Enhanced home health aide training

Trial Overview The study tests if special training for home health aides on how to handle dementia can improve behavior symptoms in older adults with dementia/cognitive impairment and enhance life quality for them and their caregivers. Participants will be randomly assigned into groups receiving either enhanced training or standard practices.

Participant Groups

Group I: Home Health Aides with Enhanced Curriculum Training Experimental Treatment 1 Intervention

The enhanced curriculum of 108 hours of home health aide (HHA) training will constitute the Experimental arm. This arm consists of the 100 hours of the standard curriculum plus an 8-hour enhanced curriculum that includes additional didactic content and a skills practicum on dementia and recognizing and responding to dementia-related behaviors. As with the standard curriculum, the enhanced curriculum will be delivered by the training entity, CCHERS (Center for Community Health Education, Research and Service, Inc.). The enhanced component is delivered over an additional 2 instructional days (10% increase in instructional days from the standard curriculum).

Group II: Home Health Aides with Standard Curriculum Training Active Control 1 Intervention

The standard curriculum of 100 hours of home health aide (HHA) training will constitute the No Intervention arm. This 100-hour training is the standard curriculum that has been used by the training entity, CCHERS (Center for Community Health Education, Research and Service, Inc.), for many years to qualify HHAs to receive certificates from the Massachusetts Home Care Aide Council. The standard curriculum includes 75 hours of basic instruction ("ABC's for Direct Care Workers") and 25 hours of additional content on mental health and dementia topics. The standard curriculum is delivered over approximately on month, or 20 instructional days.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Findings from Research

The VOICE Dementia Care Training Program significantly improved knowledge and self-efficacy among care managers and nurses, with a large effect size (d = 1.8) in these areas, indicating enhanced confidence in managing behavioral symptoms of dementia.

This evidence-informed training program demonstrates the feasibility and effectiveness of nonpharmacological approaches in dementia care, addressing the training needs of caregivers and promoting better management of dementia-related behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program. Karlin, BE., Young, D., Dash, K.[2018]

A training program developed by a consortium of home care agencies significantly reduces staff turnover and improves care for patients with Alzheimer's disease and dementia.

The program emphasizes knowledge-based care and highlights the importance of self-esteem for both home care aides and patients, suggesting that boosting confidence can lead to better outcomes in caregiving.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New directions for care of Alzheimer's disease and dementia. Gang, V.[2018]

The Home Safety Toolkit (HST) significantly improved caregiver competence in creating safer home environments for individuals with dementia, as evidenced by reduced caregiver strain and increased self-efficacy, with results showing statistical significance (P ≤ 0.001 for home safety and P = 0.002 for self-efficacy).

The intervention also led to a notable decrease in risky behaviors and accidents among care receivers, highlighting the effectiveness of the HST in enhancing safety for individuals with dementia living at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical trial of a home safety toolkit for Alzheimer's disease. Horvath, KJ., Trudeau, SA., Rudolph, JL., et al.[2021]

The IHSS + ADRD Training Project is a 10-week online training program designed to improve dementia care knowledge among IHSS caregivers in Alameda County.

Preliminary results show that caregivers who completed the training experienced significant increases in their knowledge about dementia and their confidence in providing care, highlighting the need for ongoing training initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing Dementia Knowledge and Self-Efficacy of In-Home Supportive Services Caregivers Through Online Training. Yeh, J., Pond, B., Beld, M., et al.[2023]

The Dementia Care Skills for Aged Care Workers program aims to train 17,000 aged care staff in Australia over three years, providing essential skills for dementia care and resulting in a nationally recognized qualification.

Despite challenges in training delivery, such as geographical distances and staffing issues, the program is on track to meet its goals, with positive feedback indicating it is effectively improving care practices, including a notable participation rate of 9% from registered nurses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Large-scale training in the essentials of dementia care in Australia: Dementia Care Skills for Aged Care Workers project. Fleming, R., Fitzgerald, D.[2016]

References

1. England pubmed.ncbi.nlm.nih.gov

Promoting Independence Through quality dementia Care at Home (PITCH): a research protocol for a stepped-wedge cluster-randomised controlled trial. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Cost effectiveness of a training program for dementia carers. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Montessori-based training makes a difference for home health workers & their clients. [2006]

4. England pubmed.ncbi.nlm.nih.gov

Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

New directions for care of Alzheimer's disease and dementia. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Safety Implications for the Homebound Patient With Dementia. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Clinical trial of a home safety toolkit for Alzheimer's disease. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Risks and risk mitigation in homecare for people with dementia-A two-sided matter: A systematic review. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Enhancing Dementia Knowledge and Self-Efficacy of In-Home Supportive Services Caregivers Through Online Training. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Large-scale training in the essentials of dementia care in Australia: Dementia Care Skills for Aged Care Workers project. [2016]

11. England pubmed.ncbi.nlm.nih.gov

A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study. [2021]