Training Programs for Dementia Care

Overseen By Johanna Hickey, MSW

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of North Carolina, Chapel Hill

Disqualifiers: Under 18 years

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

Compensation: Varies

Number of Visits: 10

1764 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

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

What data supports the effectiveness of the treatment essentiALZ, essentiALZ Plus, Project ECHO, and Project Extension for Community Healthcare Outcomes for dementia care?

The Project ECHO model has been shown to enhance dementia education for primary care providers, improving their knowledge and confidence in managing dementia. Additionally, dementia-specific training programs like Basic Care I and the IHSS + ADRD Training Project have demonstrated increased dementia knowledge and self-efficacy among caregivers, suggesting that similar educational approaches can be effective in dementia care. ^{1 2 3 4 5}

Is the dementia care training program safe for participants?

The available research does not provide specific safety data for the dementia care training programs like essentiALZ or Project ECHO, but they focus on improving caregiver knowledge and reducing harmful practices in care settings, suggesting a focus on safety and quality improvement. ^{5 6 7 8 9}

How is the treatment 'Training Programs for Dementia Care' different from other treatments for dementia?

This treatment is unique because it combines online training programs like essentiALZ and Project ECHO to enhance the skills and knowledge of caregivers and healthcare providers, especially in rural or under-resourced areas, through virtual clinics and telementoring, rather than focusing on medication or direct patient interventions. ^{5 10 11 12 13}

What is the purpose of this trial?

This project will compare two training models of an evidence-based online dementia care training program for direct care staff in assisted living to a waitlist control: 1) essentiALZ training and 2) essentiALZ training + Project ECHO. It will examine the extent to which each model is implemented and achieves its intended outcomes to improve staff knowledge and attitudes, change care practices, and improve the wellbeing of staff, residents, and residents' family members. Results will inform next steps in dementia care training for the assisted living (AL) and broader long-term care workforce. To examine these outcomes, data will be collected from AL staff and families over the course of 6 months. Staff will complete questionnaires and participate in interviews (as applicable) at baseline, post-training, 3-months, and 6-months. Families will participate in interviews at baseline, 3-months, and 6-months.

Research Team

Sheryl Zimmerman, PhD

Principal Investigator

University of North Carolina, Chapel Hill

Eligibility Criteria

This trial is for direct care staff in assisted living facilities. It aims to improve dementia care by enhancing staff knowledge and practices, as well as the wellbeing of staff, residents, and their families. Participants will be involved in data collection over a 6-month period.

Inclusion Criteria

Family: At follow-up, resident lived in AL community at least one month during the three months prior to interview date

I work in assisted living, providing direct care to residents.

I am over 18 and can read and speak English fluently.

Exclusion Criteria

I am under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants receive essentiALZ training, a web-based program with five modules, over four weeks. In the ECHO arm, additional weekly sessions are conducted via Zoom.

4 weeks

6 virtual sessions (ECHO arm only)

Post-Training Assessment

Staff complete questionnaires and participate in interviews to assess training impact at baseline, post-training, 3-months, and 6-months.

6 months

4 assessment points (baseline, post-training, 3-months, 6-months)

Follow-up

Participants are monitored for changes in knowledge, attitudes, and care practices over an additional 6 months after the intervention ends.

6 months

Treatment Details

Interventions

• essentiALZ
• Project ECHO

Trial Overview The study compares two training models: essentiALZ alone, and essentiALZ combined with Project ECHO against a waitlist control group. The goal is to see which model better improves dementia care workforce skills.

Participant Groups

Group I: essentiALZ + ECHO Experimental Treatment 2 Interventions

Communities randomized to this arm will receive the essentiALZ training: a web-based training taken by AL staff that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks. Additionally, they will receive access to Project ECHO. ECHO is a virtual tele-mentoring model grounded in case-based learning. It includes six weekly one-hour sessions of didactic and discussive learning. The first five sessions will reflect the content of the five essentiALZ modules, and the final session will address maintenance. ECHO sessions are group sessions that will be conducted via Zoom.

Group II: essentiALZ Experimental Treatment 1 Intervention

Communities randomized to this arm will receive the essentiALZ training: a web-based training taken by AL staff that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks.

Group III: No Intervention Active Control 1 Intervention

Standard care will be provided.

essentiALZ is already approved in United States for the following indications:

Approved in United States as essentiALZ for:

• Dementia care training for assisted living staff

Who Is Running the Clinical Trial?

University of North Carolina, Chapel Hill

Lead Sponsor

Trials

1,588

Recruited

4,364,000+

Alzheimer's Association

Collaborator

Trials

103

Recruited

44,300+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Findings from Research

Project ECHO is an innovative educational model designed to enhance dementia care in primary care settings, emphasizing the importance of ongoing education for clinicians managing dementia.

The mixed-methods evaluation of the program revealed valuable insights into primary care providers' motivations for participating, which can inform the development of future ECHO courses and improve geriatrics education in dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care. Waters, L., Sohmer, D., Goldman, RE., et al.[2023]

In a pilot study involving 47 participants aged 60 and over with dementia, person-centered care (PCC) significantly improved behavioral and neuropsychiatric symptoms and care quality compared to usual care after 4-5 days.

Sustained improvements in care quality were observed for patients with longer hospital stays, indicating that PCC can be beneficial for enhancing the overall care experience for individuals with dementia in acute hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. Chenoweth, L., Williams, A., Fry, M., et al.[2022]

Participation in the Basic Care I training course significantly improved dementia knowledge, with 76.4% of participants showing increased scores.

While the effects on stress levels and work-related self-esteem were inconclusive, the study highlights the need for further research in these areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Basic care I: the effect of dementia-specific training on certified nursing assistants and other staff. Peterson, D., Berg-Weger, MS., McGillick, J., et al.[2019]

The DementiaNet program, which lasted for 2 years, significantly improved collaboration among 35 primary care networks and enhanced the quality of dementia care, with measurable increases in both areas during the program.

These improvements in collaboration and care quality were sustained even after the program ended, suggesting that DementiaNet successfully facilitated a lasting transition to integrated primary dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. Oostra, DL., Nieuwboer, MS., Melis, RJF., et al.[2023]

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]

Participation in Project ECHO-AGE significantly reduced the use of physical restraints in nursing homes, with residents being 75% less likely to be physically restrained compared to control facilities over an 18-month period.

There was also a trend towards reduced prescription of antipsychotic medications, with ECHO-AGE residents being 17% less likely to receive these medications, indicating potential improvements in managing dementia-related behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study. Gordon, SE., Dufour, AB., Monti, SM., et al.[2022]

A consensus workshop with 31 healthcare professionals identified and ranked common adverse events in community care, highlighting the need for better understanding of how these events affect care quality.

The workshop emphasized the importance of further research to establish standardized definitions of adverse events and to prioritize research questions that can improve patient safety in community care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in community care: developing a research agenda. Masotti, P., Green, M., Shortt, S., et al.[2022]

In a study of 123 patients treated with donepezil for Alzheimer's dementia, 21% discontinued treatment due to adverse events (AEs), highlighting the need for careful monitoring during the initial months of therapy.

The most common AEs leading to discontinuation were nausea/vomiting, diarrhea, and loss of appetite, indicating that these side effects are significant considerations in the management of patients on donepezil.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adverse events causing discontinuation of donepezil for Alzheimer's dementia]. Carøe, TK., Moe, C.[2018]

Caregivers of individuals with Alzheimer's disease face significant challenges in managing home safety, highlighting the need for targeted interventions.

The transtheoretical model of health behavior change (TTM) can be useful in understanding caregivers' stages of adopting safety measures, suggesting that tailored strategies could enhance their ability to prevent accidents and injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caregiver perspectives on safety in home dementia care. Lach, HW., Chang, YP.[2015]

A training program for Family Health Teams (FHTs) significantly improved the knowledge, confidence, and ability of 124 health professionals in assessing and managing dementia, as evidenced by follow-up surveys conducted 6 months after the program.

After the training, nearly all participating FHTs established memory clinics, indicating a successful implementation of dementia care practices within primary care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing memory clinics in primary care: an evidence-based interprofessional program of continuing professional development. Lee, L., Weston, WW., Hillier, LM.[2013]

The Project ECHO program successfully provided over 250 hours of dementia-related education to more than 50 primary care providers across 20 sites, improving their knowledge and confidence in diagnosing and managing dementia.

Post-session surveys indicated that two-thirds of providers planned to change their practice based on what they learned, highlighting the program's effectiveness in enhancing dementia care in rural and under-resourced settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

UW Project ECHO-Dementia: Implementation of a virtual clinic and telementoring program to improve dementia diagnosis and treatment in rural and under-resourced primary care settings. Rhoads, K., Isenberg, N., Schrier, A.[2022]

The CARES® Dementia-Friendly Hospital™ program significantly improved the knowledge of nursing assistants and allied hospital workers about dementia care, with a p-value of less than 0.001, indicating strong statistical significance.

The online training was perceived as feasible, useful, and efficient, suggesting that it could effectively enhance the quality of care for individuals with dementia in hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and Utility of Online Dementia Care Training for Hospital Staff: The CARES® Dementia-Friendly Hospital™ Program. Hobday, JV., Gaugler, JE., Mittelman, MS.[2018]

The CARES® Dementia Basics online program led to significant improvements in dementia caregivers' knowledge and sense of competency, with participants showing sustained knowledge retention even after 30 days.

While caregivers felt more competent in their roles after the training, there was no significant improvement in their ability to identify person-centered caregiving techniques, indicating a need for further training in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An evaluation of the CARES® Dementia Basics Program among caregivers. Pleasant, ML., Molinari, V., Hobday, JV., et al.[2019]

References

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

Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care. [2023]

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

Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. [2022]

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

Basic care I: the effect of dementia-specific training on certified nursing assistants and other staff. [2019]

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

DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. [2023]

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

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

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

Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study. [2022]

7. Canada pubmed.ncbi.nlm.nih.gov

Adverse events in community care: developing a research agenda. [2022]

8. Denmark pubmed.ncbi.nlm.nih.gov

[Adverse events causing discontinuation of donepezil for Alzheimer's dementia]. [2018]

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

Caregiver perspectives on safety in home dementia care. [2015]

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

Developing memory clinics in primary care: an evidence-based interprofessional program of continuing professional development. [2013]

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

UW Project ECHO-Dementia: Implementation of a virtual clinic and telementoring program to improve dementia diagnosis and treatment in rural and under-resourced primary care settings. [2022]

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

Feasibility and Utility of Online Dementia Care Training for Hospital Staff: The CARES® Dementia-Friendly Hospital™ Program. [2018]

13. England pubmed.ncbi.nlm.nih.gov

An evaluation of the CARES® Dementia Basics Program among caregivers. [2019]