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2014 Senior Care Innovation Scholarship Winner Alicia Roth

Caitlin Burm
By Caitlin BurmApril 30, 2014

A Place for Mom is proud to announce the winning essays of our annual $1,000 scholarship for the advancement in the field of gerontology. 10 finalists were narrowed down to 5 winners whom are being awarded with a financial donation. Applicants were required to write a compelling essay about senior care innovation in preparing for America’s “Silver Tsunami” of aging Baby Boomers.

Congratulations to Alicia Roth, 2014 Senior Care Innovation Scholarship Winner! We invite you to read Alicia’s essay below and comment with your thoughts.

Senior Care Innovation Winner 2014 Alicia Roth

Alicia’s Essay

The Administration on Aging estimates that by 2050, nearly a quarter of Americans will be age 65 or older. By 2025, the number of people 65 and older with Alzheimer’s disease is expected to reach 7.1 million – a 40 percent increase in the number of those currently affected.  How we prepare for America’s “Silver Tsunami” of aging Baby Boomers is of critical importance. What innovations in the senior care industry need to happen in order to care for our aging population? What contributions will you make to solving this problem?

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I begin my days as most graduate students in clinical psychology do; I irresponsibly snooze when my alarm goes off, panic when I have slept too late. I cram books, articles, and my iPad into my bag. I stand in an obligatory line at the coffee stand, say hello to friends in the hallway, then make my way to my office and login to my computer.

But then I take the high definition camera out of my desk and attach it to my computer monitor. I log into Skype and make a call to a person I have never met, roughly 200 miles away, to begin our first therapy session. This person is an informal caregiver of person with dementia, struggling with sleep difficulties and the stress of caregiving. They answer, we tentatively say hello, and I am no longer in my office basement sipping on coffee during a typical graduate student morning. Suddenly, I am in the dining room of a couple that has lived in the same home for decades. Or sometimes I am in the cramped apartment of a middle-aged child and her parent. Sometimes the person is in their pajamas, also imbibing their morning coffee or eating cereal. Their dogs are in their lap, there are picture frames on the wall, or there are televisions on in the background. Often I observe a juxtaposition of hope and hopelessness as we discuss their mother, father, or spouse with Alzheimer’s. I am now face-to-face with a fast growing national public health issue; a powerful combination of research and technology has transported me into the home of a family caregiver of a person with dementia.

Given the broad negative consequences of informal caregiving for persons with dementia, preparing for the America’s “Silver Tsunami” will require future innovations in care concentrated on this distinctive yet underserved population. As the population of older adults with Alzheimer’s exponentially increases so will the need for their round-the-clock care; informal caregiving has become more prevalent because of the evolving nature of aging, including increased life expectancy and a shift from acute illness leading to mortality to living with chronic illness for many years before death. Informal caregiving has skyrocketed in the past few decades; estimates of the number of informal caregivers in the US vary between 40-60 million, with approximately 23% taking care of a person with dementia.

Caregiving for dementia patients has been singled out as a particularly unique form of caregiving; a survey by the AARP rated caregiving for dementia patients as the most stressful type of informal caregiving, characterized by both its long-term physical and psychological effects. The amalgamation of these problems is defined as “caregiver burden” — the financial, psychological, and physical burden associated with caring for a disabled adult.

An increasingly common complaint amongst caregivers of persons with dementia is disturbed sleep. Approximately 35% of adults aged 65 and older experience insomnia and as a result, may experience associated negative consequences (e.g., decreased quality of life, disturbed mood, increased medication dependence). Caregivers have been found to have less overall total sleep time, with the sleep of CG’s averaging approximately one hour less than controls.

Few studies have investigated optimal methods for treating this serious health problem.  My doctoral research involves a unique amalgamation of traditional science, psychology, and new technology to treat insomnia in at-home caregivers of persons with dementia. The aim of the project, which is housed in the College of Nursing at the University of South Florida and Department of Clinical and Health Psychology at the University of Florida and lead by Drs. Meredeth Rowe and Christina McCrae, is to improve sleep for caregivers utilizing two state-of-the-art approaches. The first is an in-home monitoring system for nighttime awakenings for the person with dementia developed by the USF research team. This system mimics a home security system, with sensors on doors on the perimeter and within the home as well as an in-bed-monitoring sensor; voice and alarms alert the caregiver to the person’s location within the home and emergency alerts are provided if the person with dementia exits the home. This technology may provide caregivers reassurance that their care recipient is safe without the constant stress of having to have an open ear for their care recipients’ activities; constantly having to do so can cause significant interference with caregivers’ sleep.

The second approach to improving caregivers’ sleep is implementing cognitive behavioral therapy for insomnia (CBTi). CBTi is a highly efficacious treatment for both middle-aged and older adults; it involves behavioral and cognitive techniques aimed at changing behaviors and thoughts that perpetuate sleep difficulties. I have worked to develop this treatment to also be caregiver-specific, including psychoeducation on Alzheimer’s disease and providing an outlet to discuss the difficulties that have arisen has a result of becoming a caregiver.

The true innovation of providing CBTi to caregivers in this study has been the treatment implementation. We have designed this treatment for videoconferencing specifically for caregivers who cannot easily leave their homes because of their caregiving duties. We have had to be very creative in terms of making this technology not only functional, but also accessible to older adult caregivers.

My role in developing this unique treatment has required collaboration across several domains not typically encountered by clinical psychologists. Although every course I have ever taken on psychological treatment has touted that tele-health and technology-based psychotherapy is “the future of psychology,” actually implementing tele-health is much more complex than I anticipated. This has required testing of numerous videoconferencing systems, including hardware (e.g., tablets, iPads), cameras, software (e.g., Skype, Microsoft Lync, Cisco Jabber), and video recording software. Our research team also developed an iPad application specifically to collect self-report sleep data from participants in this study. We have also worked tirelessly in using the technology in a way that would protect participant personal health information and privacy as well as provide the most efficient and secure network connections.

This research study is still in progress and we have yet to demonstrate the effect of our treatment on caregivers’ sleep and health. However, utilizing this technology allows me to see the caregiver experiencing the difficulties of being a full-time caregiver. One such patient I worked with was tremendously sleep deprived, which impacted her caregiving for her mother with Alzheimer’s as well as her career and interactions with other family members. Once, while discussing these stressors, her mother called out to her in confusion and she responded angrily. Because I was connected to this participant in her home, I was able to witness this interaction and discuss better approaches to communication with persons with dementia. As the treatment progressed, this participants’ sleep improved and so did her ability to manage stress and interactions with her mother. Providing psychological treatment for this participant’s sleep disturbances would not have been possible without this technology; moreover, I would not have been able to witness the difficulties she was having communicating with her mother first-hand if she was not in her home environment during our sessions.

As a clinician, I am better able to appreciate the demands on these individuals when I see a piece of their life unfold; I have actually witnessed the concept of “caregiver burden” unfold in front of me. As the population of persons with dementia continues its exponential rise so will the number of informal caregivers. Successful interventions aimed at assuaging their burden will be paramount to their ability to effectively care for their loved ones. Our research on sleep interventions utilizing tele-health will benefit this community through use of an innovative in-home approach that minimizes the difficulty of leaving their care recipient unattended.

As described above, the preparation for use of this technology was extensive. The grind of logistics makes it easy to lose sight of the individuals you are observing. But I have been fortunate that, for many mornings, I begin my workday in the homes of caregivers. In utilizing videoconferencing, I experience their world in a way that other healthcare providers cannot and can use my doctoral training to truly make an impact on the surge of Alzheimer’s patients in the coming years.

View and read all of the 2014 Senior Care Innovation Scholarship finalists and congratulate them on making it closer to the scholarship prize.

Did Alicia’s essay inspire you? Don’t forget to share your thoughts below.

Caitlin Burm
Caitlin Burm
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