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1 Introduction
Pages 19-38

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From page 19...
... Because of the disease's effects on the ability to perform daily activities, persons living with dementia co-manage its demands with or rely on the support of a wide range of care partners and caregivers, including spouses, 19
From page 20...
... . Yet, while there are places where persons living with dementia and their care partners and caregivers are receiving and delivering high-quality care, many are still struggling, lack access to care interventions, and are unable to live as well as they might (NASEM, 2016)
From page 21...
... The body of evidence on care interventions for persons living with dementia and their care partners and caregivers is large and complex. Hundreds of interventions have been tested in randomized controlled trials ­ (RCTs)
From page 22...
... In this second phase, after the AHRQ systematic review is released, the com mittee will reconvene to consider the evidence found. The committee's scope will be based on the final key questions and scope of the AHRQ systematic r ­ eview, which will address care interventions relevant to Alzheimer's disease and ­ lzheimer's disease–related dementias (AD/ADRD, to include Lewy body A dementia, frontotemporal ­ ementia, and vascular cognitive impairment/dementia)
From page 23...
... The scope also included care partners and caregivers who are related to the person living with dementia, such as spouses, family members, friends, and volunteers, as well as direct care workers, such as certified nursing assistants, home health aides, auxiliary workers, personal care aides, hospice aides, promotoras or promotores, and community health workers. The scope encompassed a wide range of care interventions whose primary target is persons living with dementia, care partners and caregivers, or both together, such as memory evaluation, art therapy, social support, skills training, changes to the physical environment, care coordination, and many more (see Box 1-3 for a full list of examples)
From page 24...
... . Care partners may or may not be i ­nvolved in the provision of hands-on assistance with daily activities as a care giver.
From page 25...
... Care interventions, services, and supports: This term denotes an array of paid and unpaid personal care, health care, and social services and supports generally provided over a sustained period of time. They are delivered by health care, social services, and other community organizations or care partners and caregivers with the intent of having a direct impact on either persons with dementia or their caregivers/care partners or both.
From page 26...
... • Bereavement support • Wandering and wayfinding • Improving acute care systems • Reminiscence therapy • Skill training, including for CNAs, • Prompts and multicomponent home health aides, and/or informal interventions caregivers • Engagement interventions • Training for CNAs, home health • Exercise interventions aides, and/or informal caregivers • Psychoeducational • Improving care transitions • Art therapy • Care coordination • Dance movement therapy • Multicomponent interventions NOTE: ADL = activity of daily living; CNA = certified nursing assistant; PLWD = people living with dementia. SOURCE: Excerpted from Butler et al., 2020, pp.
From page 27...
... . AHRQ Systematic Review Design The AHRQ systematic review provides a thorough review of evidence from available RCTs on care interventions for persons living with dementia and their care partners and caregivers.
From page 28...
... systematic review developed 10 key questions to guide the research and organize the literature. These key questions are organized by four broad intervention categories and subsequently by the target of the intervention and population in which outcomes are being evaluated.
From page 29...
... NOTE: Terminology and abbreviations used in this box are those of the AHRQ systematic review and do not necessarily correspond to the terminology used in this report. SOURCE: Excerpted from Butler et al., 2020, pp.
From page 30...
... for a complete description of the design of the AHRQ systematic review. An important step in the AHRQ systematic review was to assess potentially eligible studies for risk of bias -- the extent to which the study design and procedures are likely to have guarded against sources of bias that could affect the results.
From page 31...
... The AHRQ systematic review authors made decisions through this lens, including the exclusion of studies judged to be pilots, that inform the interpretation of the review findings and conclusions (see Chapter 5 for further discussion)
From page 32...
... used methodologies that did not meet the AHRQ systematic review's inclusion criteria. Nevertheless, as a complement to the studies included in the AHRQ systematic review, these studies provide such information as feasibility, equity, and resources required, which are important to inform decisions about implementation in the real world.
From page 33...
... Therefore, in addition to examining the AHRQ systematic review's intervention categories for potential signals of benefit, the committee considered such sources as stakeholder testimony during the committee's public information-gathering meetings, including testimony from persons ­ living with dementia, care partners, and caregivers and representatives from advocacy organizations, professional associations, care systems, and payers; the Best Practice Caregiving database, which provides information from real-world implementation of interventions in practice settings (Benjamin Rose Institute on Aging and FCA, 2020a) ; and reports and presentations from the two National Research Summits on Care, Services, and Supports for Persons with Dementia and Their Caregivers (Gitlin and Maslow, 2018; Sferrazza, 2020)
From page 34...
... . With a forward-looking focus aimed at driving future research and action, these summits have produced a number of recommendations regarding dementia care and research across 12 themes based on contributions from researchers, clinicians, and stakeholders, including persons living with dementia, care partners and caregivers, service providers, government programs, and payers (Gitlin and Maslow, 2018; Sferrazza, 2020)
From page 35...
... Chapter 5 provides the committee's analysis of the available evidence and recommendations regarding the implementation of the two types of interventions for which the AHRQ systematic review found low-strength evidence of benefit -- collaborative care models and REACH (Resources for Enhancing Alzheimer's Caregiver Health) II and its adaptations -- with monitoring and evaluation, quality improvement, and information sharing.
From page 36...
... 2020. Care interventions for people living with dementia and their care­givers.
From page 37...
... 2018. Considerations for the design of a systematic review of care interventions for individuals with dementia and their caregivers: Letter report.


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