Knowledge and Interpersonal Skills to Develop Enhanced Relationships (KINDER)

Browse trials for

• Dementia 2,162

Study arms

• Experimental
  KINDER Intervention Arm

  KINDER is an 8-week intervention that consists of three facilitated group discussion sessions conducted over Zoom with a small group of caregivers, in addition to self-paced lessons delivered using a printed or PDF workbook, depending on participant preference. Throughout KINDER, caregivers reflect on their relationship, including how their behavior toward the care recipient may need to change considering new vulnerabilities with dementia, and how to communicate about topics that often contribute to conflict, such as balancing safety and independence (e.g., driving).

  Behavioral: Knowledge and Interpersonal Skills to Develop Enhanced Relationships

• Placebo comparator
  Control Condition

  Caregivers in the control arm will receive a workbook that covers 8 weeks of content focused on healthy living (e.g., nutrition).

  Behavioral: Healthy Living for the Caregiver

Interventions

• BehavioralKnowledge and Interpersonal Skills to Develop Enhanced Relationships

  KINDER is an 8-week intervention that consists of three facilitated group discussion sessions conducted over Zoom with a small group of caregivers, in addition to self-paced lessons delivered using a printed or PDF workbook, depending on participant preference. Throughout KINDER, caregivers reflect on their relationship, including how their behavior toward the care recipient may need to change considering new vulnerabilities with dementia, and how to communicate about topics that often contribute to conflict, such as balancing safety and independence (e.g., driving).

• BehavioralHealthy Living for the Caregiver

  Caregivers in the control arm will receive a workbook that covers 8 weeks of content focused on healthy living (e.g., nutrition).

Primary outcomes

1. Psychological Elder Abuse

   The investigators will use a modified version of the Conflict Tactics Scale 2 to measure psychological EA (MCTS 2). This scale includes five psychological EA behaviors, such as insulting, swearing at, or yelling at the care recipient, as well as threatening to stop taking care of the care recipient, placing them in a nursing home, threatening physical harm, and stomping out of the room. Participants will be asked to describe the frequency of each behavior in the last 2 months, such that response options will include: None, Once, Twice, 3 to 5 times, 6 to 10 times, and More than 10 times. Scores range from 0 to 30. Higher scores indicate greater frequency of mistreatment. Higher scores indicate greater frequency of abuse. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

2. Quality of Caregiving

   To measure quality of care, the investigators will use the 11-item Exemplary Caregiving Scale, which focuses on providing care that meets the care recipient's needs (α=0.73) and is respectful (α=0.76). Response options include Never, Sometimes, Often, and Always (range: 11 to 44). Higher scores indicate higher quality of caregiving. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

Secondary outcomes

1. Resourcefulness

   Resourcefulness is measured using the 28-item Caregiver Resourcefulness Scale (α=0.85). This scale has two factors: one focused on help-seeking and another on self-help. Caregivers are asked the frequency at which they use different strategies to manage challenges, and may respond: Not at all like me (0), Pretty much not like me (1), A little bit not like me (2), A little bit like me (3), Pretty much like much like me (4), or Very much like me (5). Items are added together to create a total score. Scores range from 0 to 140, where higher scores indicate higher levels of resourcefulness. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

2. Caregiving Relationship Strain

   Relationship strain will be measured using the 5-item Strain Scale of the Dyadic Relationship Scale (α=0.69). Respondents are asked to indicate agreement with statements such as, "The patient made too many requests," and may indicate Strongly Disagree, Disagree, Agree, or Strongly Agree. The scale has a range of scores from 4 to 20, where higher scores indicate greater levels of relationship strain. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

Other outcomes

1. Other Types of Elder Abuse

   Other types of elder abuse will be measured with the Geriatric Mistreatment Scale (GMS). The GMS is a 22-items scale that measures psychological, physical, sexual, financial abuse, and neglect using "yes" and "no" questions (range of response: 0 to 22). Higher scores indicate greater frequency of abuse. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

2. Depressive Cognitions

   Caregiver depressive cognitions will be measured using the Depressive Cognitions Scale, which measures thinking patterns preceding depression. The 8-item Depressive Cognitions Scale is validated for use among AD/ADRD CGs, with a Cronbach's alpha of 0.75 to 0.88. Respondents indicate their level of agreement with each statement on a 6-point Likert scale with responses from "totally disagree" to "totally agree." Scores range from 0 to 40. Higher scores indicate higher levels of depressive cognitions. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

3. Social Support

   Social Support will be measured using the NIH Toolbox measure for emotional support. This scale has 8 items about how frequently individuals access support (e.g., someone who understands my problems). Scores range from Never, Rarely, Sometimes, Usually, and Always (range=8-40). Higher scores indicate higher levels of social support. The outcome measure will use the average change score from baseline scores until each post-intervention survey.

   Time frame: Baseline, 2 weeks post-intervention, 12 weeks post-intervention, 24 weeks post-intervention

Individual participant data

Plan to share: Yes — Baseline and follow up surveys with participants; Referral, screening, enrollment, and retention data; Fidelity surveys. All data will be de-identified.

Supporting information: Study protocol, Sap, Icf, Analytic code