Reducing disability via a family centered intervention for acutely ill persons with Alzheimer's disease and related dementias: protocol of a cluster-randomized controlled trial (Fam-FFC study)

Marie Boltz, Ashley Kuzmik, Barbara Resnick, Rebecca Trotta, Jacqueline Mogle, Rhonda BeLue, Douglas Leslie, James E Galvin, Marie Boltz, Ashley Kuzmik, Barbara Resnick, Rebecca Trotta, Jacqueline Mogle, Rhonda BeLue, Douglas Leslie, James E Galvin

Abstract

Background: Hospitalized older persons with Alzheimer's disease and related dementias are at greater risk for functional decline and increased care dependency after discharge due to a combination of intrinsic factors, environmental, policy, and care practices that restrict physical and cognitive activity, lack of family involvement and limited staff knowledge of dementia care. We have developed a theory-based intervention, Family centered Function-focused Care, that incorporates an educational empowerment model for family caregivers (FCGs) provided within a social-ecological framework to promote specialized care to patients with dementia during hospitalization and the 60-day post-acute period. Primary aims are to test the efficacy of the intervention in improving physical and cognitive recovery in hospitalized persons living with Alzheimer's disease and related dementias (ADRD) and improving FCG preparedness and experiences.

Method: We will implement Family centered Function-focused Care in a cluster-randomized trial of 438 patient/FCG dyads in six hospital units randomized within three hospitals. We hypothesize that patients who receive the intervention will demonstrate better physical function, less delirium occurrence and severity, neuropsychiatric symptoms, and depression compared to those in the control condition (Education-only). We also hypothesize that FCGs enrolled in Family centered Function-focused Care will experience increased preparedness for caregiving, and less strain, burden, and desire to institutionalize, as compared to FCGs the control group. We will also examine the costs and relative cost savings associated with the intervention and will evaluate the cultural appropriateness of Family centered Function-focused Care for families from diverse backgrounds.

Discussion: Our theory-based intervention makes use of real-world applicable approaches in a novel and innovative way to change the paradigm of how we currently look at acute care and post-acute transitions in persons with ADRD.

Trial registration: ClinicalTrials.gov, ID: NCT03046121 . Registered on 8 February 2017.

Keywords: Dementia; Family engagement; Functional recovery; Hospitalization; Post-acute.

Conflict of interest statement

Ethics approval and consent to participate

The Fam-FFC study was approved by the Pennsylvania State University Institutional Review Board on 9 February 2017 (Study #:00006201). Any proposed modifications to the protocol will be submitted to the IRB for approval, and ClinicalTrials and participants apprised when indicated. Authors will have access to the final trial dataset. We will actively disseminate the findings of the proposed research via standard peer review mechanisms including the submission of abstracts for poster and podium presentations at local, regional, national, and international scientific meetings. We will prepare summary findings for key NIH staff as requested for inclusion in relevant reports. We plan to prepare and submit manuscripts for publication in geriatric/gerontological, behavioral health, and medical journals. As is customary, findings will also be presented to lay audiences following appropriate peer review.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Social Ecological Model: factors influencing functional recovery in hospitalized persons with dementia
Fig. 2
Fig. 2
Overall schedule and time commitment for trial participants

References

    1. Alzheimer’s Association Alzheimer’s disease facts and figures. Alzheimers Dement. 2017;2017:1–49.
    1. Zhao Y, Kuo T-C, Weir S, Kramer M, Ash A. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv Res. 2008;8(1):108. doi: 10.1186/1472-6963-8-108.
    1. Feng Z, Coots LA, Kalaganova Y, Wiener JM. Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Aff. 2014;33(4):683. doi: 10.1377/hlthaff.2013.1179.
    1. Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307:165–117. doi: 10.1001/jama.2011.1964.
    1. Zekry D, Herrmann FR, Grandjean R, et al. Demented versus non-demented very old inpatients: the same co-morbidities but poorer functional and nutritional status. Age Ageing. 2008;37:83–89. doi: 10.1093/ageing/afm132.
    1. Margiotta A, Bianchetti A, Ranieri P, Trabucchi M. Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients. J. Nutr. Health Aging. 2006;10(6):535–539.
    1. Mecocci P, von Strauss E, Cherubini A, et al. Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: results from the GIFA study. Dement Geriatr Cogn Disord. 2005;20(4):262–269. doi: 10.1159/000087440.
    1. Watkin L, Blanchard MR, Tookman A, et al. Prospective cohort study of adverse events in older people admitted to the acute general hospital: risk factors and the impact of dementia. Int J Geriatr Psychiatry. 2012;1:76–82. doi: 10.1002/gps.2693.
    1. Maslow K. How many people with dementia are hospitalized? In: Silverstein N, Maslow K, editors. Improving hospital care for persons with dementia. New York: Springer; 2006. pp. 3–22.
    1. Sampson EL, Blanchard MR, Jones L, et al. Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br J Psychiatry J Ment Sci. 2009;195(1):61–66. doi: 10.1192/bjp.bp.108.055335.
    1. Fong TG, Jones RN, Shi P, et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology. 2009;72(18):1570–1575. doi: 10.1212/WNL.0b013e3181a4129a.
    1. Kiely DK, Jones RN, Bergmann MA, Murphy KM, Oray EJ, Marcantonio ER. Association between delirium resolution and functional recovery among newly admitted postacute facility patients. J Gerontol A Biol Sci Med Sci. 2006;61(2):204–208. doi: 10.1093/gerona/61.2.204.
    1. Kiely DK, Jones RN, Bergmann MA, Murphy KM, Oray EJ, Marcantonio ER. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2007;62(2):174–179. doi: 10.1093/gerona/62.2.174.
    1. Daiello LA, Gardner R, Epstein-Lubow G, Butterfield K, Gravenstein S. Association of dementia with early rehospitalization among Medicare beneficiaries. Arch Gerontol Geriatr. 2014;59(1):162–168. doi: 10.1016/j.archger.2014.02.010.
    1. Boltz M, Galvin J. Family-centered strategies to promote cognitive and functional recovery in acutely ill person with dementia. Alzheimers Dement. 2013;9(S5):515–516. doi: 10.1016/j.jalz.2013.04.231.
    1. Jutkowitz E, Kane RL, Gaugler JE, MacLehose RF, Dowd B, Kuntz KM. Societal and Family Lifetime Cost of Dementia: Implications for Policy. J Am Geriatr Soc. 2017;65(10):2169–2175.
    1. Boltz M, Chippendale T, Resnick B, Galvin J. Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses. Alzheimer’s Dis Assoc Disord. 2015;29(3):236–241. doi: 10.1097/WAD.0000000000000072.
    1. Boltz M, Galvin J. Post-acute needs of the person with dementia and their family caregivers. Gerontologist. 2013;53:S1. doi: 10.1093/geront/gnt004.
    1. Erdem E. Prevalence of chronic conditions among Medicare Part A beneficiaries in 2008 and 2010: are Medicare beneficiaries getting sicker? Prev Chronic Dis. 2014;11:130118.
    1. Miu DK, Chan CW, Kok C. Delirium among elderly patients admitted to a post-acute care facility and 3-months outcome. Geriatrics & gerontology international. 2016;16(5):586–92.
    1. Sands LP, Yaffe K, Covinsky K, et al. Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. J Gerontol A Biol Sci Med Sci. 2003;58(1):37–45. doi: 10.1093/gerona/58.1.M37.
    1. Goodwin JS, Howrey B, Zhang DD, Kuo YF. Risk of continued institutionalization after hospitalization in older adults. J Gerontol A Biol Sci Med Sci. 2011;66(12):1321–1327. doi: 10.1093/gerona/glr171.
    1. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability. JAMA. 2011;306(16):1782–1784. doi: 10.1001/jama.2011.1556.
    1. Mathews SB, Arnold SE, Epperson CN. Hospitalization and cognitive decline: can the nature of the relationship be deciphered? Am J Geriatr Psychiatry. 2014;22(5):465–480. doi: 10.1016/j.jagp.2012.08.012.
    1. Borbasi S, Jones J, Lockwood C, Emden C. Health professionals’ perspectives of providing care to people with dementia in the acute setting: toward better practice. Geriatr Nurs. 2006;27(5):300–308. doi: 10.1016/j.gerinurse.2006.08.013.
    1. Waugh A1, Marland G, Henderson J, Robertson J, Wilson A. Improving the care of people with dementia in hospital. Nurs Stand. 2011;25(32):44–9.
    1. Brown CJ, Redden DT, Flood KL, Allman RM. The under-recognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009;57(9):1660–1665. doi: 10.1111/j.1532-5415.2009.02393.x.
    1. Boltz M, Resnick B, Shabbat N, Capezuti E. Function-focused care and changes in physical function in Chinese American and non-Chinese American hospitalized older adults. Rehabil Nurs. 2011;36(6):233–240. doi: 10.1002/j.2048-7940.2011.tb00088.x.
    1. Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older patients with dementia. Ann Intern Med. 2007;146:775–786. doi: 10.7326/0003-4819-146-11-200706050-00006.
    1. Minnick AF, Mion LC, Johnson ME, Catrambone C, Leipzig R. Prevalence and variation of physical restraint use in US acute care settings. J Nurs Scholarsh. 2007;39(1):30–37. doi: 10.1111/j.1547-5069.2007.00140.x.
    1. Galvin JE, Kuntemeier B, Al-Hammadi N, Germino J, Murphy-White M, MFCGillick J. Dementia-friendly hospitals: care not crisis. Improving the care of the hospitalized patient with dementia. Alz Dis Assoc Disord. 2010;24:372–379. doi: 10.1097/WAD.0b013e3181e9f829.
    1. Gandesha A, Souza R, Chaplin R, Hood C. Adequacy of training in dementia care for acute hospital staff. Nursing Older People. 2012.
    1. Boltz M, Capezuti E, Shabbat N. Nursing staff perceptions of physical function in hospitalized older adults. Appl Nurs Res 2011. 24(4):215–22.
    1. Boltz M, Capezuti E, Shabbat N, Hall K. Going home better not worse: older adults’ views on physical function during hospitalization. Int J Nurs Pract. 2010;16(4):381–388. doi: 10.1111/j.1440-172X.2010.01855.x.
    1. Boltz M, Resnick B, Capezuti E, Shuluk J. Activity restriction vs self-direction: hospitalised older adults’ response to fear of falling. Int J Older People Nurs. 2014;9:44–53. doi: 10.1111/opn.12015.
    1. Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12:240–249. doi: 10.1097/00019442-200405000-00002.
    1. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009;11(2):217–228.
    1. Drame M, Lang PO, Jolly D, et al. Nursing home admission in elderly subjects with dementia: predictive factors and future challenges. J Am Med Dir Assoc. 2012;13(1):83. doi: 10.1016/j.jamda.2011.03.002.
    1. Resnick B, Boltz M, editors. Optimizing physical activity and function across settings. Annual review of gerontology and geriatrics. New York: Springer; 2016.
    1. Clissett P, Porock D, Harwood RH, Gladman JRF. The challenges of achieving person-centred care in acute hospitals: a qualitative study of people with dementia and their families. Int J Nurs Stud. 2013;50(11):1495–503.
    1. Howard R, Ballard C, O’Brien JO, Burns A. Guidelines for the management of agitation in dementia. Int J Geriatr Psychiatry. 2011;16(7):714–717. doi: 10.1002/gps.418.
    1. Bannon K. Reforming dementia care. Nurs Times. 2013;109:12–27.
    1. Jeste DV, Blazer D, Casey D, Meeks T, Salzman C, Schneider L, Tariot P, Yaffe K. ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology. 2008;33(5):957–970. doi: 10.1038/sj.npp.1301492.
    1. Pretzer-Aboff I, Galik E, Resnick B. Testing the feasibility and long-term impact of a function focused care intervention for people with Parkinson’s in the community setting. Nurs Res. 2011;60(4):276–228. doi: 10.1097/NNR.0b013e318221bb0f.
    1. Shankar KN, Hirschman KB, Hanlon AL, Naylor MD. Burden in caregivers of cognitively impaired elderly adults at time of hospitalization: a cross-sectional analysis. J Am Geriatr Soc. 2014;62(2):276–284. doi: 10.1111/jgs.12657.
    1. Campbell P, Wright J, Oyebode J, et al. Determinants of burden in those who care for someone with dementia. Int J Geriatr Psychiatry. 2008;23:1078–1085. doi: 10.1002/gps.2071.
    1. Ory MG, Hoffman RR, Yee JL, et al. Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. Gerontologist. 1999;39:177–185. doi: 10.1093/geront/39.2.177.
    1. Cooper C, Katona C, Orrell M, Livingston G. Coping strategies and anxiety in caregivers of people with Alzheimer’s disease: the LASER-AD study. J Affect Disord. 2006;90:15–20. doi: 10.1016/j.jad.2005.08.017.
    1. Gaugler JE, Yu F, Krichbaum K, Wyman JF. Predictors of nursing home admission for persons with dementia. Med Care. 2009;47:191–198. doi: 10.1097/MLR.0b013e31818457ce.
    1. Elliot R, Adams J. The creation of a dementia nurse specialist role in an acute general hospital. J Psychiatric Mental Health Nurs. 2011;18(7):648–652. doi: 10.1111/j.1365-2850.2011.01771.x.
    1. Li H, Powers BA, Melnyk BM, et al. Randomized controlled trial of CARE: an intervention to improve outcomes of hospitalized elders and family caregivers. Res Nurs Health. 2012;35:533–549. doi: 10.1002/nur.21491.
    1. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150:178–187. doi: 10.7326/0003-4819-150-3-200902030-00007.
    1. Naylor MD, Stephens C, Bowles KH, Bixby MB. Cognitively impaired older adults: from hospital to home. AJN. 2005;105(2):52–61. doi: 10.1097/00000446-200502000-00028.
    1. Boltz M, Chippendale T, Resnick B, Galvin J. Testing family centered, function-focused care in hospitalized persons with dementia. Neurodegen Dis Manag. 2015;5(3):203–215. doi: 10.2217/nmt.15.10.
    1. Boltz M, Resnick B, Chippendale T, Galvin J. Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. J Am Geriatr Soc. 2014;62(12):2398–2407.
    1. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297–322. doi: 10.1146/annurev.publhealth.27.021405.102100.
    1. Resnick B, Galik E, Boltz M. Function focused care approaches to care for older adults: literature review of progress and future possibilities. J Am Med Direct Assoc. 2012;14(5):313–8.
    1. Bandura A. Self-efficacy: the exercise of control. New York: WH Freeman Company; 1997.
    1. Nasreddine Z, Phillips N, Bédirian V, et al. The Montreal Cognitive Assessment (MoCA): a brief screening tool for mild cognitive impairment. JAGS. 2005;53:695–699. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Goldstein FC, Ashley AV, Miller E, et al. Validity of the Montreal Cognitive Assessment as a screen for mild cognitive impairment and dementia in African Americans. J Geriatr Psychiatry Neurol. 2014;27(3):199–203. doi: 10.1177/0891988714524630.
    1. Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatr. 2007;52(5):329–332. doi: 10.1177/070674370705200508.
    1. Validation of the Montreal Cognitive Assessment Spanish Version test (MoCA-S) as a screening tool for mild cognitive impairment and mild dementia in Bogotá, Colombia. Alzheimer’s Dementia. 2013;9(4):P452–P453.
    1. Berstein IH, Lacritz L, Barlow CF, Weiner MF, DeFina LF. Psychometric evaluation of the Montreal Cognitive Assessment (MoCA) in three diverse samples. Clin Neuropsychol. 2011;25(1):119–126. doi: 10.1080/13854046.2010.533196.
    1. Galvin JE, Roe CM, Powlishta KK, et al. The AD8, a brief informant interview to detect dementia. Neurology. 2005;65:559–564. doi: 10.1212/01.wnl.0000172958.95282.2a.
    1. Galvin JE, Roe CM, Xiong C, Morris JC. The validity and reliability of the AD8 informant interview for dementia. Neurology. 2006;67:1942–1948. doi: 10.1212/01.wnl.0000247042.15547.eb.
    1. Morris JC. Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr. 1997;9(Suppl 1):173–176. doi: 10.1017/S1041610297004870.
    1. Resnick R, Gruber-Baldini AL, Pretzer-Aboff L, et al. Reliability and validity of the evaluation to sign consent measure. Gerontologist. 2007;47:69–67. doi: 10.1093/geront/47.1.69.
    1. Pfeffer RI, et al. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323–329. doi: 10.1093/geronj/37.3.323.
    1. Kiresuk TJ, Smith A, Cardillo JE. Goal attainment scaling: applications, theory and measurement. Mahwah: Lawrence-Erlbaum; 1994.
    1. Resnick B, Galik E, Boltz M. Basic Physical Capability Scale: psychometric testing with cognitively impaired older adults. Am J Alzheimers Dis. Other Demen. 2014;29(4):326–332. doi: 10.1177/1533317513517039.
    1. Resnick B, Rogers V, Galik E, Gruber-Baldini A. Measuring restorative care provided by nursing assistants: reliability and validity of the Restorative Care Behavior Checklist. Nurs Res. 2007;56:387–398. doi: 10.1097/.
    1. Bellg AJ, Borrelli B, Resnick B, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23:443–451. doi: 10.1037/0278-6133.23.5.443.
    1. Resnick B, Bellng AJ, Borrelli B, et al. Examples of implementation and evaluation of treatment fidelity in the BCC studies: where we are and where we need to go. Ann Behav Med. 2005;29:46–54. doi: 10.1207/s15324796abm2902s_8.
    1. Van Doorn C, Bogardus S, Williams C, Concato J, Towle V, Inouye S. Risk adjustment for older hospitalized persons: a comparison of two methods of data collection for the Charlson Index. J Clin Epidemiol. 2001;54:694–701. doi: 10.1016/S0895-4356(00)00367-X.
    1. Mahoney F, Barthel D. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.
    1. Ware JE. SF-36 Health Survey. Boston: The Health Institute, New England Medical Center; 1993.
    1. Dumenci L, Matsuyama RK, Kuhn L, Perera RA, Siminoff LA. On the validity of the Shortened Rapid Estimate of Adult Literacy in Medicine (REALM) Scale as a measure of health literacy. Commun Methods Meas. 2013;7(2):134–143. doi: 10.1080/19312458.2013.789839.
    1. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res. 1997;42(1):17–41. doi: 10.1016/S0022-3999(96)00216-4.
    1. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69–77. doi: 10.1016/S0022-3999(01)00296-3.
    1. National Institute of Mental Health website. The Ask Suicide-Screening Questions. Accessed 21 Mar 2018 at:
    1. Resnick B, Daly MP. Predictors of functional ability in geriatric rehabilitation patients. Rehabil Nurs. 1998;23:21–29. doi: 10.1002/j.2048-7940.1998.tb01752.x.
    1. Nicholl L, Hobart J, Dunwoody L, Cramp F, Lowe-Strong A. Measuring disability in multiple sclerosis: is the Community Dependency Index an improvement on the Barthel Index? Mult Scler. 2004;10:447–50.
    1. Ranhoff AH. Reliability of nursing assistants’ observations of functioning and clinical symptoms and signs. Aging (Milano) 1997;9:378–380.
    1. Tinetti ME, Williams TF, Mayewski R. Fall Risk Index for elderly patients based on number of chronic disabilities. Am J Med. 1986;80:429–434. doi: 10.1016/0002-9343(86)90717-5.
    1. CamnTech MotionWatch8 . Accessed 2 April 2018.
    1. Warms CA, Belza BL. Actigraphy as a measure of physical activity for wheelchair users with spinal cord injury. Nurs Res. 2004;53:136–143. doi: 10.1097/00006199-200403000-00010.
    1. Landry GJ, Falck RS, Beets MW, Liu-Ambrose T. Measuring physical activity in older adults: calibrating cut-points for the MotionWatch 8©. Front Aging Neurosci. 2015;1025:25.
    1. Landry GJ, Best JR, Liu-Ambrose T. Measuring sleep quality in older adults: a comparison using subjective and objective methods. Front Aging Neurosci. 2015;7:166.
    1. Eggermont LHP, Scherder EJA. Ambulatory but sedentary: impact on cognition and the Restactivity rhythm in nursing home residents with dementia. J Gerontol B Psychol Sci Soc Sci. 2008;63:279–287. doi: 10.1093/geronb/63.5.P279.
    1. Inouye S, Van Dyck C, Alessi C, Balkin S, Siegal A, Horwitz R. Clarifying confusion: the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–948. doi: 10.7326/0003-4819-113-12-941.
    1. Trzepacz P, Baker R, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23:89–97. doi: 10.1016/0165-1781(88)90037-6.
    1. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry. 1998;23:271–284. doi: 10.1016/0006-3223(88)90038-8.
    1. Korner A, Lauritzen L, Abelskov K, et al. The Geriatric Depression Scale and the Cornell Scale Depression in Dementia. A validity study. Nord J Psychiatry. 2006;60:360–364. doi: 10.1080/08039480600937066.
    1. Kaufer DI, Cummings JL, Ketchel P, et al. ST. Brief Neuropsychiatric Inventory (NPI-Q) Validation of the NPI-Q, a Brief Clinical Form of the Neuropsychiatric Inventory. J Neuropsychiatry. 2000;12(2):233–239.
    1. Archbold PG, Stewart BJ, Greenlick MR, Harvath TA. Key aspects of eldercare. New York: Springer; 1992. The clinical assessment of mutuality and preparedness in family caregivers to frail older people; pp. 328–339.
    1. Robinson B. Validation of a Caregiver Strain Index. J Geron. 1983;38:344–348. doi: 10.1093/geronj/38.3.344.
    1. Thornton M, Travis SS. Analysis of the reliability of the Modified Caregiver Strain Index. J Geron. 2003;58B(2):S127–S132. doi: 10.1093/geronb/58.2.S127.
    1. Herbert R, Bravo G, Preville M. Reliability, validity, and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Can J Aging. 2000;19:494–507. doi: 10.1017/S0714980800012484.
    1. Martın-Carrasco M. EDUCA study: psychometric properties of the Spanish version of the Zarit Caregiver Burden Scale. Aging Ment Health. 2010;14(6):705–711. doi: 10.1080/13607860903586094.
    1. Morycz RK. Caregiving strain and the desire to institutionalize family members with Alzheimer’s disease. Res Aging. 1985;7:329–361. doi: 10.1177/0164027585007003002.
    1. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999;319:670–67117. doi: 10.1136/bmj.319.7211.670.
    1. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46(3):399–424. doi: 10.1080/00273171.2011.568786.
    1. SAS / STAT 9.2 User’s Guide (SAS Institute Inc.). . Accessed 2 April 2018.
    1. Gibbons RD, Hedeker D. Random effects Probit and logistic regression models for three-level data. Biometrics. 1997;4:1527. doi: 10.2307/2533520.
    1. Raman R, Hedeker D. A mixed-effects regression model for three-level ordinal response data. Stat Med. 2015;24(21):3331–45.
    1. Singer JD. Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educ Behav Stat. 1998;4:323. doi: 10.3102/10769986023004323.
    1. Das S, Krishen A. Some bootstrap methods in nonlinear mixed-effect models. J Stat Plann Infer. 1999:75(2)37–45.
    1. Samanta M, Welsh A. Bootstrapping for highly unbalanced clustered data. Comput Stat Data Anal. 2013:59(1)70–81.
    1. Thai H, Mentre F, Holford N, Veyrat-Follet C, Comets E. A comparison of bootstrap approaches for estimating uncertainty of parameters in linear mixed-effects models. Pharm Stat. 2013;12(3):129–40.
    1. Hedeker D, Gibbons RD. Application of random-effects pattern-mixture models for missing data in longitudinal studies. Psychol Methods. 1997;2(1):64. doi: 10.1037/1082-989X.2.1.64.
    1. Chatterji P, et al. Applying cost analysis methods to school-based prevention programs. Prev Sci. 2001;2(1):45–55. doi: 10.1023/A:1010086928908.
    1. Crowder SJ, Broome ME. A framework to evaluate the cultural appropriateness of intervention research. West J Nurs Res. 2012;34(8):1002–1022. doi: 10.1177/0193945912451656.
    1. Bernal G, Sáez-Santiago E. Culturally centered psychosocial interventions. J Community Psychol. 2006;34(2):121–132. doi: 10.1002/jcop.20096.
    1. Neuendorf K. The content analysis guidebook. Thousand Oaks: Sage; 2002.
    1. Boltz M, Chippendale T, Lee K-H, Trotta R. The influence of family caregiver factors upon pre-admission functional decline in hospitalized persons with dementia. Arch Gerontol Geriatr. 2018;74:49–54. doi: 10.1016/j.archger.2017.09.006.

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