Abstract Details

Title Aligning the Realities of Caregivers of Neurodegenerative Disease with the Visit-Associated Logistics (VAL) Framework

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 12-001

Objective

To integrate observed caregiver experiences in dementia care within the Visit-Associated Logistics (VAL) framework to identify intervention targets for patients with neurological disorders (ND).

Background Caregivers of people with ND face extensive challenges in coordinating medical visits and navigating health system logistics. Our prior studies highlight that clinic encounters for persons with ND (e.g., dementia) are multi-stage processes encompassing preparation, travel, and in-person medical visit experiences. The recently introduced Visit-Associated Logistics (VAL) framework offers six domains—Scheduling, Preparing, Visit-Related Time/Travel, Caregiver Independence, Routine Disruption, and Feelings/Impressions—to systematically characterize these challenges.

Design/Methods An online survey of informal caregivers of older Veterans asking about visit coordination challenges and a structured synthesis linking two datasets: qualitative interviews with dementia caregivers describing medical visit experiences and VAL constructs. Themes were coded across visit stages and mapped to VAL domains to generate medical-visit-specific constructs.

Results

The 27% (137/511) who provided ND caregiving reported poorer QoL (M= 67.1, SD = 13.52 vs. M=70.2, SD=12.78; t(509) = 2.38, p = 0.018), a higher rate of problematic behavior in the care recipient (16.1% vs. 9.6%) prior to attending the visit, and had a higher likelihood of reporting stress during medical visits (35.0% vs. 19.3%) compared to those without ND. Caregiver experiences clustered into VAL-aligned domains: (1) Preparing—anticipatory anxiety and repetitive cueing in persons with dementia; (2) Visit-Related Time/Travel—fatigue, disorientation, and travel barriers leading to missed or shortened visits; (3) Feelings/Impressions—clinic environments and rapid communication pace overwhelmed patients, while caregiver-only discussions enhanced understanding.

Conclusions Mapping neurological caregiver experiences to VAL domains reveals concrete targets for neurology clinics: clustered scheduling, pre-visit therapies to reduce anxiety, hybrid or tele-neurology follow-ups, protected caregiver consultations, and timing visits to match dyad routines. Applying VAL to caregiving can reduce caregiver burden, improve visit completion, and enhance continuity for patients with ND.

Authors/Disclosures
Lauren R. Moo, MD, FAAN (VA Bedford Healthcare System) PRESENTER	Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pilltrax. An immediate family member of Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor and Francis. Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Smith Mirabella Blake. The institution of Dr. Moo has received research support from VA HSR&D. The institution of Dr. Moo has received research support from VA Office of Rural Health. Dr. Moo has received research support from NIH.
Victoria Ngo	Victoria Ngo has nothing to disclose.
Megan Gately	Ms. Gately has nothing to disclose.
Steven Shirk	Steven Shirk has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with ICRG.
Elizabeth Chamberlin	Elizabeth Chamberlin has nothing to disclose.
Jaye McLaren (Veterans Health Administration)	Jaye McLaren has nothing to disclose.
Elizabeth (Beth) Marfeo (Tufts University Department of Community Health)	Elizabeth (Beth) Marfeo has nothing to disclose.

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