Posted December 18, 2020

David Geldmacher, M.D., University of Alabama at Birmingham

 David Geldmacher, M.D., University of Alabama at Birmingham Dr. David Geldmacher

Caring for individuals who live with a neurological impairment such as traumatic brain injury (TBI) or Alzheimer’s disease (AD)/AD-related dementia can be challenging. Caregivers must show compassion for individuals with a variety of symptoms that can include memory issues, poor judgement, and depression. Quite often, a caregiver is faced with the challenge of helping an individual eat, get dressed, or shower. That individual may refuse their help, and may even not be able to complete that activity. This leads to a declining state of health for not only the person with the impairment, but the caregiver as well. Tools and strategies that enable a caregiver to deal with these significant challenges are truly needed.

Dr. David Geldmacher has developed a strategy that prepares caregivers for encounters with care-resistant behaviors. Dr. Geldmacher’s approach involved six weekly online coaching sessions conducted by a nurse practitioner. These helped participants set goals for improving how they interact with their family member. The sessions were tailored to individual needs since the personal history of the person affected by the neurological impairments was a factor in the overall intervention. The coaching involved role-playing and script development to guide the caregiver when confronted with a care challenge at home. Using the combination of education, role-playing, and custom-tailoring, the training has shown some success in a small cohort of participants funded by the PRARP; the study is currently ongoing1. While study outcomes have thus far focused on individuals living with dementia, it also tests this coaching approach for caregivers for those living with TBI.

Cognitive losses in people with AD or TBI may cause them to perceive caregiving activities as physical or psychological threats. This results in a dysfunctional cycle of resisting care that can increase caregiver burden and decrease quality of life in the family setting. This project coaches caregivers to use individualized strategies to change their approach to care activities, with the intent to trigger less care-resistant behavior. A successful intervention would result in reduced caregiver burden and improved quality of life for the family.


Jablonski R, Winstead V, and Geldmacher D. 2019. Description of process and content of online dementia coaching for family caregivers of persons with dementia. Healthcare (Basel) 7(1):13. doi: 10.3390/healthcare7010013.


Public and Technical Abstracts: Improving Family Quality of Life through Training to Reduce Care-Resistant Behaviors by People with Alzheimer Dementia and Traumatic Brain Injury

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