by Nancy Clark, reprinted with permission from the Alzheimer’s Disease Education and Referral Center (ADEAR) newsletter, Connections, Spring, 2006
Community-based dementia caregiver interventions can reduce caregiver depression, teach effective behavior management skills, improve caregiver-care recipient relationships, and positively affect overall quality of life for caregivers, according to Alzheimer’s Disease Center researchers who recently presented results of three randomized controlled clinical trials at the Gerontological Society of America conference in Orlando, Florida.
In a joint symposium on caregiving interventions, Mary Mittelman, D.P.H., of New York University, Rebecca Logsdon, Ph.D., of the University of Washington, Ann Steffen, Ph.D., of the University of Missouri - St. Louis, and Lisa Gwyther, M.S.W., CCSW, of Duke University, discussed the results of three successful caregiver intervention studies conducted in community-based settings. They concluded that interventions for family caregivers have made significant strides in the research arena and can be adapted to larger programs in community settings.
In a study funded by NIA and the National Institute of Mental Health (NIMH), Dr. Mittelman and her colleagues conducted a randomized trial that included 406 caregivers and their families, who were randomly assigned to enhanced counseling and support or usual care. This study began in 1987 and is still ongoing. The multicomponent psychosocial intervention was designed to help improve caregiver well-being. Caregivers regularly completed a battery of structured questionnaires. Previous reports showed that the intervention reduced caregiver depression, improved reactions to patient behavior, strengthened the caregiver’s social support network, helped with family relationships, and enabled spouse caregivers to keep their husbands and wives out of nursing homes significantly longer. In her symposium presentation, entitled “Physical Health Effects of the NYU Spouse Caregiver Intervention,” Dr. Mittelman discussed the effects of the intervention on the self-rated health of caregivers over a five-year period. Mittelman and her team determined that the self-rated physical health of caregivers receiving counseling and support was better than that of caregivers in the control group. The difference in the two groups occurred within the first year of participating in the study. While differences between the control group and the experimental group diminished over time, the improvements remained statistically significant for four years.
Dr. Logsdon presented “An Interdisciplinary Approach to Community Care: Training Community Consultants to Incorporate Behavioral Interventions into Clinical Practice.” This study, funded by an Alzheimer’s Association Pioneer Award to Linda Teri, Ph.D., focused on implementing a behavioral intervention for dementia caregivers which can be delivered by community home health providers. Dr. Teri and her research team based the intervention on the Seattle Protocol, a manual-based, behavioral approach to problem solving in dementia. They trained community home health providers to deliver the treatment and studied its impact on caregivers’ mood and behavior. Compared to caregivers in the control group, those who received the behavioral intervention had significantly reduced depression, burden, and reactivity to care recipient behavior problems.
Caregivers in the treatment condition also reported decreased frequency of targeted problem behaviors and overall improvement in quality of life of the care recipient. Results were maintained at six-month follow-up. Dr. Logsdon and colleagues concluded that these results demonstrate that training community home health providers to deliver the Seattle Protocol behavioral intervention provides a practical approach to translating research-based AD caregiving tactics into usable clinical settings.
“Reducing Distress in Dementia Family Caregivers Through a Distance-Based Intervention,” a study presented by Dr. Steffen, examined the effectiveness of a distance-based intervention for female caregivers (ages 35-85) of dementia patients. Caregivers were randomly assigned to a fourteen-week telehealth intervention course or to a basic education course. The intervention course used videos, a workbook, and weekly telephone coaching sessions. The basic education course involved a caregiving manual and biweekly phone checkups. Caregivers who participated in the “telehealth” intervention demonstrated reduced stress shortly after the study completed. However, while positive results were maintained after three months, they were not maintained after six months. This study was originally funded by NIMH, and the current longitudinal phase is now funded by the Alzheimer’s Association.
These studies provide a range of strategies for providing dementia caregiver support. Noted AD caregiving expert Lisa Gwyther concluded that teaching caregivers communication skills and focused counseling interventions are generally very successful. Gwyther also stressed that it is necessary to have a clinically meaningful outcome to each study that also entails a randomized control group. She commented that in order to make a translational research study successful, it must also be fundable and sustainable. For future caregiver intervention studies assessing effectiveness of specific strategies, she suggested that researchers adopt multicomponent interventions with various steps and frequent checkups from professionals. Studies must be flexible, Gwyther said, to adapt to the stressful nature of caregiving and deliver interventions based on individual caregivers’ and patients’ needs.