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Alzheimer's, Dementia & Mental Health
Dementia Caregivers See Lives Greatly Improved by
Personalized Intervention
Unique program studied results with different
ethnic groups
November 29, 2006 - A program featuring personalized intervention has
been found to significantly improve the quality of life for caregivers
of people with dementia. The study, Resources for Enhancing Alzheimer’s
Caregiver Health II (REACH II), found differing results, however, among
ethnic groups.
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REACH II is the first randomized, controlled trial
to look systematically at the effectiveness of a multi-component
caregiver intervention provided to ethnically diverse populations. A
report was published Nov. 21 in the Annals of Internal Medicine.
The program was funded by the National Institute on
Aging (NIA) and the National Institute of Nursing Research (NINR), both
components of the National Institutes of Health (NIH).
The research was conducted at five sites nationwide
— the University of Alabama (Birmingham and Tuscaloosa), Thomas
Jefferson University (Philadelphia), the University of Tennessee
(Memphis), the University of Miami (Fla.) and Stanford University (Palo
Alto, Calif.). The University of Pittsburgh served as the coordinating
center, and Pittsburgh’s Richard Schulz, Ph.D., was corresponding author
for the study.
“Family members and friends provide most of the
care for millions of people with dementia who live at home, often facing
challenges that can seriously compromise their own quality of life,”
notes NIA Director Richard J. Hodes, M.D. “REACH II tells us that a
well-designed, tailored intervention can make a positive, meaningful
difference in caregivers’ lives.”
The REACH II study included 642 individuals, more
than 200 each of Hispanic, white and African American caregivers of
persons with dementia. The caregivers within each ethnic/racial group
were randomly assigned to either an intervention or a control group.
Trained project staff visited the caregivers in the
intervention group at home nine times, talked with them during three
half-hour telephone calls, and offered five structured telephone support
sessions.
The strategies included information sharing,
instruction, role playing, problem solving, skills training,
stress-management techniques and telephone support groups. Those in the
control group received a packet of dementia education materials and two
brief “check-in” telephone calls. Spanish-language services and
materials were offered to the Spanish-speaking caregivers in Miami, Palo
Alto and Philadelphia.
Before the services began and six months later,
researchers assessed caregivers’ quality of life overall and in five
specific quality of life areas:
● depressive symptoms,
● the burden of caregiving (such as the level of stress),
● engagement in self-care activities (such as getting rest or seeing a
doctor when needed),
● level of social support, and
● problem behaviors exhibited by the person with dementia.
The investigators also measured the prevalence of
clinical depression among the caregivers and collected data on whether
the care recipients had been placed in institutions during the six-month
study period.
After six months, improvements in the caregivers’
overall quality of life were significant among the Hispanic and white
caregivers who took part in the intervention and, while significant
among African American spouse caregivers, were less so among non-spouse
African American caregivers.
Large and clinically important quality of life
improvements were found for 45 percent of Hispanic caregivers, 40
percent of white caregivers and 28 percent of African American
caregivers in the intervention group, compared with 7 percent, 13
percent and 11 percent among Hispanics, whites and African Americans,
respectively, in the control group.
For Hispanics, the intervention was found to be
most effective in reducing depressive symptoms and problem behaviors of
the care recipient. Among whites, the greatest impact was in the area of
social support, and among African Americans, there were positive effects
specifically in reducing the caregiver burden and improving self-care
among spouse caregivers.
The research also showed that following the
program, the rate of clinical depression was significantly lower among
caregivers in the intervention group than those in the control group
(12.6 percent and 22.7 percent, respectively). The rate of
institutionalization for care recipients was lower in the intervention
group when compared with the control group (4.3 percent vs. 7.2
percent), but this difference was not statistically significant.
The researchers also collected data on how study
participants viewed the intervention. Caregivers in the intervention
group reported that taking part in the program helped them feel more
confident in working with the care recipient, made life easier for them,
improved their ability to care for the person with dementia, improved
the care recipient’s life, and helped them keep the patient at home.
Many members of the control group also said they benefited “some” or “a
great deal” from participating in the study, suggesting that even
minimal support and attention can help caregivers.
“REACH II was a carefully constructed, controlled
study involving a diverse group of caregivers at five sites across the
country. We are excited to demonstrate that the intervention really
helps family members caring for people with Alzheimer’s,” says Sidney M.
Stahl, Ph.D., chief of the Individual Behavioral Processes Branch within
the NIA’s Behavioral and Social Research Program.
Based on the current
study, the REACH program looks promising for widespread community use,
especially if the outcomes are replicated by other organizations and the
program is found to be cost-effective when compared with alternatives,
Stahl adds.
The study was developed based on the findings of
the earlier REACH I study, which tested multiple interventions at six
sites in the United States to identify the most promising approaches to
decrease caregiver burden and depression.
“This important research demonstrates that the
intervention can readily benefit the diverse communities of caretakers
who provide care to individuals with Alzheimer’s disease,” adds NINR
Director Dr. Patricia A. Grady. “It also underscores the substantial
cost that caregivers face — financially, physically, spiritually and
emotionally — and helps to illustrate why caregiving research is a
priority for NINR and NIA.”
Follow-up studies, the researchers suggest, should
examine how the intervention might be used in communities through the
nation’s existing network of health and aging services.
Editor's Notes:
The NIA leads the federal effort supporting and
conducting research on aging and the medical, social and behavioral
issues of older people, including Alzheimer’s disease and age-related
cognitive decline. For information on dementia and aging, please visit
the NIA’s Alzheimer’s Disease Education and Referral (ADEAR) Center at
www.nia.nih.gov/alzheimers, or call 1-800-438-4380. For more general
information on research and aging, go to
www.nia.nih.gov.
The primary mission of the NINR is to support
clinical and basic research to establish a scientific basis for the care
of individuals across the life span. For additional information, visit
the NINR Web site at
www.ninr.nih.gov.
The National Institutes of Health (NIH) — The
Nation's Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
www.nih.gov.
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