|Novel Program Enhances Dementia Caregivers’ Quality
A multifaceted, personalized intervention can significantly improve
the quality of life for caregivers of people with dementia, new
research published Nov. 21, 2006, in Annals of Internal Medicine has
found. The study, Resources for Enhancing Alzheimer’s Caregiver
Health II (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.
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.
REACH II 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.”
“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.”
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.
To reach the corresponding author, Richard Schulz, Ph.D., professor
of psychiatry, School of Medicine, University of Pittsburgh, contact
Jocelyn Uhl Duffy at 412-647-3555 or firstname.lastname@example.org
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.