Intervention for Dementia Caregivers Cuts Through Racial Barriers

|

According to a UTHSC-led study published in Annals of Internal Medicine, individualized interventions can significantly ease the burden, improve quality of life and reduce the likelihood of clinical depression in the caregiver.

According to a University of Tennessee Health Science Center-led study published today in Annals of Internal Medicine, individualized interventions can significantly ease the burden, improve quality of life and reduce the likelihood of clinical depression in the caregiver. The study is the first randomized, controlled trial to look at the effectiveness of a multi-component caregiver intervention on quality of life across a racially and ethnically diverse population.

Robert Burns, MD, Jennifer Martindale-Adams, EdD, and Linda Nichols, PhD, UTHSC and VA Medical Center investigators on the study, said the findings are significant. They point out that not only is caring for a loved one with dementia extremely stressful, the experience can contribute to the development of psychiatric and physical illnesses and increased risk for death. Approximately 4.5 million Americans with Alzheimer’s disease live at home with 75 percent being cared for by family members, making caregiver health a matter of significant interest and importance.

The researchers found that, overall, the intervention was effective across racial and ethnic groups, with the most significant improvements among Hispanic and white caregivers. “The caregiver’s quality of life diminishes immensely when loved ones are suffering from dementia,” said Robert Burns, MD, professor of Preventive and Internal Medicine at the University of Tennessee Health Science Center, and principal, Geriatrics Group of Memphis. Dr. Burns, the study’s principal investigator, explained, “For the millions of Americans who care for a loved one at home, an intervention can make meaningful differences in their ability to better care for both themselves and the patient by lessening the burden of caregiving.”

The study enrolled 642 people who were caring for a relative with Alzheimer’s disease or a related disorder at sites in Birmingham, Ala.; Memphis, Tenn.; Miami, Fla., Palo Alto, Calif.; and Philadelphia, Pa. Hispanics, whites and African-Americans were evenly represented. The more than 200 participants in each racial or ethnic group were randomized to receive either the intervention or an approach used for controlled comparison.

The study intervention used strategies such as role playing, problem solving, skills training, stress management and telephone support groups to address five problem areas. These areas, central to caregiver quality of life, include: depression; caregiver burden and stress; attention to personal health needs; social support; and problem behaviors exhibited by the care recipient, such as aggressive outbursts or feelings of hopelessness. Based on the intensity with which each caregiver experienced problems in these areas, the intervention was tailored to meet the individual needs, providing the skills necessary to better cope with the inherent stress of round-the-clock care and help manage troublesome behaviors in both the care recipient and themselves.

“Medicine doesn’t work in the same way across all races and ethnicities, or even from person-to-person,” noted Dr. Martindale-Adams, study co-investigator, who also is assistant professor in the UTHSC College of Medicine Department of Preventive Medicine. “This study showed that one size doesn’t fit all.” Hispanic and white participants saw the greatest benefit. African-American spouse-caregivers also saw improvement in the problem areas as a result of the intervention, while African-Americans caring for a non-spousal relative did not see any benefit. In the intervention group, Hispanics had the greatest improvement in reduction of caregiver depressive symptoms and problem behaviors of the recipient. Whites saw the most impact in the area of social support and African-American spouse-caregivers had the most positive outcome in reducing the caregiver burden and improving self-care.

“Families and health professionals need to identify caregivers whose quality of life has been compromised and help them get the help they need, for their sake and the sake of their loved ones,” said Dr. Nichols, the study co-principal investigator, who is a health services researcher at the VA Medical Center and professor of Preventive and Internal Medicine at the University of Tennessee Health Science Center.

The current study, REACH II, was a $1.2 million study funded by the National Institute on Aging and National Institute of Nursing Research, both of the National Institutes of Health.