In the United States, nearly 11 million caregivers provide 12.5 billion hours of care annually to those with Alzheimer’s disease, according to Linda Nichols, PhD, professor of Preventive Medicine and Internal Medicine at the University of Tennessee Health Science Center (UTHSC).
The value of this informal care, performed primarily by relatives and friends of dementia patients, is roughly $144 billion, more than what is spent on nursing home care and home health care combined, said Dr. Nichols, who is also co-director of the Caregiver Center at the Memphis VA Medical Center. She and Jennifer Martindale-Adams, EdD, Caregiver Center co-director and an assistant professor of Preventive Medicine at UTHSC, have spent years researching the physical and mental effects of intervention sessions on dementia caregivers.
The National Institute on Aging of the National Institutes of Health (NIH) has awarded Dr. Nichols $597,313 over a three-year period to study whether these interventions do more than just improve quality of life for caregivers and reduce difficult patient behaviors. The grant will let the researchers study whether the interventions translate into reduced health care use and costs for the patient and the caregiver. If lower costs can be documented, they believe more health care systems would adopt and fund interventions for caregivers of dementia patients.
“We know that doing the interventions decreases burden, depression and caregiver frustrations, which are potential triggers for abusive behaviors, and caregivers report that they have more time for themselves per day and that there is a decrease in the patients’ behavioral problems,” Dr. Nichols said. But that’s not enough for a health care system to implement an intervention program, without documented cost savings.
Dr. Nichols, Dr. Martindale-Adams, Robert Burns, MD, professor of Preventive Medicine and Internal Medicine at UTHSC, and Teresa Waters, PhD, professor of Preventive Medicine at UTHSC, will examine data from previous studies of caregiver interventions, including REACH II (Resources for Enhancing Alzheimer’s Caregivers Health), the first major national study, and REACH VA, a clinical translation of the earlier study that was conducted at VA hospitals in 24 sites across the country, including Memphis. They will also look at Medicare claims data.
“We’re going to compare those who were in the intervention with those who were not in the intervention and see if there are any differences in health care costs,” Dr. Nichols said. “We’re looking at whether being in a successful dementia caregiving intervention and having your depression and your burden go down, and feeling like you’re doing a better job of managing the patient’s problems, translated into decreased health care costs, both for the patient and the caregiver. It’s something that’s really not been done.”
The interventions, which include home visits and phone consultations, teach caregivers problem-solving skills, coping strategies, stress-management skills and cognitive restructuring. They also address specific logistical and financial problems associated with caring for a dementia patient.
“We hope to find out that a successful intervention can reduce health care cost for the caregiver and the patient,” Dr. Martindale-Adams said.
Dr. Nichols said showing a cost savings would make health care systems more receptive to setting up caregiver intervention programs. “If you could show, ‘Look, if you pay for this service, they’re not going to be coming into the hospital as much, because you’re going to teach them how to manage problems,’ a hospital system would say, ‘It’s worth it for us to have somebody do this.’ ”
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. NIH is the primary federal agency conducting and supporting basic, clinical and translational medical research, and is investigating the causes, treatments and cures for common and rare diseases. For more information about NIH and its programs, go to www.nih.gov.