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Preserving Health of Alzheimer Caregivers: Impact of a Spouse Caregiver Intervention

https://doi.org/10.1097/JGP.0b013e31805d858aGet rights and content

Objective

The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease.

Methods

A randomized controlled trial, conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care. Structured questionnaires were administered at baseline and regular follow-ups. A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period. Enhanced counseling and support consisted of six sessions of individual and family counseling, support group participation, and continuous availability of ad-hoc telephone counseling. Indicators of physical health included self-rated health (SRH) of caregivers and the number of reported illnesses.

Results

Controlling for baseline SRH (mean: 7.24), intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline (6.87 versus 7.21), and this significant difference was maintained for two years (6.70 versus 7.01). The effect of the intervention on SRH remained significant after controlling for the effects of patient death, nursing home placement, caregiver depressive symptoms and social support satisfaction. Similar benefits of intervention were found for number of illnesses.

Conclusion

Counseling and support preserved SRH in vulnerable caregivers. Enhancing caregivers' social support, fostering more benign appraisals of stressors, and reducing depressive symptoms may yield indirect health benefits. Psychosocial intervention studies with biological measures of physical health outcomes are warranted.

Section snippets

Study Design

The study included 406 spouse caregivers, recruited over a 9.5-year period between 1987 and 1997. To be eligible, potential participants had to be living with the patient at baseline and they or the patient had to have at least one relative living in the metropolitan area.

Caregivers were recruited through the NYU Alzheimer's Disease Center and referrals from the New York City Chapter of the Alzheimer's Association, other community organizations, private physicians, and other study participants.

Psychometric Properties of SRH

The internal consistency of SRH (Cronbach alpha) was 0.715. The test–retest reliability (Pearson's correlation) between baseline and the four-month follow-up was r197 = 0.741 (p <0.001) for the treatment group and r195 = 0.700 (p <0.001) for the usual care control group.

Characteristics of Study Subjects at Baseline

There were 203 caregivers in each group at baseline. Among these, four assigned to the treatment group and six assigned to the control group had no follow-up data for one or more of the variables used in these analyses (one

DISCUSSION

Our findings suggest that the enhanced support intervention led to significant benefits to caregiver self-rated health. While both groups showed worsening SRH over time, the treatment group showed less of a decline in the first four months after enrolling in the study, which was when the formal counseling sessions took place. This suggests that there was a delay in the negative health effects of caregiving as a result of intervention. The six individual and family counseling sessions took place

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    This work was supported by grants from the National Institute of Mental Health (R01 MH 42216), the National Institute on Aging (R01 AG14634), the Alzheimer's Disease Core Center (P30-AG08051), and the Florida Alzheimer's Disease Research Center (P50-AG025711 to WEH).

    The authors thank the NYU Caregiver Counseling staff, Steven Ferris, Ph.D., and the caregivers for their participation.

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