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The Effects of Counseling Spouse Caregivers of People With Alzheimer Disease Taking Donepezil and of Country of Residence on Rates of Admission to Nursing Homes and Mortality

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Objective:

Does psychosocial intervention for caregivers whose spouses with Alzheimer disease (AD) are taking donepezil delay nursing home (NH) placement or death of patients?

Design:

Randomized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up (mean: 5.4 years, SD: 2.4).

Setting:

Outpatients of research clinics in Australia, the United Kingdom, and the United States.

Participants:

One hundred and fifty-five persons with AD and their spouses.

Intervention:

Five sessions of individual and family counseling (+ prn ad hoc counseling) or usual care.

Measurements:

Time to institutionalization and death using Cox proportional hazards methods.

Results:

Over a mean of 5.4 years (SD: 2.4), there were no differences in NH placement or mortality by intervention group, but there were by country, with Australian patients admitted to NHs earlier than U.S. than U.K. patients.

Conclusion:

Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care, NH systems, availability, and affordability.

Section snippets

Subjects

Subjects were a volunteer sample of 158 patient/caregiver dyads (Australia: 52; the United Kingdom: 54; the United States: 52) recruited at one of three sites: Australia, the University of New South Wales, Academic Department for Old Age Psychiatry, Prince of Wales Hospital in Sydney, Australia; United Kingdom, the University of Manchester, Division of Psychiatry; and United States, the Silberstein Aging & Dementia Research Center at the New York University School of Medicine (NYU-ADRC). All

Baseline Variables

Baseline characteristics of patients and caregivers are summarized in Table 1. Briefly, the mean ages of patients and caregivers were 73.8 years (SD: 7.48, 52-91 years) and 71.3 years (SD: 8.20, 47-88 years) respectively, with patients having a mean MMSE score of 20.3 (SD: 5.61). Eighty-eight patients were rated as GDS4 on the GDS, 62 as GDS5. Five patients were inadvertently included with GDS ratings of 3 or 6, which was only discovered after randomization, so they permitted to remain in the

CONCLUSION

In this first international study of psychosocial intervention performed across three countries, counseling did not alter rates of NH admission or death although there were significant intercountry differences in rates of institutionalization. Contrary to our previous findings that comprehensive caregiver training7, 8 and counseling and support10, 11 significantly delayed NH placement, by more than 1.5 years in the NY study,11 no difference in time to NH admission was observed between the

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    • Cited by (0)

    The authors thank the patients and their caregivers, the NYU counseling staff, Sean Page and Jane Winter in Manchester, and Angi Leimina, Karen Berman, Lynne Seifman and Annette Altendorf in Sydney, Australia. They also thank Henrietta Wolland for developing and maintaining the study database. Lee-Fay Low commented on an earlier version of this article.

    This work was supported by Pfizer International.

    Professor Brodaty has been a consultant or advisor for Eisai, Pfizer, Novartis, Janssen Cilag, Wyeth, and Landbeck. Professor Burns has been a consultant for Eisai, Pfizer, Shire, Novartis, Janssen Cilag, Wyeth, and Landbeck.

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    Copyright © 2009 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.