Caregivers of Alzheimer's Patients Less Stressed with Active Intervention Treatments

PITTSBURGH—Interventions for family caregivers of persons with Alzheimer's disease reduce stress and ameliorate depression, according to a multisite research study sponsored by the National Institute on Aging (NIA) and the National Institute on Nursing Research (NINR). Results of the study were detailed in five articles in the September edition of Psychology and Aging, published by the American Psychological Association.

"REACH (Resources for Enhancing Alzheimer's Caregiver Health) is one of the most ambitious caregiver intervention trials ever conducted," according to Richard Schulz, one of the principal investigators and director of the University Center for Social and Urban Research at the University of Pittsburgh.

A total of 1,222 caregivers and care recipients from six areas in the United States—Boston, Birmingham, Memphis, Miami, Palo Alto, and Philadelphia—participated in the trial. REACH grew out of a National Institutes of Health (NIH) initiative that recognized well-documented burdens associated with family caregiving and the existence of promising interventions reported in research literature.

"Because the caregiving experience in race and ethnic minority families is particularly neglected as a research focus in the field, there was a strong emphasis placed on the inclusion of African American and Hispanic caregivers," said Schulz.

The results showed that among all caregivers combined, active treatments were superior to control conditions, in which participants didn't receive treatments, in reducing a caregiver's burden. In particular, women and those with less education (high school or lower) reported a significantly lower burden with active treatments than similar individuals who did not receive active treatments.

Caregivers in active interventions who were Hispanic, those who were nonspouses, and those who had less than high school education reported lower depression scores than those with the same characteristics in the control group.

Interventions that emphasized active participation of the caregiver in acquiring new skills had the greatest impact in reducing caregiver depression.

Among the active interventions the study explored were changing the nature of the specific stressors and the caregivers' assessments of these stressors, as well as the caregivers' responses to the stressors.

The multicomponent interventions implemented across the six sites included:

• supplying the caregiver with information about Alzheimer's disease and caregiving;

• offering group support and family therapy;

• providing education and skill training on how to deal with problem behaviors of persons with Alzheimer's disease;

• making physical modifications to the home care environment to ameliorate problems; and

• providing caregiver support, respite, information, and access to services through advanced telephone and computer technology interventions.

Although different interventions were carried out at different sites, all sites used the same measurement protocol, enabling the researchers to assess the effects of active treatments vs. control conditions (i.e., no active treatments) as well as to identify key elements of interventions that contributed most to positive caregiver outcomes.

In addition to Schulz, other principal investigators were Nell Armstrong, NINR; Louis Burgio and Alan Stevens, University of Alabama at Birmingham; Robert Burns, University of Tennessee at Memphis; Sara Czaja and Carl Eisdorfer, University of Miami; Dolores Gallagher-Thompson, Stanford University; Laura Gitlin, Thomas Jefferson University; Diane Mahoney, Hebrew Rehabilitation Center for Aged; and Sidney Stahl, NIH.

###

10/02/03/tmw