Alzheimer's disease (AD) has a catastrophic impact on the well-being of the spouses of the patients, often leading to inappropriate or premature nursing home placement. Results of our current treatment/control study (N=200) suggest that a multifaceted structured intervention (individual and family counseling sessions tailored to each specific situation, ad hoc consultation at any time and support group participation indefinitely) has a significant impact on the well-being of AD caregivers and reduces the long-term social and economic burden of the disease. The intervention increases the involvement of other family members and improves spouse caregivers' social network satisfaction in the short term, and has a salutary effect on their physical and mental health in the long term. Furthermore, there have been more than twice as many nursing home placements from the control group than from the treatment group. The proposed longitudinal study includes an extension of our current study, as well as a longitudinal evaluation of an improved intervention. We wil measure the long-term consequences both of caregiving and of the intervention by continuing to assess all the subjects of the current study at six-month intervals whether th AD patient is at home or in a nursing home, and for two years after the patient is deceased. We will assess the potentially greater efficacy of an improved intervention with a treatment/control study of the additional group of 200 spouse caregivers. Modifications to the current treatment will include postponing one family counseling session to one year after intake to help the family deal with changes in the patient, and further custom tailoring the family counseling by explicitly taking into account the caregiver's personality and the strengths and weaknesses of the caregiver's social suppport system. The evaluation will be expanded to include an enriched assessment of social support, a caregiver personality profile and an assessment of the financial cost of caregiving. We will further develop a causal model of the impact of the intervention on the mechanisms by which formal and informal support affects thw well-being of spouse caregivers of AD patients and on the health care costs associated with caregiving. The large number of subjects and the length of time over which many will have been followed will provide an extraordinary research resource and the statistical power necessary for analysis of the long-term economic, physical and emotional implications of caregiving and the potential benefits of a psychosocial intervention designed to buttress the formal and informal support systems in the community.
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