This is a resubmission of a previously reviewed project. Older rural home health care recipients are a group overlooked in gerontological research. These persons experience significant problems with emotional well-being and decrements in quality of life that are not being adequately addressed by existing resources. The present study will investigate the effectiveness of a psychosocial intervention for improving the quality of life of these frail and sick elders. The treatment will be delivered in the homes of the care recipients and the primary family caregiver will participate in the therapy as a facilitator. Improved quality of life and emotional well being should result in the care recipient's reduced use of health care services.
Aim 1 of the study is to test the efficacy of a brief, in-home psychosocial treatment in improving thew quality of life of rural home health care recipients. The treatment will be delivered by clinical social workers and will entail the provision of 16 sessions of cognitive-behavioral therapy. Family caregivers will attend therapy sessions and will facilitate the therapy by providing reminders, prompts and assistance to the care recipients in implementing therapeutic tasks. A delayed treatment control group design will be used to evaluate effectiveness of the treatment package on measured quality of life and emotional well-being. The investigators will also assess whether teaching problem solving skills and using the caregiver as treatment facilitator has a positive effect on such factors as caregiver burden and the caregiver care recipient relationship.
Aim 2 of the study is to assess the effects of the intervention on the home health care recipient's use of home health care services. The conceptual framework on which the intervention is based posits that improvements in quality of life and emotional well being will mediate decreases in health care use. This model will be empirically evaluated through the assessment data collected in this study.
Aim 3 is to investigate the success of efforts to make the intervention responsive to white and African-American home care recipients. One-half of the participants, as well as half of our therapists and research assistants, will be African-American. It is expected that there will be no differences in the effectiveness of the intervention among African-Americans and white participants. The research team is interdisciplinary and includes two clinical geropsychologists, a doctoral level clinical social worker, a nurse scientist (Ph.D.) and a geriatrician. The investigators have prior experience, publications, and preliminary data on the implementation of treatment protocols with older adults, community caregivers, and rural dwelling home health care recipients.
