This amended application from the State University of New York (SUNY) at Albany proposes to examine the short- and long-term effectiveness of a health education program (HEP) for frail elderly and their spouse caregivers. The HEP is a program that focuses on teaching small groups of caregivers several techniques for understanding, coping, and dealing with emotions and for solving problems. The program consists of a year-long intervention for the caregiver: eight weekly two-hour group sessions (eight caregivers per group) and ten monthly two-hour follow-up groups. One hundred-sixty pairs of spouses and frail elderly will be recruited from members of the Community Health Plan (from members enrolled in the traditional HMO plan) in two geographic areas. Eligibility criteria for caregivers include: married to and living with the care recipient, age 55 or older, being the primary care provider, having at least a moderate score on the Zarit burden scale (to ensure that they have the potential to benefit from the program), not participating in any other individual or group program for caregivers, and reporting that one's spouse has at least one chronic disease and is in poor health (based on preliminary studies in a VA, care recipients with these characteristics were most likely to benefit from the program in terms of cost and utilization reduction). The care recipient must be 55 or older and have at least one chronic health problem. Both caregiver and recipient must have been members of the CHP for at least one year and cannot be participating in a formal hospice program. The project uses a randomized control design; eligible volunteers will be randomly assigned to participate in HEP or receive usual care. Measurements will be taken at five intervals: one week prior to beginning the intervention (baseline), after the initial two-month intensive training period (""""""""one week after the 8th group meeting""""""""), and at 01, 02, and 03 years after the baseline interview. Both caregivers and recipients will be assessed for demographic variables initially and their health and functional status, emotional well-being, and social support at each time period. Caregivers will also be assessed for their burden level and knowledge and use of community resources; recipients will be assessed for cognitive impairment. The effect on outpatient, inpatient, and nursing home care utilization will be measured by HMO records and data collected from the study participants.
