Alzeheimer's disease (AD), an irreversible neurodegenerative condition, is the most common cause of severe intellectual deterioration in the elderly. Most AD patients do not require institutional care, but the alternative, custodial care at home, presents unrelenting demands on families; caregivers of AD patients shoulder extraordinary emotional and physical burdens that frequently prove overwhelming. As a result, care-givers come to consider institutionalization to be essential to their own welfare. We propose to test the hypothesis that caregiver well- being can be improved through various support measures, and that this will decrease the incidence of institutionalization of AD patients. Although there is a growing literature on the factors that affect AD caregivers, there are few family intervention studies designed to test the efficacy of strategies specifically developed to improve caregiver well-being. Thus, the primary objective of thist study is to evaluate the effectiveness of a multicomponent treatment approach whose goal is to optimize the condition of the caregiver, with a secondary objective to assess the effectiveness of this intervention in preventing or postponing institutionalization. The components will consist of individual and family counseling, support group participation, and a home visit by a counselor and occupational therapist.
The specific aims are: (1) to complete the counseling program with 100 randomly selected spouse caregivers of AD patients. A parallel control group of 100 caregivers will also complete the study; (2) to administer a caregiver assessment battery to the treatment and control group at baseline, after three, six, and 12 months and every six months thereafter. It will include assessment of patient functional status and cargicer burden, mental and physical health, social network and financial difficulties; (3) to evaluate the effectiveness of counseling for improving caregiver well-being, to determine the longitudinal outcome of variables other than treatment, and to assess the influence of treatment and other caregiver variables on ultimate institutionalization. If the results confirm the hypothesis about the utility of treatment, this project will provide and effective model intervention program for assisting and enhancing the well-being of caregivers. Given the greater cost-effectiveness of home care versus institutionalization, the widespread implementation of similar programs would have the potential to have a major impact on reducing the economic burden of AD on individual families and on the federal heatlh care system.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH042216-03
Application #
3381337
Study Section
Life Course and Prevention Research Review Committee (LCR)
Project Start
1987-07-01
Project End
1991-06-30
Budget Start
1989-08-01
Budget End
1990-06-30
Support Year
3
Fiscal Year
1989
Total Cost
Indirect Cost
Name
New York University
Department
Type
Schools of Medicine
DUNS #
004514360
City
New York
State
NY
Country
United States
Zip Code
10012
Mittelman, Mary S; Bartels, Stephen J (2014) Translating research into practice: case study of a community-based dementia caregiver intervention. Health Aff (Millwood) 33:587-95
Gaugler, Joseph E; Roth, David L; Haley, William E et al. (2011) Modeling trajectories and transitions: results from the New York University caregiver intervention. Nurs Res 60:S28-37
Szychowski, Jeff M; Roth, David L; Clay, Olivio J et al. (2010) Patient death as a censoring event or competing risk event in models of nursing home placement. Stat Med 29:371-81
Haley, William E; Bergman, Elizabeth J; Roth, David L et al. (2008) Long-term effects of bereavement and caregiver intervention on dementia caregiver depressive symptoms. Gerontologist 48:732-40
Gaugler, Joseph E; Roth, David L; Haley, William E et al. (2008) Can counseling and support reduce burden and depressive symptoms in caregivers of people with Alzheimer's disease during the transition to institutionalization? Results from the New York University caregiver intervention study. J Am Geriatr Soc 56:421-8
Mittelman, Mary S; Roth, David L; Clay, Olivio J et al. (2007) Preserving health of Alzheimer caregivers: impact of a spouse caregiver intervention. Am J Geriatr Psychiatry 15:780-9
Mittelman, Mary S; Haley, William E; Clay, Olivio J et al. (2006) Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology 67:1592-9
Drentea, Patricia; Clay, Olivio J; Roth, David L et al. (2006) Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease. Soc Sci Med 63:957-67
Roth, David L; Mittelman, Mary S; Clay, Olivio J et al. (2005) Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease. Psychol Aging 20:634-44
Mittelman, Mary S; Roth, David L; Coon, David W et al. (2004) Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. Am J Psychiatry 161:850-6

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