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.
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