Caregivers of persons with Alzheimer's disease and related disorders (ADRD) must often deal with chronic and disabling behavioral problems associated with the care recipient's disorder. Despite our growing understanding of the dementias and the severe negative consequences of caregiving for this population, little research has focused on the development, implementation and evaluation of nursing interventions that are theoretically driven and clinically useful, especially in rural environments. The Progressively Lowered Threshold (PLST) model provides the framework for designing just such a nursing intervention, for management of behavioral problems. A sample of 240 rural caregivers of persons with ADRD will be selected from sites in four counties in Iowa and randomly assigned to the experimental (PLST intervention) group or control group. Following initial in-home screening and an individualized needs assessment, caregiver participants randomly assigned to the experimental group will receive 2 two-hour training sessions in the home, a one hour in -home follow-up session one week later and fortnightly phone calls from the investigator. Control group members will receive routine information, case management, community-based services, and social support referrals during 3, one-hour in-home sessions one week apart, and may elect the PLST intervention one year later. Testing of caregivers' subjective and affective responses, knowledge, subjective burden , satisfaction, and mastery and care recipients' behavior symptoms, functional ability and behavioral responses will occur at baseline and at 3, 6, and 12 months, using both qualitative and quantitative methods. All outcome measures will be collected by a research associate blind to treatment condition. ADRD are tragic, currently incurable illnesses. The tragedy is compounded by the negative consequences associated with caregiving. This proposal investigates a nursing approach to decrease the adverse effects of caregiving by teaching behavioral management techniques. The study builds upon and extends previous research by testing the PLST model, which has been tested previously only in institutional settings, in community/home settings and with rural subjects.
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