Research reveals that Alzheimer's disease (AD) family caregivers (CGs), particularly spouses, do not relinquish their role after placing their loved one in a nursing home. Caregivers report increased emotional upset around the time of nursing home placement, with sustained losses over time leading to chronic grief. Chronic grief increases caregivers' risk for depression, suicide, and increased mortality. Interventions targeting the mental health of caregivers have focused on in-home care. There are no documented interventions designed to decrease AD caregivers' chronic grief post nursing home placement. We propose a pilot study examining the feasibility of a Chronic Grief Management Intervention (CGMI) designed to increase knowledge and skills and decrease grief and depression in spouse caregivers of persons with AD within the first year after they placed their loved ones in nursing home care. The CGMI is a12-week group-based program that uses guided discussion as a strategy to deliver knowledge of AD and teach skills in communication, conflict resolution, and chronic grief management. Using a randomized design, 120 spouse CGs (50 percent African American; 80 percent female) from 4 nursing home facilities will receive either the CGMI (n=60) or a comparison condition consisting of two check-in calls (n=60). Participants will be assessed at baseline, 3 months (immediately post-intervention), and at 6-months (post-baseline) using measures of knowledge (Knowledge of Alzheimer's Test), skill (Family Perception of Caregiving Role), chronic grief (Marwit-Meuser Caregiver Grief Inventory), and depression (CES-D).
The specific aims are to: 1) determine the feasibility of implementing the CGMI including recruitment, attendance at group sessions, intervention delivery, and consumer satisfaction, 2) evaluate the effects of the intervention on spouses' knowledge and skill and their chronic grief and depression, and 3) determine if there are racial differences (African American and Caucasian) in intervention feasibility and study outcomes. We hypothesize that knowledge and skills will increase and chronic grief and depression will decrease at 3 months (immediately post-intervention and at 6 months (post baseline) follow-ups for the CGMI group but not for the comparison condition. The goal is to develop an effective intervention that alleviates chronic grief and depression experienced by spouse caregivers of persons with AD post nursing home placement.

Public Health Relevance

The exponential rise in the number of persons with Alzheimer's disease places a heavy burden particularly on elderly spouse caregivers. The caregiving role that extends well beyond the placement of their partner in a nursing home is associated with chronic grief and depression. This study will develop a group- based chronic grief management intervention to improve spouse caregiver grief and depression after their loved one is placed in a nursing home. ? ? ? ? ? ? ? ?

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Nursing Science: Adults and Older Adults Study Section (NSAA)
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Boyington, Josephine
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Rush University Medical Center
Other Health Professions
Schools of Nursing
United States
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Paun, Olimpia; Farran, Carol J; Fogg, Louis et al. (2015) A chronic grief intervention for dementia family caregivers in long-term care. West J Nurs Res 37:6-27
Paun, Olimpia; Farran, Carol J (2011) Chronic grief management for dementia caregivers in transition: intervention development and implementation. J Gerontol Nurs 37:28-35