The specific aim of this study is to assess, by means of a multi-site randomized controlled feasibility study, the impact of an automated telecommunications system, Telephone-Linked Care for Alzheimer's Disease (TLC-AD), on reducing caregiver (GG) stress related to disruptive behaviors in Alzheimer's Disease (AD). TLC-AD speaks over the telephone to CGs using a computer controlled human voice system. CGs press designated keys on the touch tone keypad of their home telephone to communicate with TLC-AD. TLC-AD will 1) monitor the primary caregiver's stress and health status weekly and make recommendations and referrals if necessary, 2) provide a voice-mail caregiver support network to reduce social isolation, 3) provide an bask the expert call option for recalcitrant caregiving problems, and 4) offer a distraction conversation for CGs to use when they desire a mini-respite break from the person with AD. The primary outcome variable is CG stress, and this is proposed for the common assessment protocol as well as caregiver health status. Pearlin's model of caregiver stress in Alzheimer's Disease provides the conceptual framework for the study and suggests that the manifestations of CG stress include depression, decline in physical health status, and yielding of the CG role. The primary hypothesis of this study is that primary CGs of persons with AD and dementia related disruptive behaviors who use TLC-AD will experience fewer manifestations of caregiver stress than subjects who do not receive the intervention. The study will be conducted at five sites with 688 caregivers: 80% female, 30% minority. Subjects will be randomized within each site to usual care (UC) or TLC-AD (which they will use weekly for 12 months). The analysis will compare TLC and UC subjects at baseline, 6, 12, and 18 months using standardized instruments and controlling for common confounding CG and care recipient (CR) variables. If the TLC-AD exerts a significant effect on CG stress, path analysis will be used to clarify the relationships among the variables and CG stress. The cost effectiveness of the TLC intervention will also be determined. In previous TLC applications, the operating costs have averaged $1.00 per call for weekly monitoring. The results will provide insight into the potential of telecommunications technology to help sustain primary CGs in their vital role.
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