This application proposes a three year research projcet to test the effectiveness of a home-based intervention for individuals caring for and residing with a family member with moderate impairment from dementia (Alzheimer's discase or mixed-type). The overall goal of the intervention is to enhance the caregiver's ability to integrate information about environmental influences into his/her problem-solving process, resulting in an improved ability to manage the behavioral or secondary symptoms of dementia. In response to demographic changes and rising costs of long-term care, this approach addresses a critical nced to develop pragmatic and cost-effective strategies to support the efforts of family caregivers. Based on a competence-environmental press framework, the intervention assists caregivers in acquiring skill in solving management problems by manipulating their environment in response to the numerous and changing issues which emerge while caring for a family member with dementia. The introduction of assistance to the caregiver in his/her own environment offers the unique opportunity to provide a service approach which is relevant and sensitive to the skill level, needs and home environment of the caregiver and care recipient. The study will yield important information about the nature and role of collaboration in therapeutic relationships, thc cost-benefit of home-based support services, and the effectiveness of environmental manipulations in the home to modify behavior. A two-group, randomized experimental design targeting 250 primary caregivers will be used to test the effectiveness of the intervention. Subjects will be randomly assigned to either a treatment or control group, blocking on caregiver gender and familial relationship (spouse vs. non-spouse). The treatment group will participate in a 5 visit, home-based intervention while the control group will not participate in such services. A three month post-test will evaluate the immediate effect of the experimental program to: 1) expand caregiver approach to problem-solving, 2) expand caregiver ability to identify and introduce environmental modifications in the home, 3) improve caregiver's sense of efficacy about his/her problem-solving, 4) reduce degree of caregiver upset, and 4) lessen frequency of care recipient problem behaviors. A six month telephone interview will assess the long-term impact of the program on: 1) incidence of nursing home placement, 2) caregiver health behaviors, and 3) caregiver expansion of management skills to new problems.
