An estimated 4.5 million individuals in the U.S. currently live with Alzheimer's Disease (AD) or a related dementia, and this number will increase dramatically in the future. Most persons with AD are cared for at home by informal carers who provide non-paid assistance for their family member or friend. Caregiving is challenging and carers often have negative outcomes, including depression, strain and other disruptions in health and well-being. Carers are advised to 'take care of yourself, yet receive little direction regarding how to do this and may lack resources to attend to their coexisting personal health needs. Older adults who have adopted a caregiving role for a spouse with AD are in a particularly high-risk context, and need support to maintain their health. Providing guidance about self-care early in the caregiving trajectory may foster health among carers. The overall aim of the proposed study is to test the effectiveness of a health-promoting self- care education and support partnership (Self-Care TALK) between advanced practice nurses and spouse caregivers in reducing strain, enhancing self-efficacy related to health and in promoting improved perception of health.
Specific aims of the study are to determine a) the effect of the self-care partnership on caregiving strain and self-efficacy, and on health outcomes, and b) the mediating effects of caregiving strain and self- efficacy on health. A randomized, treatment/comparison, repeated-measures experimental design is used to test the effectiveness of the intervention compared to usual care for older (at least 60 years), spouse caregivers (n=82) of persons diagnosed with AD in the previous 2 years. Self-Care TALK is provided using a telephone-based approach in recognition of the demands of caregiving responsibilities. Six weekly conversations are used to discover health beliefs and identify current and desired self-care activities. Core content includes: practicing healthy habits, building self-esteem, focusing on the positive, avoiding role overload, communicating, and building meaning. Basic content is standardized, but conversations are individualized for each carer. A notebook provides additional information about self-care. The intervention group is hypothesized to experience less strain, more self-efficacy, and report better health at 8 and 24 weeks, compared to the usual care group. Promoting health through self-care is an appropriate focus for new interventions with AD caregivers. ? ? ? ?
