The objective of this proposal is to refine and test a multi-component psychosocial behavioral intervention to reduce burden and depression among family caregivers of persons with Alzheimer's Disease or related disorders. This competing renewal will build on existing infrastructures and results obtained from its parent multi-site feasibility study, Resources for Enhancing Alzheimer's Caregiver Health (REACH). REACH, (funded by the National Institute on Aging (NIA) and the National Institute for Nursing Research (NINR) U01-AG13305) explored the effectiveness of different interventions to reduce burden and distress of family caregivers in six participating sites. Detailed analyses of these data suggest specific components of the REACH interventions that may be efficacious in improving caregiver outcomes. The current study integrates identified components from the REACH interventions and tests a single multi-component intervention. This intervention will be evaluated among a sample of geographically and racially/ethnically diverse caregiver populations. The study design is a multi-site, two-group randomized clinical trial. The same two conditions: an in-home multi-component intervention or a standardized information only control condition will be implemented at five sites (Birmingham, Memphis, Miami, Palo Alto, and Philadelphia), with the Coordinating Center in Pittsburgh. Recruitment of 600 (120 per site) caregiver-care recipient dyads will yield 510 completing the protocol (15% attrition expected). Equal numbers of African Americans/Blacks, Hispanic/Latinos, and CaucasianMhites will be recruited and assigned to each condition at each site. Phase 1 involves a refinement of the intervention and training of the interventionists across sites; in Phase 2, the randomized clinical trial will be conducted. The intervention is designed to enable caregivers to learn and use cognitive and behavioral strategies, to impact both care recipient behaviors (e.g., wandering) and their own behaviors (e.g., managing stress). The intervention will consist of 10 home visits by trained staff plus 5 pre-planned contacts with trained staff through innovative technology over a six month period. The technology will also provide access to formal services, family, and other caregivers. A uniform battery of predictor and outcome measures will be collected at baseline, three and six months. Cost-effectiveness and clinical significance of the two conditions will also be evaluated.
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