Measuring Self-Appraised Changes following Participation in an Intervention for Caregivers of Individuals with Dementia.

This study examined the psychometric properties of the Self-Appraisal of Change Scale, a measure designed to capture domains that are subjectively relevant to caregivers, associated with overall well-being, and amenable to change upon engaging in an intervention. Data from 107 caregivers of veterans with dementia enrolled in a randomized controlled trial of a telephone-delivered caregiver psychoeducation and support group program (the Telehealth Education Program (TEP)) were analyzed. The TEP, which was delivered by master's prepared social workers and a nurse dementia care manager, targeted caregivers' dementia-related knowledge, attitudes, and self-management skills. Analyses were conducted to determine the factor structure, reliability, validity, and measurement invariance of the scale. Factor analyses yielded a single-factor solution for the scale's nine items. The reliability and construct validity of the scale were also supported by the analyses. Multi-group analyses suggested that meaningful comparisons of scale items and total raw scores can be made across usual care (UC) and intervention groups. The findings offer preliminary support that the scale may represent a valid and reliable instrument that captures perceived changes in key domains (e.g. caregiving knowledge, attitudes, and skill) following participation in a psychoeducational and support intervention trial.

Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial.

OBJECTIVE: To evaluate the Advanced Illness Coordinated Care Program (AICCP), delivered by allied health personnel to improve care for patients coping with advanced illness and in need of preparation for end-of-life (EOL) care. STUDY DESIGN: Clinical trial involving 275 patients and 143 surrogates in 6 settings who were randomly assigned to the AICCP or usual care (UC). METHODS: The AICCP participants met with a care coordinator for assistance with provider communication, care coordination, and support. The AICCP was evaluated for effects on satisfaction with care, advance planning, consistency of care with patient preferences, and healthcare costs. RESULTS: The AICCP increased patient satisfaction with care and communication (P = .03), and AICCP surrogates reported fewer problems with provider support (P = .03). More AICCP than UC participants completed an advance directive (AD) (69.4% vs 48.4%; P = .006), and the AICCP group completed more ADs per participant (P = .01). Median time to AD documentation was 46 days for AICCP and 238 days for UC (P = .02). There was no difference in survival (AICCP 43% vs UC 42%). Six-month costs were lower with AICCP than with UC (12,123 US dollars vs 16,295 US dollars); however, the difference did not reach statistical significance. CONCLUSIONS: The AICCP improved satisfaction with care and helped patients develop and revise more ADs, sooner, without affecting mortality. This program may be delivered in a range of managed care, fee-for-service, and group-model settings.

The effectiveness of a telephone support program for caregivers of frail older adults.

PURPOSE: The purpose of this study was to evaluate the effectiveness of a telephone support group program on spouses and adult child caregivers of frail older adults. DESIGN AND METHODS: The Telephone Support Group (TSG) model is a multicomponent group program offered in 12 weekly, 90-minute group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. We recruited for this study 36 spouses and 61 adult children and randomly assigned them to TSG or to usual services. We assessed the participants before and after the completion of TSG or usual services. RESULTS: The results indicated that, for adult child caregivers, TSG was more effective than usual services in reducing burden, depression, social support, and pressing problems, and increasing knowledge and use of community services. We found no significant differences for spouse caregivers. IMPLICATIONS: This is the first study to compare the effectiveness of TSG for adult child and spouse caregivers of frail older adults. TSG showed itself to be an effective means of delivering support to adult child caregivers of frail older adults but not to spouses. More research is needed about how to make TSG effective for spouse caregivers.

Predictors of health and human services use by persons with dementia and their family caregivers.

The aim of this study was to identify predictors of the use of health and human services by community residing persons with dementia and their family caregivers. Telephone interviews were conducted with a sample of 608 primary caregivers of community residing persons with dementia who were randomly selected from a state-wide dementia registry. The Anderson Behavioral Model of Health Care Use was used as the analytic framework. Hierarchical ordinary least squares regression models were developed to analyze predictors of health and human services use. Predisposing, enabling, and need variables explained 40.9% of the variance in service use, 29.8% of the variance in health service use, and 38.1% of the variance in the use of human services. Enabling variables explained more variance in the use of health and human services than did need or predisposing variables. In contrast to the health services utilization literature that points to the importance of need variables, the results of this study lend support to findings in the caregiving literature that indicate that enabling variables are at least as important as need variables in predicting the use of community services by family caregivers of persons with dementia.

Supporting caregivers of frail older adults in an HMO setting.

The long-term effectiveness of a structured health education program (HEP) for spouses and frail older adults was evaluated in a staff model health maintenance organization (HMO). HEP is a multicomponent group program that includes emotion-focused and problem-focused coping strategies, education, and support. For caregivers, HEP was more effective than usual care (UC) in reducing depression, increasing knowledge of community services and how to access them, and changing caregivers' feelings of competence and the way they respond to the caregiving situation. For care recipients, HEP was more effective than UC in preventing increases in somatic symptoms and symptoms of anxiety/insomnia. ((c) 2004 APA, all rights reserved)

The effect of telephone support groups on costs of care for veterans with dementia.

PURPOSE: Few studies have addressed the effects of caregiver interventions on the costs of care for the care recipient. This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost. DESIGN AND METHODS: The Telehealth Education Program (TEP) is a manualized program of education and support designed for caregivers of veterans with moderate-to-severe dementia. One hundred fifty-eight spousal caregivers were randomly assigned to either the ten 1-hr sessions of TEP or the usual care (UC). Health care utilization and cost data were extracted from veterans Information System Technology Architecture databases and included outpatient, inpatient, and nursing home data within the VA. RESULTS: Total health care cost data showed a significant (p = .039) average cost savings of $2,768 per patient at 6 months for TEP as compared with UC, but these were not maintained at 1 year. All costs included in the total costs measure contributed to this difference. Inpatient, outpatient, and nursing home costs were all assessed separately, but only nursing home costs reached significance (p = .009), with a savings of $1,057 per patient at 6 months. IMPLICATIONS: The TEP caregiver intervention resulted in short-term cost savings for veteran care recipients. Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes.

Effectiveness of advanced illness care teams for nursing home residents with dementia.

This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and randomly assigned them to AICT or to usual care (UC). They assessed the participants before and after the completion of AICT or UC and found that as compared with UC, the AICTs were effective in reducing agitated behavior and pain but not depression. This is one of a few pioneering studies to examine the effectiveness of team care on the health and well-being of nursing home residents with advanced dementia. More research is needed about how to intervene effectively with this population and to overcome the methodological challenges associated with doing research on real-world clinical practice issues in busy and often understaffed nursing home settings.

Increasing the use of formal services by caregivers of people with dementia.

This study evaluated the impact of an information and referral intervention designed to help family caregivers of people with dementia obtain needed health and human services. Caregivers (N = 608) of community-residing people with dementia were surveyed about their need for and use of community services. Of the 608 caregivers, 203 agreed to be referred to a staff member of an Alzheimer's Association chapter to get help finding needed health and community services. The results of a logistic regression indicated that education, marital status, and perceptions about the helpfulness of services were significant predictors of wanting a referral. The information and referral help given by staff of the Alzheimer's Association chapters resulted in a significant increase in the use of human services, but no change in the use of health services. Practice implications are discussed.