Randomized Trial of the Family Intervention: Telephone Tracking-Caregiver for Dementia Caregivers: Use of Community and Healthcare Resources.

OBJECTIVES: To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver (FITT-C), on community support and healthcare use by dementia caregivers. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Dyads (n = 250) of distressed informal dementia caregivers and care recipients. INTERVENTION: Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support (TS; n = 117). Both groups received 16 telephone contacts from a master's-level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem solving, and other directive approaches based on assessment of critical areas (e.g., mood, behavior, family functioning, social support). TS provided supportive therapeutic strategies. MEASUREMENTS: Outcome variables were caregiver report of community support service use, number of visits to the emergency department (ED) for caregivers and care recipients, and hospital stays for caregivers during the interventions. RESULTS: Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C used community support services at end of treatment significantly more than those receiving TS (P = .02). FITT-C caregivers had a significantly lower rate of ED visits (rate difference 9.5%, P = .048) and hospital stays (rate difference 11.4%, P = .01) over the 6-month course of the intervention than TS caregivers. Care recipient use of community or medical resources did not differ according to group. CONCLUSION: An entirely telephone-delivered intervention was effective in increasing caregiver engagement in community resources and reducing caregiver use of hospital-based healthcare resources. Results highlight the potential effect of FITT-C on healthcare use.

Psychosocial telephone intervention for dementia caregivers: A randomized, controlled trial.

BACKGROUND: Identifying effective and accessible interventions for dementia caregivers is critical as dementia prevalence increases. OBJECTIVE: Examine the effects of a telephone-based intervention on caregiver well-being. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: Two hundred and fifty distressed, family, dementia caregivers. INTERVENTION: Caregivers randomized to receive 16 telephone contacts over 6 months of either the Family Intervention: Telephone Tracking-Caregiver (FITT-C) or Telephone Support (TS). OUTCOME: Primary outcome variables were family caregivers' depressive symptoms, burden, and reactions to care recipients' behavior problems at 6 months. RESULTS: The FITT-C intervention resulted in significantly improved caregiver depressive symptoms (P = .003; 27% net improvement) and less severe reactions to care-recipient depressive behaviors (P = .009; 29% net improvement) compared with the control condition (TS). CONCLUSION: An entirely telephone-based intervention improves caregivers' depressive symptoms and reactions to behavior problems in the care recipient and is comparable with reported results of face-to-face interventions.

A telephone intervention for dementia caregivers: background, design, and baseline characteristics.

Family caregivers of individuals with dementia are at heightened risk for emotional and mental health problems. Many caregivers do not seek assistance or become isolated in their caregiving role. Multi-component interventions have demonstrated efficacy for reducing emotional distress and burden, although these approaches are potentially costly and are not widely accessible. In response to these issues, we developed the Family Intervention: Telephone Tracking - Caregiver (FITT-C), which is an entirely telephone-based psychosocial intervention. The purpose of this paper is to describe the study design, methodology, and baseline data for the trial. This study uses a randomized controlled trial design to examine the efficacy of the FITT-C to reduce depressive symptoms and burden in distressed dementia caregivers. All participants (n=250) received a packet of educational materials and were randomly assigned to receive 6 months of the FITT-C intervention or non-directive telephone support. The FITT-C intervention was designed to reduce distress in caregivers and is based on the McMaster Model of Family Functioning, transition theory, and Lazarus and Folkman's Stress and Coping Models. The primary dependent variables were depressive symptoms (Centers for Epidemiological Studies - Depression) and burden (Zarit Burden Interview, Revised Memory and Behavior Problems Checklist - Reaction). Secondary outcome measures included family functioning, self-efficacy, and health-related quality of life. Results of the study will provide important data about the efficacy of a telephone-based approach to reduce distress in dementia caregivers.

A telephone-delivered psychosocial intervention improves dementia caregiver adjustment following nursing home placement.

OBJECTIVE: Study the preliminary efficacy of a telephone intervention, Family Intervention: Telephone Tracking-Nursing Home (FITT-NH) for improving dementia caregivers' adjustment following nursing home placement. METHODS: Caregivers were enrolled on average 6 weeks following the care-recipients' placement in a nursing home. Baseline assessment included self-report measures of caregiver emotional functioning, staff-caregiver interactions, placement satisfaction, health-related quality of life, and social support. Caregivers were randomly assigned to FITT-NH (n = 24) or a non-contact control condition (n = 22). Caregivers were urn randomized to balance groups on caregiver gender, relationship (spouse versus other), and facility type (dementia special care versus general). The intervention was entirely telephone-delivered in 10 contacts over 3 months. Caregivers randomized to non-contact control were not prevented from using other community-based mental health or support resources, therefore reflecting standard care. Intervention strategies were based on assessment of caregiver emotional adjustment, family functioning, staff-caregiver interactions, health, and social support. Treatment strategies are based on models of stress and coping process and family functioning. RESULTS: Groups did not differ in caregiver age, education, gender, relationship to the care recipient, length of caregiving, length of dementia diagnosis, or time since placement. Using mixed model analysis of variance, caregivers receiving FITT-NH showed a significant reduction in feelings of guilt related to placement, F(1,43) = 5.00, p < 0.05, and reported more positive perceptions of interactions with staff, F(1,43) = 4.59, p < 0.05, compared to standard care. CONCLUSION: Findings provide preliminary evidence for FITT-NH as a potentially efficacious, brief, targeted psychosocial intervention for improving caregiver emotional adjustment following nursing home placement.

Family functioning is associated with depressive symptoms in caregivers of acute stroke survivors.

OBJECTIVE: To determine whether family functioning is uniquely associated with caregiver depressive symptoms in the immediate aftermath of stroke. DESIGN: Cross-sectional data from the baseline assessment of an intervention study for stroke survivors and their families. SETTING: Neurology inpatient service of a large urban hospital. PARTICIPANTS: Stroke survivors (n=192), each with a primary caregiver. The mean age of stroke survivors was 66 years, and most, 57%, were men (n=110). The mean age of caregivers was 57 years, and 73% (n=140) of the caregivers were women. Eighty-five percent of caregivers were white. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures were chosen to assess caregivers' depressive symptoms (Centers for Epidemiologic Studies Depression Scale), family functioning (Family Assessment Device), and additional factors such as health status (Medical Outcomes Study 36-Item Short-Form Health Survey) and stroke survivors' cognitive abilities (modified Mini-Mental State Examination) and functional impairments (FIM and Frenchay Activities Index). RESULTS: Depressive symptoms were mild to moderate in 14% and severe in 27% of caregivers. Family functioning was assessed as unhealthy in 34% of caregiver-patient dyads. In statistical regression models, caregiver depression was associated with patients' sex, caregivers' general health, and family functioning. CONCLUSIONS: Forty-one percent of caregivers experienced prominent depressive symptoms after their family member's stroke. Higher depression severity in caregivers was associated with caring for a man, and having worse health and poor family functioning. After stroke, the assessment of caregivers' health and family functioning may help determine which caregivers are most at risk for a depressive syndrome.

Telephone-Delivered Psychosocial Intervention Reduces Burden in Dementia Caregivers.

OBJECTIVES: To examine the preliminary efficacy of Family Intervention: Telephone Tracking-Dementia (FITT-D), a multi-component intervention that is delivered in 23 telephone contacts over 12 months. METHOD: Thirty-three dementia caregivers were randomly assigned to receive either FITT-D (n =16) or standard care (n =17) using urn randomization to balance the groups on dementia severity, caregiver gender, and relationship type (spouse versus other). Inclusion criteria included formal dementia diagnosis, caregiving for at least 6 months, residing with the care recipient, and providing at least 4 hours of direct supervision per day. Master's-level therapists contacted caregivers by telephone over 12 months. Each contact followed a standardized treatment manual, involving assessment and individualized application of interventions to address mood, family functioning, social support, and health. Outcomes included Zarit Burden Interview, Revised Memory and Behavior Problem Checklist, and the Geriatric Depression Scale at baseline and 12 months (end of treatment). RESULTS: Caregivers receiving FITT-D exhibited significantly lower burden scores and less severe reactions to memory and behavior problems than caregivers in the standard care condition. CONCLUSION: Findings provide preliminary evidence for the efficacy of FITT-D, a potentially highly accessible, low-cost intervention for dementia caregivers.

Unique contribution of family functioning in caregivers of patients with mild to moderate dementia.

The relationship between family functioning and dementia caregiving is complex. The present study examined the interrelationships between family functioning, caregiver burden, and patient characteristics. Participants were 72 live-in, family caregivers of patients with mild (n = 47) or moderate dementia (n = 25). Caregivers completed measures of burden, family functioning, depression, and anxiety. Ratings of patients' memory/behavior problems and patients' activities of daily living were also collected. Results indicated that higher levels of caregiver burden were significantly associated with increased caregiver depression and anxiety, greater frequency of memory and behavior problems in the dementia patient, worse activities of daily living, and poorer family functioning. Even after controlling for caregiver depression, caregiver anxiety, and frequency of memory/behavior problems in dementia patients, poorer family functioning continued to be associated with higher levels of caregiver burden. Caregivers with high levels of burden reported greater family dysfunction in communication and roles, regardless of their relationship to the patient (i.e., spouse or child). These findings suggest that including a family systems component in caregiver interventions may be beneficial in reducing burden in these very distressed individuals.

Families and stroke: The clinical implications of research findings.

Clinical and research attention to stroke care has focused on managing the acute stage of recovery and on evaluating the short-term effectiveness of rehabilitation programs. However, studies suggest that stroke affects the quality of life and the well-being of the entire family over much longer time frames. This article reviews the stroke literature as it relates to stroke rehabilitation and the family. Research findings strongly suggest that stroke is a family affair and that more rigorous attention to family assessment, education, advocacy, and counseling is needed along with development of new intervention methods focused on addressing specific family dimensions that have a demonstrated relationship to specific stroke problems. It is clear that health professionals shou Id thi nk farm ly, involvethefamily, and work with the family.

Depression and stroke.

Depression in stroke patients was observed many years ago but only recently has become the subject of systematic study. While estimates of depression vary, some have noted its occurrence in more than half of stroke patients. Our understanding of depression has been facilitated by refinements in diagnostic categories, analysis of contributing factors including the biology of depression, and refinements in evaluation to include cognitive and linguistic impairments that are common after stroke. The ways in which depression may affect rehabilitation and the fate of depression over time have been the subject of recent studies. Management includes sensitizing of caregivers, environmental change, education for patients and families, psychotherapy, and pharmacological interventions.

Psychobehavioral problems other than depression in stroke.

With the exception of depression and cognitive changes, there has been relatively little attention paid to psychiatric disorders or to psychosocial and behavioral changes that may present after stroke. This article addresses that deficiency by reviewing psychiatric symptoms and syndromes and other psychosocial and behavioral problems that may present in the stroke survivor: mood disorders other than unipolar depression, anxiety and adjustment disorders, substance abuse, sexual dysfunction, sleep disturbance, organic mental disorders, and behavioral problems. The special concerns and functional impact these presentations have in the stroke population are discussed along with diagnostic and treatment options.

Psychopharmacology and stroke.

The use of psychopharmacology for stroke patients requires careful attention to diagnosis, selection of medications for a particular use and avoidance of specific actions that interfere with recovery and function, and careful monitoring for results and side effects. Any given psychotropic medication may be used to treat a number of psychiatric and other problems. This review focuses on specific clinical implications for the use of antipsychotic, antidepressant, psychostimulant, antimanic, anxiolytic, and other selected agents in stroke.