[Effectiveness of a psychotherapeutic intervention group program in the improvement of caregiver well-being in Alzheimer's disease patients' family caregivers: the CuiDem study]. / Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem.

INTRODUCTION: Caregivers of patients with Alzheimer's Disease experience physical and emotional burnout that can be treated with non-pharmacological interventions. AIM: Assess the efficacy of a group cognitive behavioural psychotherapeutic intervention, for improving well-being perception in caregivers, compared to a support group. Also, we assessed its efficacy after a follow-up period of 1-year post-intervention. SUBJECTS AND METHODS: A multicentre, open, quasi experimental study with control group was conducted. 221 caregivers of patients with Alzheimer's Disease, with mild to moderate-severe dementia, were non-randomly assigned to either IG-intervention group: psychotherapeutic program without active follow-up period (n = 80); IGF-intervention group: psychotherapeutic program with active follow-up period (n = 78); or CG-control group: support program with active follow-up period (n = 63). The psychotherapeutic intervention (IG and IGF) is a structured cognitive behavioural group program, of one weekly session over four months. The CG had the same duration. Caregiver's burden, mood disorders, resilience, perceived functional social support and quality of life were measured at baseline, post-intervention and after 1-year follow-up. RESULTS: At post-intervention, statistically significant improvements were observed in the IG and IGF compared to CG in caregiver burden (p = 0,0216). After one year follow-up, significant improvements were found in IGF compared to IG in emotional state (p = 0,0271), resilience (p = 0,0018), perceived social support (p = 0,014); quality of life (p = 0,0001) and mental health (p = 0,0002); and in CG versus GI in emotional state and social support (p < 0,05). CONCLUSIONS: These results support the efficacy of this psychotherapeutic intervention for improving well-being (burden), and the supportive follow-up period for increasing its efficacy.

TITLE: Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem.Introducción. Las personas cuidadoras de familiares con enfermedad de Alzheimer presentan agotamiento físico y emocional, que puede abordarse con intervención no farmacológica. Objetivo. Evaluar la efectividad de una intervención psicoterapéutica grupal cognitivo-conductual para mejorar la percepción de bienestar de personas cuidadoras, respecto a una intervención de acompañamiento, y su sostenibilidad tras un período de seguimiento activo de un año postintervención. Sujetos y métodos. Estudio multicéntrico, cuasi experimental, abierto y con grupo control. Se asignó de forma no aleatorizada a 221 personas cuidadoras de familiares con enfermedad de Alzheimer, con demencia leve a moderada-grave, a tres condiciones de intervención: grupo de intervención psicoterapéutica sin seguimiento activo (GI) (n = 80); grupo de intervención psicoterapéutica con seguimiento activo (GIS) (n = 78); y grupo control de acompañamiento con seguimiento activo (GC) (n = 63). La intervención psicoterapéutica grupal (GI y GIS) es un programa estructurado, cognitivo-conductual, de una sesión semanal durante cuatro meses. La del GC tenía la misma duración. Se evaluaron preintervención, postintervención y, al año, sobrecarga percibida, estado de ánimo, resiliencia, apoyo social funcional y calidad de vida. Resultados. Se observó una mejora significativa postintervención en el GI y el GIS respecto al GC en percepción de sobrecarga (p = 0,0216). Al año de seguimiento, se observaron mejoras significativas en el GIS respecto al GI en estado de ánimo (p = 0,0271), resiliencia (p = 0,0018), apoyo social percibido (p = 0,014), calidad de vida (p = 0,0001) y salud mental (p = 0,0002); y en el GC frente al GI en estado de ánimo y apoyo social (p menor de 0,05). Conclusiones. Los resultados respaldan la efectividad de esta intervención psicoterapéutica para mejorar la percepción de bienestar (sobrecarga) y el seguimiento de apoyo para incrementar su eficacia.

Spanish version of the Bayer Activities of Daily Living scale in mild cognitive impairment and mild Alzheimer disease: discriminant and concurrent validity.

AIMS: To test the discriminant and concurrent validity of the Spanish version of the Bayer Activities of Daily Living scale (B-ADL) in mild cognitive impairment (MCI) and mild Alzheimer disease (AD). METHODS: The B-ADL scale, the Blessed Dementia Rating Scale (BDRS), and the Interview for Deterioration in Daily Living in Dementia (IDDD) were administered to 277 elderly Spanish patients (78 MCI and 199 AD). Correlations between scales were performed, and ROC curves were plotted. RESULTS: In MCI and mild AD discrimination, an area under the ROC curve of 0.84 was found; a cut-off point of 3.3 was proposed with values of 0.81 for sensitivity and 0.72 for specificity. The B-ADL correlated positively to both the BDRS (r = 0.7) and the IDDD (r = 0.8). CONCLUSION: The B-ADL is a valid and sensitive scale that can be used to discriminate mild AD from MCI.

A new planning methodology to assess the impact of the health care system on health status.

This article summarizes a new methodology recently developed by the Rand Corporation which permits health planners to assess the impact of the local health care system on the health status of the population. The methodology, in algorithm form, should assist health planners in developing objectives and actions related to the occurrence of selected health status indicators and should be amenable to health care interventions. Emphasis has been placed on developing a simplified, approximate analysis that health planners will find both feasible and effective. No detailed mathematic analyses are called for. The data required are, in most instances, readily obtainable. The algorithm is a methodology by which HSAs can investigate determinants of health status, identify breakdowns in the health care system, and specify needed improvements in the system. The goal of these algorithms is to assist HSAs to obtain valid and sufficiently detailed data that will provide a basis for monitoring breakdowns in the health care system and to improve planning decisions aimed at preventing such breakdowns. This should, in turn, affect population health status in the planning area.