Outcomes for patients with dementia from the Cleveland Alzheimer's Managed Care Demonstration Behavioral change in persons with dementia: relationships with mental and physical health of caregivers. A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study. Worksite-based internet multimedia program for family caregivers of persons with dementia. Reducing anxiety in Alzheimer's disease family caregivers: The effectiveness of a nine-week cognitive-behavioral intervention Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention. The Cleveland Alzheimer's managed care demonstration: outcomes after 12 months of implementation. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial. Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. Coping with dementia: evaluation of four nonpharmacologic interventions. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. Alzheimer's disease caregiving information and skills, part III: group process issues and concerns. Impact of a Psychoeducational Intervention on Caregiver Response to Behavioral Problems Training community consultants to help family members improve dementia care: a randomized controlled trial. Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: a randomized controlled trial. Understanding the outcomes of a psycho-educational group intervention for caregivers of persons with dementia living at home: A process evaluation The effect of a family therapy and technology-based intervention on caregiver depression. Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders. Caregiver attribution and resentment in dementia care Caregiving appraisal and interventions based on the progressively lowered stress threshold model Evaluation of geriatric day care units: effects on patients and caregivers. The Effect of a Structured Intervention on Caregivers of Patients With Dementia and Problem Behaviors: A Randomized Controlled Pilot Study Improving the quality of reporting of randomized controlled trials. The CONSORT statement. Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative. Improving quality of life for persons with Alzheimer's disease and their family caregivers: brief occupational therapy intervention. Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease. Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Continuum of care for Alzheimer's disease: a nurse education and counseling program. Effects of supporting community-living demented patients and their caregivers: a randomized trial. The Resources for Enhancing Alzheimer's Caregiver Health (REACH): project design and baseline characteristics. Primary care interventions for dementia caregivers: 2-year outcomes from the REACH study. A pilot study on a home‐based caregiver training program for improving caregiver self‐efficacy and decreasing the behavioral problems of elders with dementia in Taiwan Providing education about Alzheimer's disease Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet. The mediating effects of situational control on social support and mood following a stressor: a prospective study of dementia caregivers in their natural environments.
This investigation evaluates effects of care consultation delivered within a partnership between a managed health care system and Alzheimer 's Association chapter .  Care consultation is a multi-component telephone intervention in which Association staff work with patients and caregivers to identify personal strengths and re sources within the family , health plan , and community . The primary hypothesis is that care consultation will decrease utilization of managed care services and improve psychosocial outcomes . A secondary modifying-effects hypothesis posits benefits will be greater for patients with more severe memory impairment . The sample is composed of managed care patients whose medical records indicate a diagnosis of dementia or memory loss . Patients were r and omly assigned to an intervention group , which was offered care consultation in addition to usual managed care services , or to a control group , which was offered only usual managed care services . Data come from two in-person interviews with patients , and medical and administrative records . Results supporting the primary hypothesis show intervention group patients feel less embarrassed and isolated because of their memory problems and report less difficulty coping . Findings consistent with the modifying-effects hypothesis show intervention group patients with more severe impairment have fewer physician visits , are less likely to have an emergency department visit or hospital admission , are more satisfied with managed care services , and have decreased depression and strain The purpose of this study was to examine the effects that changes in behavioral and psychological symptoms of dementia of persons with Alzheimer 's disease have on their caregivers ' mental health and physical health . The research design was a prospect i ve , longitudinal follow-up study conducted in a major medical center and in participants ' homes . Longitudinal analysis linking change in behavior to caregiver outcomes was based on 64 cases . Care recipients were assessed at the time of diagnosis with the Mini-Mental State Examination ( MMSE ) .  To provide information on the care recipient 's behaviors , caregivers participated in an interview with the Modified Neuropsychiatric Inventory at diagnosis and at follow-up . Caregivers also completed a battery of established instruments to measure stress appraisal , mental health , and perceptions of their physical health at follow-up . Results showed that increases in problem behaviors among persons living with dementia , along with residence status , were significant predictors of caregivers ' mental health and also their physical health . However , these relationships were mediated through stress appraisal . Variables such as MMSE score of the person with dementia , number of years caregiving , relationship status , and education level were not significant predictors of caregivers ' health when behavior change was in the model PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients . They also determined if treatment effect varied by caregiver gender , race , and relationship to patient . DESIGN AND METHODS Families ( N = 171 ) of dementia patients were r and omized to intervention or usual care control group .  The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications . RESULTS Compared with controls , intervention caregivers reported fewer declines in patients ' instrumental activities of daily living ( p = .030 ) and less decline in self-care and fewer behavior problems in patients at 3 months post-test . Also , intervention spouses reported reduced upset ( p = .049 ) , women reported enhanced self-efficacy in managing behaviors ( p = .038 ) , and women ( p = .049 ) and minorities ( p = .037 ) reported enhanced self-efficacy in managing functional dependency . IMPLICATION S The environmental program appears to have a modest effect on dementia patients ' IADL dependence . Also , among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving PURPOSE Few empirical studies have compared the efficacy between psychoeducational ( skill-building ) approaches for reducing  caregivers ' psychological distress  and interventions modeled after typical community-based support groups . We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia . DESIGN AND METHODS The change from pre assessment to post assessment ( baseline to 3 months ) for 213 female caregivers ( 122 Anglo and 91 Latino ) is presented . They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program ( instruction and practice in small groups to learn specific cognitive and behavioral skills ) or in the Enhanced Support Group condition ( guided discussion and empathic listening to develop reciprocal support within the group ) . Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers , and they were delivered in either English or Spanish by trained interventionists . RESULTS Overall , participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms , increased use of adaptive coping strategies , and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition . Results were similar for both ethnic groups : there were no main effects for ethnicity , and no significant ethnicity by treatment interaction effects . IMPLICATION S This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone . We find it very encouraging that the Latino caregivers responded well on key outcome variables , suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer 's disease ( AD ) family caregivers , a surprisingly small amount of research exists on anxiety . Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers , brief group cognitive-behavioral therapy ( CBT ) interventions may offer assistance . To assess CBT 's effectiveness , 38 anxious AD family caregivers were recruited and r and omly assigned to a nine-week group CBT intervention or to a waitlist control . Caregivers r and omized to CBT demonstrated less anxiety on self-report and clinician-administered question naires than waitlist group participants at posttreatment and six-week follow-up assessment s. A sub sample of caregivers also demonstrated improved sleep , as assessed through actigraph measurements . Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects . The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold ( PLST ) model . The PLST intervention is design ed to strengthen the psychological re sources of dementia caregivers by teaching methods of preventing and /or managing behavioral problems exhibited by the person with dementia . Mood and immune outcomes were compared between caregivers r and omly assigned to receive either the PLST or a comparison intervention . Results of this pilot study suggest that caregivers who received the PLST intervention showed significantly stronger T-cell proliferative responses to both PHA and ConA , indicating an improvement in T-cell immune function immediately after the in-home intervention ( T2 ) and again after 6 months of telephone support for application of the PLST model ( T3 ) . Findings do not support the hypothesis that the PLST intervention had a significant effect on total mood disturbance or natural killer cell cytotoxicity over the course of the study PURPOSE This demonstration evaluates the effects of integrating  Alzheimer 's Association care consultation service with health care services offered by a large managed care system . The primary hypothesis is that Association care consultation will decrease service utilization , increase satisfaction with managed care , and decrease caregiver depression and care-related strain . Secondary modifying-effects hypotheses posit that the effects of the intervention will be intensified when patients have not received a firm dementia diagnosis , patients have more severe memory problems , caregivers use other Association services in t and em with care consultation , and caregivers are not patients ' spouses . DESIGN AND METHODS The demonstration is a r and omized trial that examines outcomes after a 12-month study period . Interview data from 157 primary family caregivers are combined with data abstract ed from medical/administrative records . RESULTS Support for the primary hypothesis is found for selected , but not all , service utilization outcomes and for caregiver depression . Support for secondary modifying-effects hypotheses is found for satisfaction outcomes and care-related strain outcomes . IMPLICATION S Care consultation delivered within a partnership between a managed care health system and an Alzheimer 's Association is a promising strategy for improving selected outcomes for patients with dementia and their caregivers PURPOSE This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers , and it also examines the role of specific moderator and mediator variables on caregiver outcomes . DESIGN AND METHODS Female participants ( N = 169 ) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were r and omly assigned to one of three treatment interventions : anger management , depression management , or a wait-list control group . These interventions took place over a 3- to 4-month period . The primary outcomes examined were anger or hostile mood , depressed mood , frequency of use of positive and negative coping strategies , and perceived caregiving self-efficacy . RESULTS Significant main effects in the expected direction were found for changes in most of these measures . Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group . Use of positive cognitive coping strategies increased in the anger management group only . Self-efficacy significantly increased for participants in both intervention groups , and it was also demonstrated to function as a mediator of intervention effects . Pretreatment levels of depressive symptoms and anger expression style ( Anger Expression-Out ) moderated the relative effects of the two interventions on mood and coping . IMPLICATION S These data are consistent with a growing body of evidence supporting the effectiveness of skills training , in small groups , to improve both the affective states and the type of coping strategies used by caregivers . In addition , this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals Context Providing care for patients with dementia can pose enormous burdens that may be eased with assistance and support . Needs may differ by race or ethnicity . Contributions The investigators r and omly assigned Hispanic , black , and white dementia caregivers to receive written educational material s or an intensive intervention to improve caregiver quality of life .  The specific interventions were determined by caregivers , were delivered via trained personnel and telephone support groups , and targeted several dimensions of need . The study found that quality of life improved for Hispanic and white caregivers and for black spousal caregivers in the intervention group but not in the control group . The intervention had no detectable effect on the number of care recipients who were institutionalized . Caution s The study used only a single 6-month follow-up assessment , combined heterogeneous cultures and ethnicities into 3 groups , and excluded some ethnicities . Implication s An intensive intervention targeting several dimensions of caregiver need improved caregiver quality of life without an apparent effect on care recipient institutionalization . The effect did not differ by caregiver race or ethnicity . The Editors Caring for a family member with dementia is extremely stressful , contributes to psychiatric and physical illness , and increases the risk for death ( 1 , 2 ) . The accumulating evidence on the personal , social , and health effects of dementia caregiving has generated a broad range of intervention studies , including r and omized trials aim ed at decreasing the burden and stress of caregiving . Several studies have demonstrated statistically significant effects in reducing caregiver burden , lowering caregiver depression , and delaying institutionalization of care recipients ( 1 , 3 , 4 ) through either targeted interventions that treat a specific caregiver problem , such as depression , or broad-based multicomponent interventions that include counseling , case management , and telephone support . Persistent limitations of caregiver intervention research are the paucity of well-controlled r and omized trials , the limited range of outcomes examined , small sample sizes and insufficient power , geographic limitations , inadequate racial or ethnic variation , and a scarcity of comprehensive multicomponent interventions ( 4 ) . Indeed , none of the 41 r and omized clinical trials published in the last 5 years met Consoli date d St and ards of Reporting Trials ( CONSORT ) recommendations for reporting r and omized trials ( 5 ) , and many have serious method ologic problems that call into question the reported findings ( 4 ) . To address these limitations , the National Institute on Aging and the National Institute of Nursing Research funded a multisite research program design ed to develop and test an effective caregiver intervention : the Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) study . We performed the study in 2 phases . In the first phase ( REACH I ) , we tested several different interventions at 6 U.S. sites to identify the most promising approaches to decreasing  caregiver burden and depression ( 6 ) . Results from the study showed that active treatments were superior to control conditions in reducing caregiver burden and that active engagement in skills training statistically significantly reduced  caregiver depression ( 7 , 8) . The existing literature and findings from REACH I helped guide the design of the REACH II intervention ( 7 , 8) . We based the REACH II study on the premise that caregivers can have problems in several areas at varying levels of intensity , and thus , interventions must be responsive to variations in needs among caregivers . The findings from REACH I also suggest that interventions that use active techniques , such as role-playing and interactive practice , are more effective at improving outcomes , such as depression symptoms , compared with more passive methods , such as providing information ( 7 ) . We based the REACH II intervention on these assumptions and design ed the intervention to maximize outcomes by systematic ally targeting several problem areas , tailored the intervention to respond to the needs of each individual , and actively engaged the caregiver in the intervention process . We hypothesized that participants assigned to the intervention would do better than those in the control group on several indicators of caregiver quality of life , including depression , burden , self-care , and social support and care recipient problem behaviors , and that these differences would be largest among Hispanic or Latino persons because they have lower access to support services ( 8) . In additional analyses , we assessed the effects of treatment on rates of caregiver clinical depression and care recipient institutional placement , as well as the benefits derived from study participation . Methods Caregivers Eligibility criteria for caregivers included the following : Hispanic or Latino , white or Caucasian , or black or African-American race or ethnicity ; age 21 years or older ; living with or sharing cooking facilities with the care recipient ; providing care for a relative with diagnosed Alzheimer disease or related disorders for at least 4 hours per day for at least the past 6 months ; and reported distress associated with caregiving ( reported at least 2 of the following 6 items at baseline assessment : felt overwhelmed , felt like they often needed to cry , were angry or frustrated , felt they were cut off from family or friends , reported  moderate to high levels of general stress , or felt their health had declined ) . We excluded caregivers who were involved in another caregiver intervention study , who had participated in REACH I , or who had an illness that would prevent 6 months of study participation . Other requirements were logistic , including having a telephone , planning to remain in the geographic area for at least 6 months , and competency in either English or Spanish ( see Appendix Table 1 for a detailed list of exclusions ) . Appendix Table 1 . Reasons for In eligibility Care Recipients To be eligible for the study , caregivers had to confirm that their relative had diagnosed Alzheimer disease or related disorders . In addition , we screened care recipients for a history of severe mental illness , head injury , Parkinson disease , or stroke , and we administered the  MiniMental State Examination ( MMSE )  ( 9 ) . We excluded patients who were bedbound with MMSE scores of 0 because we felt that our intervention had little to offer caregivers who were caring for such patients . Moreover , being bedbound is a risk factor for institutional placement or death , and we sought to exclude caregivers who were likely to transition out of the caregiving role within the 6-month study . For patients who scored more than 23 on the MMSE or had other conditions , such as head injury , we required a physician 's diagnosis of Alzheimer disease or related disorders . Procedures We recruited caregiver and care recipient dyads at 5 sites : Birmingham , Alabama ; Memphis , Tennessee ; Miami , Florida ; Palo Alto , California ; and Philadelphia , Pennsylvania . Enrollment began in June 2002 , and follow-up ended in August 2004 . Recruitment occurred in memory disorder clinics , primary care clinics , social service agencies , physician offices , churches , and community centers and by using professionally design ed brochures , public service announcements on radio stations , newspaper articles , television , targeted newsletters , and community presentations . We translated all intervention material s and assessment instruments into Spanish for the Hispanic or Latino participants by using established techniques for forward- and -back translation and allowing for regional variation in language expression . We used bilingual and bicultural staff at the 3 sites that recruited Hispanic or Latino participants : Palo Alto , Philadelphia , and Miami . At all sites , assessors and interventionists received cultural sensitivity training and were certified before entering the field . Certified assessors were blinded to group assignment of study participants . The institutional review boards of all 5 site institutions and the coordinating center in Pittsburgh , Pennsylvania , approved the study . We obtained written informed consent from all caregivers and from care recipients whenever possible . Caregivers provided consent on behalf of care recipients who could not do so on their own . After telephone screening ( n= 995 ) and baseline assessment ( n= 670 ) , we r and omly assigned participants ( n= 642 ) to the intervention or control group ( Figure ) . We stratified r and omization by using a block size of 2 or 4 within strata defined by the 5 intervention sites , 3 racial or ethnic groups ( Hispanic or Latino , white or Caucasian , and black or African American ) , and 2 caregivercare recipient relationships ( spouse or nonspouse ) . We performed r and omization at the coordinating center by using a computer-generated algorithm and a st and ard protocol for transmitting r and omization information between the coordinating center and the study sites . We administered 1 of 3 follow-up batteries , on the basis of care recipient status at follow-up ( full follow-up , bereavement battery , or placement battery ) , to study participants 6 months after r and omization when the intervention was completed . To maximize the number of individuals who could be included in the outcome analyses , we ensured that the 3 batteries were as similar as possible . We did not ask caregivers about caregiver burden and care recipient functional status if their care recipients had died ; thus , we could not include these caregivers in the primary outcome analysis ( 10 ) . Figure . Study flow diagram . * See Appendix Table 1 for reasons for in eligibility . See Appendix Table 2 ( for reasons for unavailable end points and types of 6-month follow-up . Appendix Table 2 . Reasons for Unavailable End Points and Types of 6-Month Follow-up Trial Groups Intervention The intervention involved a range of strategies : provision of OBJECTIVES To test the efficacy of a psychoeducative group program for informal caregivers of persons with dementia . METHODS The study was a multicenter r and omized controlled trial . R and omization was stratified according to sex and kinship . Participants r and omized to the control group were referred to the traditional support groups . Participants in the study group had fifteen 2-hr weekly sessions focusing on stress appraisal and coping .  Eligible participants ( primary caregivers of community-dwelling persons with dementia ) were blindly assessed before the r and omization and after 16 weeks on the following measures : frequency and reactions to behavioral problems ( primary outcome ) , burden , psychological distress , anxiety , perceived social support , and personal efficacy . RESULTS A total of 158 participants were r and omized to the study ( n = 79 ) and control ( n = 79 ) groups in 12 successive waves . Results show that study participants presented a 14 % decrease in their reactions to the behavioral problems of the care-receivers as opposed to a 5 % decrease in the control group ( p = .04 ) . The frequency of behavior problems also decreased ( p = .06 ) , as did the cross-product frequency/reaction ( p = .02 ) . There was no significant effect on the secondary outcome variables . DISCUSSION This is one of the first studies showing a significant effect of this type of support group program on the caregivers of participants with dementia Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer 's disease . A sample of 406 spouses-caregivers of patients with Alzheimer 's disease was r and omized to an active multicomponent counseling and support intervention condition or to a usual care condition . Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews . R and om-effects regression models over the first 4 years after r and omization revealed that , although the intervention did not affect the frequency of patient behavioral problems , it did significantly reduce caregivers ' reaction ratings . Because caregiver appraisal s have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates , they deserve greater attention as an important target of intervention services PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences To evaluate nonpharmacologic interventions , caregivers ( 65 women , 38 men ) and their dementia-diagnosed spouses ( patients ) were r and omized to one of four treatment programs ( cognitive stimulation , dyadic counseling , dual supportive seminar , and early-stage day care ) or to a wait-list control group . Assessment s occurred initially and at postintervention ( 3 months ) . Patients were evaluated on memory , verbal fluency , and problem-solving ability , and caregivers were assessed on marital interaction , emotional status , and physical health , along with stress , coping , and social support .  Caregivers also completed a program evaluation . Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes , and caregivers decreased in depressive symptoms . Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies , respectively . Although qualitatively derived benefits differed across groups , similarities in program content reduced the potential for quantitative differentiation among the groups OBJECTIVE The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer 's disease . METHOD The participants were 406 spouse-caregivers of Alzheimer 's disease patients who lived at home at baseline . The caregivers were r and omly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care ( control group ) . Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling , agreed to join support groups 4 months after enrollment , and received ongoing ad hoc counseling . The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study . RESULTS After baseline differences were controlled for , caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects . These effects were sustained for 3.1 years after baseline , similar across gender and patient severity level , and sustained after nursing home placement or death of the patient . CONCLUSIONS Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer 's disease patients and should be widely available to provide effective , evidence -based intervention for family caregivers In this descriptive study we examined content and processes in a group-based component of an ongoing clinical trial with family caregivers of persons with dementia . The purpose was to identify issues arising from the group processes that could be used to inform future skill-building caregiver groups . Summaries from two types of intervention groups , a caregiver skill-building ( CSB ) treatment intervention and an information and support only ( ISO ) control intervention were examined , along with data collected during a group leader debriefing session . Three major categories of process information were identified : ( a ) group member behaviors that support group processes necessary for skill development , ( b ) group leader behaviors that support group processes necessary for skill development , and ( c ) the phases of learning in caregiver ( CG ) skill development . Subcategories and specific content in each of these areas are identified in this article , and a list of member and leader behaviors that might support future skill development in groups is presented Background Eighty percent of persons with Alzheimer ’s disease and related disorders are cared for by family members who often lack adequate support and training for this all-consuming job . Objective To evaluate the efficacy of a longitudinal , multisite , community-based intervention design ed to teach home caregivers to manage behavioral problems in persons with Alzheimer ’s disease . Methods Usable data were analyzed from 237 caregiver/care recipient dyads ( n = 132 Experimental;n = 105 Comparison ) . The experimental group received a psychoeducational nursing intervention that was conceptually grounded in the Progressively Lowered Stress Threshold model ( Hall & Buckwalter , 1987 ) . The comparison group received routine information and referrals for case management , community-based services , and support groups . Although a variety of psychosocial outcomes were compared between caregivers in the two groups , this article focuses on frequency and response to behavioral problems and functional decline . Results The Progressively Lowered Stress Threshold intervention had a statistically significant effect on spousal response to memory/behavioral problems ( p < .01 ) for all caregivers and on response to activities of daily living problems ( p < .01 ) for spousal caregivers . In addition , nonspouses in the experimental group reported a reduction in the frequency of memory/behavioral problems ( p < .01 ) . No intervention effect on reports of activities of daily living frequencies was found for either spouses or nonspouses . Conclusions This Progressively Lowered Stress Threshold-based intervention had a positive impact on both the frequency of and response to problem behaviors among spousal caregivers PURPOSE We investigated whether community consultants could be trained to teach family caregivers a systematic behavioral approach for reducing mood and behavior problems in persons with Alzheimer 's disease . DESIGN AND METHODS This study consisted of a r and omized controlled trial ; we r and omly assigned 95 family caregivers and care recipients with Alzheimer 's disease to STAR-caregivers ( STAR-C ) or control groups . Masked interviewers conducted assessment s at baseline , after treatment , and after 6 months . Consultants were master's-level health care professionals who were currently practicing in community setting s serving older adults . We assessed the extent to which consultants were able to learn and adhere to the treatment protocol , and the relationship between adherence and measures of caregiver mood , burden , and care recipient mood and behavior . RESULTS Community consultants were able to learn and adhere to the behavioral treatment protocol . Caregivers receiving STAR-C training showed significant improvements in depression , burden , and reactivity to behavior problems in the care recipient . There were also significant reductions in the frequency and severity of care recipient behavior problems , and improved quality of life . Results were maintained at 6-month follow-up . IMPLICATION S Community-based consultants successfully implemented a behavioral intervention with family caregivers of persons with Alzheimer 's disease . Consequently , STAR-C seems to be a practicable and reasonable evidence d-based approach to caregiver training in actual clinical setting BACKGROUND The study objective was to determine the health and quality -of-life effects of moderate-intensity exercise among older women family caregivers . METHODS This 12-month r and omized controlled trial involved a volunteer sample of 100 women aged 49 to 82 years who were sedentary , free of cardiovascular disease , and caring for a relative with dementia . Participants were r and omized to 12 months of home-based , telephone-supervised , moderate-intensity exercise training or to an attention-control ( nutrition education ) program . Exercise consisted of four 30- to 40-minute endurance exercise sessions ( brisk walking ) prescribed per week at 60 % to 75 % of heart rate reserve based on peak treadmill exercise heart rate . Main outcomes were stress-induced cardiovascular reactivity levels , rated sleep quality , and reported psychological distress . RESULTS Compared with nutrition participants ( NU ) , exercise participants ( EX ) showed significant improvements in the following : total energy expenditure ( baseline and post-test means [ SD ] for EX = 1.4 [ 1.9 ] and 2.2 [ 2.2 ] kcal/kg/day ; for NU = 1.2 [ 1.7 ] and 1.2 [ 1.6 ] kcal/kg/day ; p < .02 ) ; stress-induced blood pressure reactivity ( baseline and post-test systolic blood pressure reactivity values for EX = 21.6 [ 12.3 ] and 12.4 [ 11.2 ] mm Hg ; for NU = 17.9 [ 10.2 ] and 17.7 [ 13.8 ] mm Hg ; p < .024 ) ; and sleep quality ( p < .05 ) . NU showed significant improvements in percentages of total calories from fats and saturated fats relative to EX ( p values < .01 ) . Both groups reported improvements in psychological distress . Conclusions . Family caregivers can benefit from initiating a regular moderate-intensity exercise program in terms of reductions in stress-induced cardiovascular reactivity and improvements in rated sleep quality This qualitative process evaluation study aim ed to identify the primary processes of a psycho-educational group for caregivers of persons with dementia , in order to better underst and intervention outcomes . Semi-structured interviews were conducted with 30 participants recruited from the experimental group of a r and omised controlled trial . At pre-test , participants reported their expectations of the group . At post-test , they described their group experience , the most/least helpful aspects of the intervention , their most useful learning and their responses during a recent episode of disturbing behaviour by their relative . Results showed that the group delivered both educational and support processes . Support processes complemented educational processes . Participants learned coping strategies , with reframing playing a more important role than problem-solving or seeking social support . Daughters benefited more than spouses from educational processes . This study of group processes contributes to our underst and ing of the reported reduction in frequency of disturbing behaviours and of the change in caregivers ’ behaviours PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship BACKGROUND Few studies evaluate whether short-term intervention effects are maintained over time for families caring for persons with dementia . This article examines whether treatment effects found at 6 months following active treatment were sustained at 12 months for 127 family caregivers who participated in an occupational therapy intervention tested as part of the National Institutes of Health Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) initiative . METHODS A r and omized two-group design was implemented with three assessment points : baseline , 6 months , and 12 months . Caregivers were r and omly assigned to a usual care control group or intervention that consisted of six occupational therapy sessions to help families modify the environment to support daily function of the person with dementia and reduce caregiver burden . Following 6-month active treatment , a maintenance phase consisted of one home and three brief telephone sessions to reinforce strategy use and obtain closure . Non-inferiority statistical analysis was used to evaluate whether intervention caregivers maintained treatment benefits from 6 to 12 months in comparison to controls . RESULTS For the sample of 127 at 6 months , caregivers in intervention reported improved skills ( p = .028 ) , less need for help providing assistance ( p = .043 ) , and fewer behavioral occurrences ( p = .019 ) compared to caregivers in control . At 12 months , caregiver affect improved ( p = .033 ) , and there was a trend for maintenance of skills and reduced behavioral occurrences , but not for other outcome measures . CONCLUSION An in-home skills training program helps sustain caregiver affect for those enrolled for more than 1 year . More frequent professional contact and ongoing skills training may be necessary to maintain other clinical ly important outcomes such as reduced upset with behaviors The caregivers of 37 patients with a dementing illness completed rating scales regarding the frequency and severity of their care recipient 's general behavioral disturbance and manipulative behaviors , as well as their own resentment and depression . Caregivers were r and omized to a four-week psychoeducational group intervention or control group to investigate the effect of dementia caregiving education on the caregiving experience . Findings indicated that , while care recipient behavioral disturbance was correlated with caregiver resentment and depression , the primary relationship was between behaviors perceived by the caregiver as manipulative or willful and caregiver resentment and depression . We found no significant differences in caregiver attribution , resentment , or depression between the caregivers who participated in the group session and those in the control group . The study supports the existence of resentment among dementia caregivers , and an important relationship between caregiving outcomes and attributions made by caregivers regarding their care recipients ' actions . These results are discussed in relation to existing research on  caregiver distress and intervention The purpose of this article is to describe the impact of a theoretically driven , psychoeducational intervention based on the Progressively Lowered Stress Threshold ( PLST ) model on caregiving appraisal among communitybased caregivers of persons with Alzheimer 's disease and related disorders . A total of 241 subjects completed the year-long study in four sites in Iowa , Minnesota , Indiana , and Arizona . Caregiving appraisal was measured using the four factors of the Philadelphia Geriatric Center Caregiving Appraisal Scale : mastery , burden , satisfaction , and impact . Analysis of trends over time showed that the intervention positively affected impact , burden , and satisfaction but had no effect on mastery when measured against the comparison group . The PLST model was influential in increasing positive appraisal and decreasing negative appraisal of the caregiving situation The aim of this study was to evaluate the effects of  geriatric day care  on patients and caregivers . Day care patients ( n = 43 ) were compared with an untreated matched control group ( n = 40 ) . Matching criteria were age , gender , physical and mental health status , and socioeconomic status . The mean age of both groups was 79.5 years . Data were collected at three measurement points : T1 took place during the first 10 days of service use , T2 was conducted 6 months later , and T3 took place 9 months after service use began . In addition , a short follow-up was conducted 6 months after T3 . Well-being , dementia symptoms , health indicators , and activities of daily living were investigated . Individual growth curves of these patient variables were computed and analyzed with multivariate analyses of variance . The results show significant positive effects of  day care on well-being and dementia symptoms . Patients in day care stabilized or improved on various measures , whereas the untreated control participants worsened . Follow-up data showed a significant decline in health in the control group in comparison with the day care users . Results concerning effects on caregivers were not that clear . Individual change parameters in subjective well-being and burden did not differ between the two groups of caregivers in the longitudinal follow-up . In a semistructured interview , however , caregivers of patients in the treatment group reported substantial positive change due to use of day care The objective was to assess the effect of a structured intervention on caregiver stress and the institutionalization rate of patients with dementia and problem behaviors . Caregivers contacting the Federazione Alzheimer Italia ( AI ) to receive help , advice , or information in relation to problem behaviors of out patients were enrolled . Eligible caregiver-patient dyads were r and omized to receive either a structured intervention or the counseling AI usually provides ( control group ) . After basal assessment , families were reassessed at 6 and 12 months . Problem behavior ( particularly agitation ) was the only variable significantly correlated ( P = 0.006 ) with the baseline caregivers ’ stress score . Thirty-nine families completed the 12-month follow-up ; the mean problem behavior score was significantly lower in the intervention than the control group ( p < 0.03 ) ; the time needed for care of the patient increased by 0.5 ± 9.7 hours/day in the control group and decreased by 0.3 ± 4.1 in the intervention group ( p = 0.4 , Wilcoxon test ) . The main determinant of institutionalization seemed to be the level of caregiver stress ( p = 0.03 ) . In patients of the intervention group , there was a significant reduction in the frequency of delusions . This pilot study suggests that caregiver stress is relieved by a structured intervention . The number of families lost to follow-up , the relatively short duration of the study , and the ceiling effect due to the severity of the clinical characteristics of patients probably all partly dilute the observed findings THE R AND OMIZED controlled trial ( RCT ) , more than any other methodology , can have a powerful and immediate impact on patient care . Ideally , the report of such an evaluation needs to convey to the reader relevant information concerning the design , conduct , analysis , and generalizability of the trial . This information should provide the reader with the ability to make informed judgments regarding the internal and external validity of the trial . Accurate and complete reporting also benefits editors and review ers in their deliberations regarding su bmi tted manuscripts . For RCTs to ultimately benefit patients , the published report should be of the highest possible st and ard PURPOSE We examine 6-month effects of the Environmental Skill-Building Program on  caregiver well-being and care recipient functioning  and whether effects vary by caregiver gender , race ( White or non-White ) , and relationship ( spouse or nonspouse ) . DESIGN AND METHODS We enrolled 255 family caregivers of community-residing persons with Alzheimer 's disease or related disorders , of whom 190 participated in a follow-up interview . Caregivers were r and omized to a usual care control group or intervention group that received five home contacts and one telephone contact by occupational therapists , who provided education , problem-solving training , and adaptive equipment . Baseline and 6-month follow-up included self-report measures of caregiver objective and subjective burden , caregiver well-being , and care recipient problem behaviors and physical function . RESULTS Compared with controls ( n = 101 ) , intervention caregivers ( n = 89 ) reported less upset with memory-related behaviors , less need for assistance from others , and better affect . Intervention spouses reported less upset with disruptive behaviors ; men reported spending less time in daily oversight ; and women reported less need for help from others , better affect , and enhanced management ability , overall well-being , and mastery relative to control group counterparts . Statistically significant treatment differences were not found for hours helping with instrumental activities of daily living , upset with providing assistance with instrumental activities of daily living and activities of daily living , perceived change in somatic symptoms , White versus non-White caregivers , or care recipient outcomes . IMPLICATION S The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses OBJECTIVE This study examined the extent to which adherence to occupational therapy recommendations would increase the quality of life of persons with Alzheimer 's disease living in the community and decrease the burden felt by family members caring for them . METHOD Using a pretest-posttest control group design , the Assessment of Instrumental Function ( AIF ) was administered to two groups of persons with Alzheimer 's disease in their own homes ( n= 40 ) . Caregivers completed measures of their feelings of burden and the quality of life , including level of function of the persons with Alzheimer 's disease . RESULTS A significant ( MANCOVA ) main effect was obtained for caregiver burden and three components of quality of life , positive affect , activity frequency and self-care status , by the treatment group , F(4 , 31 ) = 7.34 , p < .001 . CONCLUSIONS Individualized occupational therapy intervention based on the person-environment fit model appears effective for both caregivers and clients . This is especially important in light of a recent directive for more favorable reimbursement for occupational therapy services for persons with dementia The spouse caregivers of 406 patients with Alzheimer 's disease were r and omly assigned to an enhanced counseling and support intervention or to a usual care control condition . Structured interviews were conducted to assess changes in social support and psychosocial outcomes for the 312 caregivers who provided care in the home for at least 1 year . The number of support persons , satisfaction with the support network , and support persons ' assistance with caregiving all increased significantly as a function of the intervention . Structural equation models indicated increased satisfaction with the social support network mediated a significant proportion of the intervention 's impact on caregiver depression . A portion of this mediated effect was further mediated by changes in caregiver stress appraisal s. Implication s for strengthening intervention programs for spouse caregivers of individuals with Alzheimer 's disease are discussed OBJECTIVES Family caregiving is an integral part of the care system for persons with dementing disorders , such as Alzheimer 's disease . This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving . DESIGN Training effectiveness was tested in a trial in which family care receiver dyads were r and omly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months , following completion of data collection . SETTING A community-based 14-hour training program provided in seven weekly 2-hour sessions . The training program curriculum was built on a stress and coping theory base . Recruitment and r and omization were ongoing . Programs were begun every 2 months over a two and one half-year period for a total of 16 programs . PARTICIPANTS Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate . MEASUREMENTS Data reported in this paper were gathered from each participating family at entry to the study and 5 months later . St and ard measures of beliefs about caregiving , burden , depression , and reaction to care receiver behavior were administered to caregivers . A st and ard measure of mental status was administered to the person with dementia and st and ardized instruments were used to gather information from caregivers concerning care receivers ' behavior and abilities to perform activities of daily living ( ADLs ) . RESULTS Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data . Treatment and control caregivers and care receivers were similar at baseline , and care receivers in both groups declined similarly over the 5-month period . Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving ( P = .044 ) and reaction to behavior ( P = .001 ) . When outcomes were compared , treatment group caregivers were significantly different ( in the expected direction ) from those in the control group on measures of the stress mediator , beliefs ( P = .025 ) , and key outcomes , response to behavior ( P = .019 ) , depression ( P = .040 ) , and burden ( P = .051 ) . There was a significant positive association between the strengthened mediator , the caregivers ' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities , and the outcome , namely improvements in burden ( P = .019 ) and depression ( P = .007 ) . CONCLUSION A caregiver training intervention focused on the work of caregiving and targeted at knowledge , skills , and beliefs benefits caregivers in important outcome dimensions . The results suggest the benefits of providing information , linkage , and role coaching to dementia family caregivers BACKGROUND The majority of patients with Alzheimer 's disease live outside institutions and there is considerable serious psychological morbidity among their carers . AIMS To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer 's disease and produces clinical benefits in the patients . METHOD A prospect i ve single-blind r and omised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups . RESULTS There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up . There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group . Based on an improvement on the General Health Question naire result ing in a carer converting from a case to a non-case , the number to treat was three immediately post-treatment and two at follow-up . CONCLUSIONS Family intervention can have significant benefits in carers of patients with Alzheimer 's disease and has a positive impact on patient behaviour This study evaluated a one year long course education and counseling program with 93 family caregivers of elders afflicted with Alzheimer 's disease . The elders had received treatment for agitation in an inpatient setting and were subsequently discharged to the caregivers ' home . Caregivers were r and omly assigned to an experimental group ( n = 68 ) and a control group ( n = 25 ) .  Baseline assessment s ( Time 0 ) were conducted while the elder was an inpatient . Postdischarge interventions and assessment s were conducted at 2 weeks , 6 weeks , 12 weeks , and 6 and 12 months ( Times 1 - 5 respectively ) . There were no significant treatment effects for care recipient agitation , caregiver stress , depression , and physical health , and no significant differences between groups in rates of institutionalization for afflicted elders . Longitudinal data , however , revealed several important trends . Afflicted elders ' agitation rose steadily for control group subjects at Times 3 through 5 but declined for experimental group subjects . Caregiver depression increased for control group subjects at Time 5 , but declined for experimental group subjects . Caregiver physical health declined for control group subjects at Times 4 and 5 but was maintained for experimental group subjects . A significantly higher number of afflicted elders were still at home among experimental group subjects at the end of the one year study . The difficulties in demonstrating efficacy of interventions with family caregivers of Alzheimer 's disease are discussed . Finally , the issue of data collection being perceived as support by control group subjects is evaluated OBJECTIVES To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case management . DESIGN R and omized controlled intervention study with 2-year follow-up . SETTING Demented patients entitled to payments from the Social Insurance Institution for community care , in five municipalities in eastern Finl and . PARTICIPANTS One hundred demented patients , age 65 and older , living at home with the primary support of informal caregivers , allocated at r and om to the intervention ( n = 53 ) or control group ( n = 47 ) . INTERVENTION Intervention patients and their caregivers were provided with a 2-year intervention program of systematic , comprehensive support by a dementia family care coordinator . MEASUREMENTS Time to institutionalization ( period in community care ) from enrollment of patients in the study to their placement in long-term institutional care . RESULTS During the first months , the rate of institutionalization was significantly lower in the intervention group than in the control group ( P = .042 ) , but the benefit of the intervention decreased with time ( P = .028 ) . Estimated probability of staying in community care up to 6 , 12 , and 24 months was 0.98 , 0.92 , and 0.63 in the intervention group and 0.91 , 0.81 , and 0.68 in the control group , respectively . Results also suggest that the intervention used in the study might be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care . CONCLUSIONS The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator . However , by the end of the 2-year intervention , the number of patients institutionalized was similar in the intervention and control group . It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers . On the basis of our experiences , we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care The Re sources for Enhancing Alzheimer 's Cargiver Health ( REACH ) project was design ed to test promising interventions for enhancing  family caregiving for persons with dementia . The purpose of this article is to describe the research design , interventions , and outcome measures used in REACH and to characterize the sample recruited for the study . Nine interventions and 2 control conditions were implemented at 6 sites ; 1,222 dyads were r and omly assigned to an intervention or a control condition . The caregiver sample was 18.6 % male with an average age of 62.3 years ( 56 % Caucasian , 24 % Black , and 19 % Hispanic ) . Caregivers reported high levels of depressive symptoms and moderate burden . Care recipients were older , with a mean age of 79 , and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30 PURPOSE This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer 's disease . The interventions , using targeted educational material s , were patient behavior management only , and patient behavior management plus caregiver stress-coping management . We hypothesized that the addition of the stress-coping component would improve caregiver outcomes . DESIGN AND METHODS A r and omized clinical trial of 167 caregiver-care recipient dyads was run , of whom 76 completed the study without bereavement or placement . RESULTS During 24 months , caregivers who received the patient behavior management component only , compared with those who also received the stress-coping component , had significantly worse outcomes for general well-being and a trend toward increased risk of depression ( i.e. , a score of > 16 on the Center for Epidemiological Studies Depression scale ) . There was a study wide improvement for bother associated with care recipient behaviors ( according to the Revised Memory and Behavior Problems Checklist ) . IMPLICATION S Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient . They further suggest that interventions that focus only on care recipient behavior , without addressing caregiving issues , may not be as adequate for reducing caregiver distress To investigate the effectiveness of a  home‐based caregiver training program for caregivers of elders with dementia and behavioral problems Improving carers ' knowledge of Alzheimer 's disease ( AD ) has been associated with benefits for carer well-being . This has led to recognition of the need to systematic ally evaluate dementia education tools . In this study dementia knowledge was measured before and after interventions design ed to improve knowledge in a sample of 100 undergraduate students .  Dementia education material s were selected from existing re sources that are readily accessible and are recommended for use in clinical setting s. Subjects were allocated to one of four conditions , including a control group . Subjects allocated to education conditions were asked to view a video on AD , read written information about the disease or do both . Results showed that education improved knowledge of AD , as measured by increased scores on a dementia knowledge question naire . This study has important implication s for public education about dementia and re source allocation for service providers The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia . 30 informal carers were allocated to the workshop sessions and 15 to the booklet . Outcome measures included awareness of communication strategies ; perceived frequency of communication breakdown at home , and the associated level of distress ; general stress ; and consumer satisfaction . At six week follow-up , the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group . Both groups reported some reduction in the frequency of communication problems at home , and a reduction in the associated level of distress . The frequency of other problem behaviours remained stable . Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner OBJECTIVES The present study examined , prospect ively and within the context of stress experienced in the natural environment , whether situational control served as a mediator between perceived social support and caregiver 's mood . METHODS Data came from baseline assessment s of individuals participating in health promotion interventions for women caregivers . Participants were 49 female caregivers of dementia patients who monitored their own acute psychological states during the day . RESULTS Results revealed that although the occurrence of a situational stressor increased negative mood , greater perceived support reduced the detrimental impact of a stressor on negative mood . Moreover , path analyses revealed that changes in situational control partially mediated the relationship between perceived support and stress-induced negative mood changes . However , changes in control did not serve as a mediator in analyses focused on happiness . DISCUSSION Results suggest that caregivers with greater perceived support were less emotionally reactive to stress occurring in their natural environments because of , in part , sustained or increased situational control
Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community .