Long-term Care

Structured health programs can greatly help frail older adults and their family caregivers

Both frail older adults and their family caregivers feel better emotionally and physically with use of a structured health education program (HEP) compared with usual care, according to a recent study supported by the Agency for Healthcare Research and Quality (HS08641) and led by Ronald Toseland, Ph.D., of the State University of New York at Albany. Dr. Toseland and his colleagues randomly selected 105 caregivers—in this study, they were caring for spouses with a chronic illness—to receive the HEP or usual care (UC) offered by one HMO.

HEP focus groups met for 8 weekly sessions, followed by 10 monthly sessions. The major components of the HEP groups included emotion-focused coping strategies, problem-focused coping strategies, education about resources and sources of support for caregiving, and support. The researchers conducted personal interviews with both groups of caregivers and the frail older adults in their care prior to implementation of the HEP, right after completion of the eight focus group meetings, and 1 year after the HEP.

Although severe depression decreased for HEP caregivers from baseline to 1 year, it significantly increased for UC caregivers. There were no significant differences at baseline between the two caregiver groups on the General Health Questionnaire on somatic symptoms, anxiety/insomnia, or social dysfunction. However, from baseline to 1 year there was a significantly greater increase in somatic symptoms and anxiety/insomnia for UC compared with HEP care recipients.

HEP caregivers perceived that their effectiveness had increased at 8 weeks, whereas UC caregivers perceived that their effectiveness had decreased, a difference that did not persist at 1 year. HEP caregivers continued to report more effectiveness at addressing pressing problems, more knowledge of community services and how to access them, and an improved relationship with and care of their spouse than UC caregivers. By 1 year, use of support services increased for both groups.

See "Supporting caregivers of frail older adults in an HMO setting," by Dr. Toseland, Philip McCallion, Ph.D., Tamara Smith, B.A., and Steve Banks, Ph.D., in the American Journal of Orthopsychiatry 74(3), pp. 349-364, 2004.

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