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Research Highlights
Alzheimer’s-caregiver study results
being implemented at 20 VA sites
March 13, 2008
An individualized approach to helping family caregivers
of older veterans with Alzheimer’s disease, shown successful
in earlier research, is now being rolled out in community-
based VA programs in 20 cities. VA investigators will
further test the approach, known as REACH VA, to see if
it boosts the health and well-being of the caregivers and
patients and reduces their need for healthcare services.
REACH stands for "Resources for Enhancing Alzheimer’s
Caregiver Health," and was the title of two earlier trials
sponsored by the National Institutes of Health and conducted
by investigators with VA, NIH and several universities.
An economic analysis of the program published this month
in the Journal of the American Geriatrics Society shows that
it costs only about five dollars a day to give caregivers about
an extra hour in their day, free from the stress and burden of
caring for their relative.
"The intervention provided that most
scarce of caregiver commodities—time,"
wrote the authors, led by Linda Nichols,
PhD, of the Memphis VA Medical Center
and the University of Tennessee Health Science
Center.
"We think the biggest outcome was in
the increase in perceived free time of one
hour,” added study team member Jennifer
Martindale-Adams, EdD. “The extra noncaregiving
time could allow the caregivers
to do what they wanted."
Caregivers report better
emotional health
Along with the extra time, most of the
caregivers involved in the earlier research
reported improvements in areas such as
caregiver burden, depression and emotional
well-being, and social support. They
also reported fewer problem behaviors by
the older family member with dementia,
although nursing-home admissions did not
differ between the intervention and control
groups.
The six-month intervention that was
included in the earlier research and will now
be implemented more widely with veterans’
caregivers includes 12 individual sessions in
the home and by telephone, complemented
by five telephone support groups. Specially
trained "interventionists" teach caregivers
how to reduce stress, solve problems, and
manage difficult behaviors by their family
member. They use role-playing and other
strategies to build coping skills. The material
is tailored to family members based on
assessments of where they need the most
help. For example, some caregivers might
simply need more knowledge about available
resources or Alzheimer’s symptoms,
while others need to learn how to reframe
their emotional responses.
"Risk priority assessment is the most
innovative part of REACH and REACH
VA," says Nichols. "Targeting the intervention
to the caregiver’s needs and not just to
the behavior problems of the patient helps
to individualize the program and to focus on
high-risk areas first."
That the program can deliver benefits
relatively cheaply is another important
feature, says Martindale-Adams, who works
with VA and the department of preventive
medicine at the University of Tennessee.
"The cost-analysis is helpful to show that
you can do behavioral interventions. There
are a lot of people who have said they won’t
work due to cost."
This article originally appeared in the March 2008 issue of VA Research Currents.
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