TUESDAY, Nov. 21, 2006 (HealthDay News) -- Quality of life among those caring for loved ones suffering from dementia can be greatly enhanced by professional support programs, a new study suggests.
In the Nov. 21 issue of the Annals of Internal Medicine, the researchers report that this in-depth look at the effect of personalized problem-solving interventions among a diverse pool of caregivers shows that such programs help white, black and Hispanic caregivers alike.
"We were motivated by the fact that we have a lot of evidence that dementia caregivers have a lot of problems such as a high level of stress, depression and anxiety, and are more prone to becoming physically ill themselves," said study co-author Richard Schulz, a professor of psychiatry at the University of Pittsburgh School of Medicine.
"And we found that we had a positive impact on Hispanics and whites on all areas of quality of life, while among African-Americans, the intervention also benefited spousal caregivers -- although not other non-spousal givers, such as adult children," Schulz said.
In the same journal, a second research effort led by Dr. Barbara G. Vickrey, of the University of California, Los Angeles, looked at in-home dementia treatment from a different angle.
In the first caretaker study -- funded by the U.S. National Institutes of Health -- Schulz and his colleagues focused on 642 dementia-patient caregivers living in Alabama, Pennsylvania, Tennessee, Florida or California.
The group was evenly divided among white, Hispanic and black caregivers.
For six months, half of them were offered support by professionally trained staff, via nine at-home visits and three half-hour phone calls. An additional five group telephone support sessions were also provided.
Over the same time frame, the non-counseled group was only given a single package of dementia education material, followed by two brief phone check-ups.
Quality of life indicators -- such as depression symptoms, stress levels, the ability to rest and take care of oneself, social support and key patient handling problems -- were tallied before the study and six months after intervention.
Schulz and his team found quality of life improved much more among caregivers in the intervention group than among those left to fend for themselves.
Among the supported group, 45 percent of Hispanics, 40 percent of whites, and 29 percent of blacks displayed quality of life boosts -- compared with 7 percent, 13 percent and 11 percent, respectively, among the non-supported group.
The researchers noted, however, that black caregivers in the support group who were related but not married to their patient did not demonstrate any such benefits.
Specifically, among the supported caregivers, Hispanics experienced the greatest improvement in their handling of difficult patient behavior and minimizing their own depression.
White caregivers benefited most in terms of social support, while blacks achieved their biggest gains when it came to reducing their stress and improving self-care.
In addition, clinical depression was found to be significantly lower among supported caregivers (just under 13 percent) when compared with those left alone (nearly 23 percent).
Counseled caregivers indicated that the help gave them a greater sense of confidence while making life easier and enabling them to offer better care and keep their loved one at home.
Schulz said the decision to offer support in Spanish that might not otherwise be linguistically accessible probably accounts for the enormous benefit Hispanics seemed to get from counseling.
In the second study, Vickrey and her associates assigned 238 pairs of dementia patients over the age of 65 and their caregivers to a case management group that received a year of in-person support at one of nine clinics in southern California.
The assisted group was offered help in identifying local resources to help them optimize caregiving.
Another 170 patient-caregiver pairs were tracked while receiving no such additional assistance. Overall, patients were primarily white and well-educated.
The researchers found that, by almost any measure, patients who received such assistance were getting higher quality of care by the end of the study year than those who hadn't.
However, assisted caregivers did not experience improvements in their own health as a result of the intervention.
But quality of life gains were clear in Schulz's study.
"This was a research project, but the approach should be made available to the broader community," said Schulz. "That would be a major new benefit, and I'm optimistic that the kind of controlled support we attempted could be adapted for the real world and would work in the community on a wide scale."
Dr. Kenneth E. Covinsky, who works in the geriatrics division of the School of Medicine at the University of California, San Francisco, agreed that such caregiver assistance is critical.
But he cautioned that the approach would require a major shift in the way both the medical community and society thinks about dementia treatment.
"The ability to provide this kind of support should be as routine as writing a prescription," said Covinsky, who outlined his thoughts in an accompanying editorial.
"If you look and compare the effectiveness of drugs that are commonly used for dementia, the benefits of these interventions were just as strong in terms of keeping both the patients and the caregivers healthy," he noted.
"But this is often not appreciated if one has not had a family member with advanced dementia," acknowledged Covinsky. "Yet, it's hard to overestimate how difficult care-giving is. And when you think about the public health savings that caregivers provide, it's really amazing, in terms of keeping patients out of nursing homes. So it seems to me that these studies show that there should be some sort of social contract that acknowledges and enables their work. Something's owed."
More information
For additional information on dementia and caregiving, visit the Family Caregiver Alliance.
