ORLANDO – The quality of life among caregivers of Alzheimer's patients can improve significantly when interventions are tailored to their needs, according to the first randomized trial of such interventions.
“Physicians are in a position to identify highly stressed caregivers and intervene,” said Richard Schulz, Ph.D., the principal investigator on the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II trial.
Speaking at the annual meeting of the Gerontological Society of America, Dr. Schulz and several other of the trial's investigators noted that a goal of the REACH team is to develop a brief assessment for use by physicians to evaluate caregivers' depressive symptoms. “This would be something a caregiver could fill out in the waiting room and would give the doctor an indication that there may be problems,” he said in an interview.
The REACH II trial randomized 642 family member caregivers of Alzheimer's patients to either usual care (control group) or a tailored intervention aimed at improving their quality of life. The primary outcome, measured after 6 months, was a multivariate quality of life indicator that assessed caregiver burden (how extensively their lives were disrupted as a result of caregiving), depressive symptoms, self-care, social support, and patient problem behaviors, said Dr. Schulz, a professor of psychiatry at the University of Pittsburgh.
The group's racial and ethnic backgrounds were equally divided among whites, blacks, and Hispanics. Most caregivers were female, in their late 50s, and living with the Alzheimer's patient.
Prior to randomization, all caregivers underwent an extensive baseline evaluation, which assessed their risk for poor or decreasing quality of life. Those in the intervention arm then received a series of 12 intervention visits tailored specifically to their areas of concern.
When reassessed at the end of the study period, whites and Hispanics showed significant improvement after the intervention, whether the caregiver was a spouse or an adult child, while blacks showed improvement only when the caregiver was a spouse.
The study also measured clinical depression among caregivers as well as their intentions of placing the Alzheimer's patient in an institution. Caregivers who received the intervention were significantly less likely than the control group to consider institutionalization (4% vs. 7%) and to be clinically depressed (13% vs. 23%).