Phone-based community intervention may improve dementia patient and caregiver outcomes
A care management program conducted via telephone for caregivers of patients with Alzheimer’s and other forms of dementia is associated with improved outcomes for both patients and carers, according to a new study in the United States.
In an assessment of 440 caregivers of older, community-dwelling, low-income care recipients (CRs) with dementia enrolled in the Pennsylvania Department of Aging’s SUSTAIN* program, it was found that caregivers who engaged in the program’s phone-based Enhanced Care Services (ECS, n=150) reported greater reductions in caregiver burden over time versus those who engaged in clinical evaluation only (n=290).
In addition, a statistically significant reduction was found in both the total reported frequency of dementia-related behaviors (p = 0.03) and caregiver distress in response to symptoms (p = 0.04) from baseline to 3-month follow-up. [Am J Geriatr Psychiatry 2017;25(9):1019–1028]
“The results further underscore the value of integrated and collaborative dementia care management interventions for caregivers,” wrote the researchers. “In addition, the findings suggest that collaborative dementia care management is effective in real-world settings, as analysis of caregivers of older adults enrolled in the SUSTAIN program allowed us access to a unique sample of geographically diverse, community-dwelling, informal caregivers who were offered services through their care recipients' health program.”
Primary outcomes of the study were perceived caregiving burden (measured via Zarit Burden Interview) and general health, while secondary outcomes were CR neuropsychiatric symptoms and caregiver distress in response to CRs' challenging dementia-related behaviors.
ECS services were delivered by nurses and social workers with expertise in symptom assessment and management strategies for caregivers of persons with moderate-to-severe dementia. These services included providing information and coordination for service referrals and community resources; as well as the Telehealth Education Program (TEP), a manualized program to train caregivers in various aspects of care management (eg, communication skills, behavioural management techniques, stress management and coping skills, and long-term planning.)
On average, caregivers involved in the study were 64.0 years old (standard deviation, SD, 11.8 years) and 62.6 percent provided care for the CR for 20 or more hours per week. Caregivers were primarily female (73.2 percent), Caucasian (90.2 percent), and spousal caregivers (72.5 percent). The total professional time dedicated to each caregiver—including intervention delivery and documentation—was approximately 12 to 20 hours.
“A service of this kind may serve as a useful adjunct to the dementia care offered in primary care practices and potentially benefit patients with dementia and their caregivers in a variety of community and clinical settings,” said the researchers. “Given that it is delivered over the phone and is in large part manual-driven, the program can be easily disseminated and implemented.”