The following are brief summaries of the programs identified as effective evidence based programs.
New York University Caregiver Intervention (NYUCI)
Counseling and support intervention for spouse caregivers that is intended to improve the well-being of caregivers and delay the nursing home placement of patients with Alzheimer’s disease. The program also aims to help spouse caregivers mobilize their social support network and help them better adapt to their caregiving role. The program consists of four components, the first two of which are delivered within 4 months of enrollment in the study: (1) two individual counseling sessions of 1 to 3 hours tailored to each caregiver’s specific situation, (2) four family counseling sessions with the primary caregiver and family members selected by that caregiver, (3) encouragement to participate in weekly, locally available support groups after participation in the intervention, and (4) ad hoc counseling, counseling provided by telephone to caregivers and families whenever needed to help them deal with crises and the changing nature of their relative’s symptoms. The program is delivered by counselors with advanced degrees in social work or allied professions. http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=74
Resources for Enhancing Alzheimer’s Caregiver Health II Intervention
Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) is a multicomponent psychosocial and behavioral training intervention for caregivers (21 years and older) of patients with Alzheimer’s disease or dementia. The intervention is designed to reduce caregiver burden and depression, improve caregivers’ ability to provide self-care, provide caregivers with social support, and help caregivers learn how to manage difficult behaviors in care recipients. REACH II participants are provided with educational information, skills to manage care recipient behaviors, social support, cognitive strategies for reframing negative emotional responses, and strategies for enhancing healthy behaviors and managing stress. Methods used in the intervention include didactic instruction, role-playing, problem-solving tasks, skills training, stress management techniques, and telephone support groups. http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=129 ]
Coping with Caregiving
A psycho-educational group intervention that teaches mood management skills through two key approaches: first, an emphasis on reducing negative affect by learning how to relax in the stressful situation, appraise the care-receiver’s behavior more realistically, and communicate more assertively; and second, an emphasis on increasing positive mood through the acquisition of such skills as seeing the contingency between mood and activities, developing strategies to do more small, everyday pleasant activities, and learning to set self change goals and reward oneself for accomplishments along the way.
Skills training for spouses of patients with AD
Two 12-week intervention groups (patient-focused skills training, caregiver-focused skills training) were compared with a control group. In Week 2, each caregiver attended 1 of 2 3-hr workshops: 1) Patient-Change Workshop, consisting of introductions, presentation of general behavioral principles as they relate to dementia symptoms, overview of in-home training sessions, and review of caregiver-completed Problem Behavior Tracking forms 2) Self-Change Workshop, consisting of introductions, presentation of three self-change strategies, overview of in-home training sessions, and review of completed Problem Behavior Tracking forms. In Weeks 3-12, trained staff visited caregiver for 1 hr at home to individualize skills training to caregivers’ needs.
Individualized plan of care based on Progressively Lowered Stress Threshold (PLST) model
Individualized plan of care based on the Progressively Lowered Stress Threshold (PLST) model (need environmental modifications because of declining cognitive/functional abilities; this reduces stress and promotes functional adaptive behavior); community-based psychoeducational intervention, combined with routine information and referrals. Approximately 3 to 4 hours of in-home intervention, and biweekly follow-up phone calls for 6 months
Savvy Caregiver is intended to train families and others for the unfamiliar role they face as caregiver for a relative or friend with Alzheimer’s disease or another dementia. Savvy Caregiver is a 12-hour training program that is usually delivered in 2-hour sessions over a 6-week period
STAR-Caregivers (STAR-C) is a standardized intervention to help family caregivers identify, reduce, and manage difficult behavioral symptoms of their relative with Alzheimer’s disease. Behavioral symptoms are a major cause of family caregiver stress, burden, and depression. STAR-C decreases both the symptoms and the caregivers’ related feelings of stress, burden, and depression.
The REACH II trials demonstrate that adapting a multicomponent intervention to a multi-ethnic population of caregivers is both possible and effective in addressing depressive symptoms, burden and quality of life of caregivers.
|Table: Summary of Better Practices for Select Caregiver Interventions|
|Psychoeducation||Active participation of CG (Peacock & Forbes, 2003) role playing or applying the attained knowledge and abilities during homework. Merely providing information in a classroom format and very limited time for discussion is insufficient for reducing stressors and influencing caregiver burden and depression. (Pinquart & Sørensen, 2006)|
|Support||Individual strategies were more effective than group strategies (although group strategies offered some benefit to SWB)|
|CBT||Individualized CBT shows more pronounced results than group based in depressed caregivers and group based interventions are more effective for less severely distressed caregivers (Gallagher-Thompson & Coon, 2007)|
|Respite||Longer treatment times are required for therapeutic effects to be realized (Zarit, Stephens, Townsend, & Greene, 1998)|
|Multicomponent||Structured programs are more efficacious than unstructured programs (Pinquart & Sørensen, 2006). Interventions that actively engage the caregiver in skill acquisition aimed at regulating their own behavior result in significant improvements in caregiver depression (Schulz et al., 2005).|