November 19, 2008
A first-of-its-kind international trial of caregivers has shown that counseling and support services can benefit those who are caring for a loved one with Alzheimer's disease when that person is also taking a medication for the disease.
The support program, which involved individual and family counseling, reduced feelings of isolation and depression in caregivers, helping to ease the stress of caring for someone with Alzheimer's. The results suggest that combining Alzheimer's medications for patients, and support services for caregivers, is an effective way to help manage an illness that affects some 25 million people around the world.
"As we search for a cure or a way of preventing Alzheimer's disease, we cannot forget about the millions of family members who are caring for relatives who are currently ill," said Dr. Mary Mittelman, director of the Psychosocial Research and Support Program at the New York University School of Medicine Silberstein Institute.
"These findings show that counseling and support of family members can be of significant benefit to Alzheimer's caregivers even when the patients are receiving medications for the disease. Caregivers who are less depressed are better able to take care of their ill family members," Dr. Mittelman continued. "Social support and counseling for family members of people with Alzheimer's disease should be considered essential components of optimal comprehensive care." Dr. Mittelman also serves on the Editorial Advisory Board for the Fisher Center for Alzheimer's Research Foundation.
Close to 10 million people care for someone with Alzheimer's disease in the United States alone, with many more affected worldwide. Caring for a family member with Alzheimer's can take a serious toll on physical and emotional health. Earlier research from New York University has demonstrated that counseling and support is not just good for easing stress in those who care for a loved one with Alzheimer's disease. It may also boost physical health in caregivers and helps keep people with Alzheimer's out of nursing homes, a costly and emotionally wrenching decision.
The current study involved 158 older men and women who were providing care at home for a spouse with Alzheimer's disease. Those with Alzheimer's were all taking donepezil, also known as Aricept, a popular drug commonly given to help ease symptoms of the disease, at least for a time.
Researchers from NYU Medical Center in New York City, the University of Manchester in the United Kingdom, and the Dementia Collaborative Research Centre at the University of New South Wales's School of Psychiatry in Sydney, Australia, divided caregivers into two groups. Half were given standard supportive care and education, while the others were given an enhanced program of counseling and support developed at New York University that has been shown to have caregiver benefits.
The NYU approach employs several key strategies designed to help friends and family cope with the stress of caring for someone with Alzheimer's disease. Components of the program include:
1) Education of caregivers and family members about Alzheimer's disease, its effects on the patient, how best to manage care and respond to symptoms, and how to improve social support for caregivers.
2) Counseling and ongoing support for the care partner and family members, including both individual and family counseling, encouragement for caregivers to join support groups, and telephone counseling for the caregiver and other family members when needed.
3) Improving social support and reducing family conflict to help the caregiver withstand the hardships of caregiving and to help family members understand the primary caregiver's needs, and how best to be helpful.
In the current study, caregivers assigned to the enhanced support group received five in-person counseling sessions. That included two individual counseling sessions, plus three sessions involving extended family members. Counseling was also provided on an as-needed basis, usually over the telephone, for two years after they enrolled in the study.
All the caregivers filled out a questionnaire designed to assess symptoms of depression at the start of the study. Caregivers were then regularly assessed at three-month periods. During the two-year course of the study, about half of the original participants dropped out after a spouse died or entered a nursing home.
The researchers found that symptoms of depression decreased among caregivers who received the five sessions of individual and family counseling. Meanwhile, symptoms of depression increased among those who did not receive the enhanced counseling. While the effects were small, they were statistically significant. The statistical analyses controlled for the effects of factors like antidepressant use among caregivers, gender of the caregiver and the country where they lived.
What's more, the benefits continued to grow and widen over the two years of the study, even though the face-to-face counseling session were given during the first three months of the study. These results provide good evidence that a counseling and support program for caregivers, modeled after the NYU Caregiver Intervention, can have significant benefits in reducing symptoms of depression in caregivers even when their spouses are taking an Alzheimer's drug.
Earlier research from the New York University group conducted over the past 20 years has shown that a targeted program of support services can provide lasting benefits for the millions of Americans who care for someone with Alzheimer's at home. Caregivers who tended to a spouse with the illness felt more connected with friends and family, less stressed and generally more satisfied when they and family members were educated about the disease and providing with ongoing counseling and support.
"The intervention has a long-lasting effect on caregiver depression, largely achieved through improving social support," Dr. Mittelman said. "Social support is key to the well-being of caregivers."
Dr. Mittelman has worked with caregiving groups around the country and in the Netherlands to expand the NYU Caregiving Program beyond its original site. The partnership with the State of Minnesota, funded by the Administration on Aging, recently received an award from the Roselynn Carter Caregiver Institute.
Mary Sherman Mittelman, Dr. P.H., Henry Brodaty, M.D., D.Sc., Aaron Seth Wallen, Ph.D., Alistair Burns, M.D.: "A Three-Country Randomized Controlled Trial of a Psychosocial Intervention for Caregivers Combined with Pharmacological Treatment for Patients with Alzheimer's Disease: Effects on Caregiver Depression," American Journal of Geriatric Psychiatry, Volume 16, November 2008, pages 893-904.