May 1, 2004
Caring for a loved one with Alzheimer's disease is among the most difficult of all life's demands. It's no surprise, then, that many of the 5 million or so Americans who care for someone with Alzheimer's or another form of dementia feel quite overwhelmed at times, a burden that can lead to serious feelings of stress and depression. But, as a study conducted at the New York University School of Medicine shows, a targeted program of counseling and support services can do much to allay these feelings of depression and stress, offering benefits that may last for years.
The research was part of the large and ongoing NYU Spouse-Caregiving Intervention Study, the longest running research project of its kind. 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.
Not only can these techniques delay the need to place a patient in a nursing home or other residential facility, but they also lead to improved well-being and less depression among caregivers. What's more, the latest research shows, the benefits are very long lasting.
"The intensive intervention in this new study was very brief, only six sessions, and yet that seems to have had a very long lasting effect," says Mary Mittelman, Dr.P.H., the lead author of the study and Director of the Physchosocial Research and Support Program at NYU School of Medicine's William and Silvia Silberstein Institute on Aging and Dementia. "I explain it as a snowball effect, whereby the benefits that started in the counseling sessions led to changes that many families made in the way they interacted afterwords."
In the study, Dr. Mittelman and colleagues followed 406 caregivers who were caring for a husband or wife with Alzheimer's. Half the caregivers got standard care, including counseling sessions when requested. The other half got enhanced care, consisting of two sessions of individual counseling and four counseling sessions with their family initially, followed by weekly support group meetings with fellow caregivers and follow-up counseling sessions as needed.
After a year, less than 30 percent of the caregivers receiving enhanced treatment had symptoms of depression, compared with more than 45 percent of those receiving standard care. Three years later, those receiving enhanced therapy showed, on average, fewer symptoms of depression than their standard-care peers. Benefits persisted even after the occurrence of highly stressful events, including the need to send a spouse to a nursing home or having a loved one with Alzheimer's die.
"Many of the effects of these therapeutic interventions are not felt immediately," says Dr. Mittelman. "In fact, the differences in the number of depressive symptoms between the two groups of caregivers grew slowly over the first year after they enrolled in the study, but then these significant differences persisted for more than 3 years after enrollment."
Multiple Benefits for Family Members
The multi-pronged NYU approach appears to offer various benefits for easing depression among caregivers. By targeting therapy to the individual situation, family members are helped as well.
"Caregivers often ask too much, ask too little, or don't ask at all of their adult children, while children can offer too little, offer the wrong things, or impose themselves in ways that are upsetting," observed Dr. Mittelman. "And adult children and other family members are not really aware of the extent to which, as the illness progresses, the person with dementia becomes less and less of a companion to the caregiver. They don't think 'Mom must be lonely' because they see Dad there."
After five years, benefits from the standard and enhanced groups did tend to diminish. Still, during that five-year period, those who received the extra counseling did have a better quality of life for much of that period. â€œFor a person who's 80 years old and depressed, five years is a long time," notes Dr. Mittelman.
Dr. Mittelman encourages doctors and caregivers to inquire about counseling programs that may be available in their areas. "Such counseling programs have proven value," she says.
The study appeared in the May 1, 2004 issue of the American Journal of Psychiatry. For more about Alzheimer's care, including the ongoing research at NYU, visit the www.ALZinfo.org.
By www.ALZinfo.org. Reviewed by Mary Mittelman, Dr.P.H., Director of the Psychosocial Research and Support Program at NYU School of Medicine's William and Silvia Silberstein Institute on Aging and Dementia. Dr. Mittelman serves on the editorial advisory board of the Fisher Center for Alzheimer's Research Foundation.
Mary S. Mittelman, Dr.P.H., David L. Roth, Ph.D., David W. Coon, Ph.D., and William E. Haley, Ph.D. "Sustained Benefit of Supportive Intervention for Depression Symptoms in Caregivers of Patients with Alzheimer's Disease." American Journal of Psychiatry 2004; 161:1-7.