By MICHELLE L. BRANDT
Interventional skill-building programs ease the depression, anxiety and anger common among family caregivers coping with a loved one who has dementia, say medical center researchers. In the first study of its kind, the researchers found that female caregivers derived more benefit from this type of program than from traditional support groups.
"The women who participated in the skill-building program reported less depression, anxiety, stress and frustration," said study leader Dolores Gallagher-Thompson, PhD, professor of research in the Department of Psychiatry and Behavioral Sciences and director of the Older Adult & Family Center. "This type of program clearly helps family members manage the emotional and physical strain of caregiving."
Gallagher-Thompson’s research was part of the National Institute on Aging’s multicenter study known as Resources for Enhancing Alzheimer’s Caregiver Health, or REACH. Her findings appear in the current issue of Gerontologist and coincide with the publication of several other REACH studies from around the country.
Numerous studies over the past decades have shown that caregiving is associated with mental anguish and poor physical health, with the impact being greater for caregivers of patients with dementia. A 1999 study showed that 40 percent of those who cared for a spouse with Alzheimer’s disease and who experienced stress from their responsibilities died sooner than caregivers who did not report stress. This suggests that a caregiver’s stress is an independent risk factor for early mortality, said Gallagher-Thompson.
Services have been developed to assist caregivers in coping with the stresses of their responsibilities, and the REACH study was designed to investigate the effectiveness of various interventions. Each participating site in the five-year REACH study developed its own intervention program; the Stanford portion, called "Coping with Caregiving," is a skill-building program designed by Gallagher-Thompson and offered through the VA Palo Alto Health Care System.
"Our program’s focus is on increasing self-efficacy: having caregivers become less emotional and better at problem solving," said Gallagher-Thompson, who is also a staff psychologist at the VA. "We teach caregivers how to manage their time better, become more assertive in asking for help from others, channel their thoughts more positively and prepare for the future."
The Stanford study was the first to compare this type of program with traditional support groups, which Gallagher-Thompson said focus on empathy over skill building. "There’s no doubt that support groups are helpful but they’re not for everyone," she said. "Many caregivers found that they help only to a certain extent, which is what led to my developing the Coping with Caregiving program in the first place."
During the study, 122 Caucasian and 91 Latina female caregivers were randomly assigned to participate in Coping with Caregiving or in an enhanced support group. After 10 weeks the researchers found that the women in the skill-building course did better as determined by outcomes measures (depression, self-efficacy, use of coping strategies) than those in the support group.
The caregivers’ mean score on a scale that measures depression dropped by two to three points; the score of caregivers in the support group dropped by less than one point. There was also a significant change in the use of positive coping strategies, such as problem solving, among women in the skill-building course.
"The interventions program is fairly robust and seems to cross cultures," said Gallagher-Thompson, adding that it’s also available in Spanish. "The techniques taught in the program seem to have helped caregivers feel more empowered. The caregivers were taught a specific array of skills so they could better manage everyday stressful situations."
The researchers found also that Latina women responded better on some measures than Caucasian women, which they say may be due to the relative lack of resources for this group in the past. Gallagher-Thompson noted that the Latino elderly population is projected to grow the fastest of any ethnic group, adding that further study of services for these caregivers is needed.
Gallagher-Thompson is now working on REACH II, the country’s largest multicenter randomized study on caregiving. Five sites are participating in the trial, which is comparing a single intervention (developed using the most effective components of the REACH I studies) with minimal telephone support. (Caregivers who are randomized to receive the latter will have the option to enroll in Coping with Caregiving at the end of the study.) Participants in REACH II must be men or women who care for an older relative with memory problems and who identify as Caucasian, Hispanic/Latino or African American.
English-speaking volunteers should call 617-2774; Spanish-speaking volunteers should call one of the bilingual staff directly at 617-2688 or the multilingual number at (800) 943-4333. Additional information can also be found at http://www.oafc-menlo.com.
Stanford Report, September 24, 2003