Caregiver counseling helps AD patients stay in home

NEW YORK (Reuters Health) - A program to provide psychosocial support for the caregivers of patients with Alzheimer's disease can delay the need to place the patient into a nursing home by approximately 18 months, according to results of an 18-year study.

Dr. Mary S. Mittelman, from the New York University School of Medicine, and colleagues had originally conducted a study of a counseling and support program provided to 206 individuals enrolled between 1987 and 1991. The results were positive and increased the number of AD patients who remained living in their home.

Since the researchers started the study, however, cost-containment measures have reduced the use of nursing homes, Mittelman and her associates report in their study, published in the medical journal Neurology. To see if their program was still feasible, they extended their study and enrolled another group of caregivers between 1991 and 1997.

The combined sample included 406 subjects followed longitudinally for up to 17 years. There were 203 families randomly assigned to each intervention.

The active intervention consisted of two individual and four family counseling sessions, which excluded the patient with AD. The caregivers were asked to participate in weekly support groups, and their counselors provided resource information, referral for auxiliary help, financial planning, and management of patient behavior problems.

Another comparison group received the usual care, with no counseling or other contact with the counselors, except to be given resource information when requested. The caregivers also had the freedom to attend support group meetings.

By 2005, 210 patients had been placed in nursing homes. The average time to placement was 1,181 days in the control group and 1,766 days for the intervention group.

Severity of illness, along with lower patient income and earlier enrollment in the study were significant predictors of nursing home placement.

"Delaying placement was not accomplished at the expense of caregiver well-being," Mittelman's team writes. In fact, caregivers exhibited "greater tolerance for patient memory and behavior problems, improved satisfaction with the support provided by family and friends, and fewer symptoms of depression."

However, the researchers recognize that in many situations, nursing home placement may be the best decision. They therefore advise that "clinicians should be alert to circumstances where placement-should be recommended to protect the caregiver's health and well-being."

SOURCE: Neurology, November 14, 2006.