Impact of a community based implementation of REACH II program for caregivers of Alzheimer's patients.

BACKGROUND: In 2009 an estimated 5.3 million people in the United States were afflicted with Alzheimer's disease, a degenerative form of dementia. The impact of this disease is not limited to the patient but also has significant impact on the lives and health of their family caregivers. The Resources for Enhancing Alzheimer's Caregiver Health (REACH II) program was developed and tested in clinical studies. The REACH II program is now being delivered by community agencies in several locations. This study examines the impact of the REACH II program on caregiver lives and health in a city in north Texas. STUDY DESIGN: Family caregivers of Alzheimer's patients were assessed using an instrument covering the multi-item domains of Caregiver Burden, Depression, Self-Care, and Social Support upon enrollment in the program and at the completion of the 6 month intervention. The domain scores were analyzed using a multivariate paired t-test and Bonferroni confidence interval for the differences in pre- and post-service domain scores. RESULTS: A total of 494 families were enrolled in the program during the period January 1, 2011 through June 30, 2012. Of these families 177 completed the 6 month program and have pre - and post service domain scores. The median age for the caregivers was 62 years. The domain scores for Depression and Caregiver Burden demonstrated statistically significant improvements upon program completion. CONCLUSION: The REACH II intervention was successfully implemented by a community agency with comparable impacts to those of the clinical trial warranting wider scale implementation.

Do acculturation and family cohesiveness influence severity of diabetes among Mexican Americans?

OBJECTIVE: The goal of the study was to evaluate the effect of family cohesiveness, acculturation, socioeconomic position, and cardiovascular risk factors on severity of diabetes among Mexican Americans. DESIGN AND STUDY POPULATION: The cross-sectional study involved a consecutive sample of 275 Mexican Americans under treatment for type 2 diabetes recruited from two medical clinics on the north side of Fort Worth, Texas. Recruitment and data collection took place during a span of 24 months from December 2001 to December 2003. MAIN OUTCOME MEASURES: Hemoglobin A1C levels, available from medical charts, were used to indicate diabetes severity. Cases were defined as individuals with poorly controlled or severe diabetes based upon abnormally high hemoglobin A1C (> or = 7.0). Controls were defined as individuals with well-controlled or mild-moderate diabetes as reflected in a normal hemoglobin A1C (< 7.0). A face-to-face questionnaire was administered to study participants to collect data on protective factors related to family cohesiveness and acculturation, demographic and socioeconomic variables, and cardiovascular risk factors. RESULTS: The results suggest that several variables were associated with severity of diabetes, including, receipt of food stamps, having spent childhood in Mexico, and current smoking status. Other variables representing acculturation and family cohesiveness, separately or combined, approached statistical significance. CONCLUSIONS: Even though acculturation and family cohesiveness as schemas were not statistically significant because of small sample size, they highlight the importance of building more sophisticated models for testing their association with severity of diabetes.