Health education groups for caregivers in an HMO.

The short-term effectiveness of a Health Education Group (HEP) intervention program for spouses of frail older adults was compared to the usual care (UC) offered to the spouses of frail older persons in a staff model health maintenance organization. HEP is a multicomponent group program offered in eight weekly, two-hour group sessions, and ten monthly, two-hour follow-up group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. One-hundred and five spouses were recruited and randomly assigned to HEP (n = 58) or UC (n = 47). Spouse caregivers and care recipients were assessed within two weeks of intervention and within two weeks after the completion of the eight weekly group meetings. The results indicate that, for caregivers, HEP was more effective than UC in reducing depression, maintaining social integration, increasing effectiveness in solving pressing problems, increasing knowledge of community services and how to access them, changing caregivers' feelings of competence, and the way they respond to the care giving situation. No significant differences, however, were found between care recipients in the two arms of the study on any of the outcome measures.

Human subjects protection in a study of caregivers of community-residing persons with dementia.

This article describes the processes and methods used to protect human subjects during a joint research project undertaken by a state health department and a university-based research team. The use of a statewide registry to obtain a sample of primary caregivers of persons with dementia provided a unique opportunity for the research team to interview a large and representative sample of caregivers. At the same time, it raised complex issues regarding the privacy of the primary caregivers and the confidentiality of the patient data that were drawn from the state-operated mandatory dementia registry. Guidelines for enabling access while ensuring the privacy and confidentiality of the study participants are presented.

Gerontological social work and the UN International Year of Older Persons. Interview by Stanley L. Witkin.

To highlight the United Nations International Year of Older Persons and to increase awareness of social work issues related to older people, the editor of Social Work conducted an interview with four distinguished social workers involved in gerontological social work. The interviewees identified professional needs and various policy and practice issues for social work education and practice.

Use of health and human services by community-residing people with dementia.

This article reports on the use of and need for health and human services by community-residing people with dementia. Telephone interviews were conducted with a sample of 608 caregivers of such individuals who were randomly selected from a dementia registry. Caregivers reported using an average of 3.2 health services and 3.7 human services to assist them in the care of the person with dementia. Despite the high level of services use, 73 percent of the caregivers indicated a high need for at least one additional service, and 72 percent indicated that additional services would reduce the likelihood of institutionalization of the recipient. Although services use was more frequent than expected, many caregivers lacked knowledge about services, a fact that suggested that social workers have a vital information and referral role to play.

Educating nursing assistants to communicate more effectively with nursing home residents with dementia.

This article describes the development and evaluation of a Nursing Assistant Communication Skills Program (NACSP). NACSP was designed to help nursing assistants (NAs) interact more effectively with nursing home residents with moderate and severe dementia. In two skilled-care nursing homes, NAs in four units were randomly assigned by unit to NACSP or to a wait-list control condition (UC) and were assessed at baseline, 3 months, and 6 months. NACSP resulted in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training. It was also found that NACSP resulted in greater knowledge of caregiving responses and reduced turnover rates among NAs, but the program had no impact on their knowledge of dementia. To disseminate the NACSP program, a leader manual, an accompanying training videotape, and a workbook for participants were developed.

An evaluation of a family visit education program.

OBJECTIVES: This study was designed to examine the impact of the Family Visit Education Program (FVEP) on family members, nursing staff, and nursing home residents with dementia. DESIGN: The study employed a 2 x 3 single-blind, randomized control group design with two study conditions, FVEP or usual care (UC), and three times of measurement, baseline, 3-months, and 6-months. SETTING: The study was conducted in five skilled-care nursing homes that ranged in size from 120 to 300 beds. PARTICIPANTS: Sixty-six residents with dementia and their primary visitor were randomly assigned to FVEP (n = 32) or UC (n = 34). MEASUREMENTS: Residents were assessed for (1) psychosocial functioning, (2) depression, (3) agitated behavior, and (4) degree of positive social interaction. Nursing staff were assessed for changes in the time and methods used to manage problem behaviors. Visitors were assessed for (1) dementia management skills, (2) extent of perceived caregiving hassles, and (3) visit satisfaction. RESULTS: FVEP was effective for reducing residents' problem behaviors and for decreasing their symptoms of depression and irritability. It was also effective for improving the way family members and other visitors communicated with residents, but, with the exception of reducing the use of mechanical restraints, it was not effective in changing nurses' management of residents' behavior problems. CONCLUSIONS: It is possible to educate family members to communicate and interact more effectively with nursing home residents with dementia. This has beneficial effects on residents but not on nursing staff's management of problem behaviors.

Does geriatric evaluation and management improve the health behavior of older veterans in psychological distress?

A randomized, controlled trial compared prospective 16-month health service use among 160 frail, elderly veterans receiving outpatient geriatric evaluation and management (GEM) or usual primary care (UPC). In this secondary analysis, multivariable regression was used to determine if the psychosocial assessment and support provided by the GEM team moderated the use of medical services by patients in psychological distress. The results indicate that GEM reduced outpatient use among patients who scored higher on a measure of somatization (p less than or equal to .05), but GEM increased outpatient use among patients with higher manifest anxiety (p less than or equal to .05) Psychological distress was not a factor in the use of inpatient services. GEM had a modest beneficial effect on the health behavior of frail older persons manifesting some symptoms of psychological distress.

Outpatient geriatric evaluation and management: is there an investment effect?

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared to usual outpatient primary care (UPC). Although GEM had no overall impact on health care utilization or cost of care for the entire study period, significant reductions were found during the sixteen- to twenty-four-month study period, suggesting a possible investment effect. In the first eight months of the study, GEM patients incurred 34.8% more in health care costs than UPC patients, but in the final eight months of the study the cost of care for UPC patients exceeded that for GEM patients by 37.8%.

The effectiveness and efficiency of outpatient geriatric evaluation and management.

OBJECTIVE: To compare the effectiveness of geriatric evaluation and management (GEM) with usual primary care (UPC). DESIGN: A 2 x 3 randomized controlled group design. SETTING: A 450-bed Department of Veterans Affairs Medical Center (VAMC) that provides general medical and surgical care to eligible veterans. PARTICIPANTS: One-hundred sixty male subjects (mean age = 72 years), who were above average users of VAMC outpatient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assigned to GEM (n = 80) or UPC (n = 80). MEASUREMENTS: Data were collected about patients' (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) health care utilization, and (5) health care costs. Data were obtained before randomization, and again at 8 and 16 months. RESULTS: The results indicated that GEM was more effective than UPC in improving some aspects of the quality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend toward decreasing acute admissions. It was not effective, however, in improving patients' psychosocial well-being. Except for a short-term survival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce overall utilization of outpatient or inpatient services, and it significantly increased total outpatient health care costs. CONCLUSIONS: Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.

Outpatient geriatric evaluation and management. Results of a randomized trial.

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared with usual outpatient primary care (UPC). One hundred sixty frail elderly outpatients were assigned randomly to GEM or UPC and assessed at baseline and at 8 months on measures of (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) use of inpatient and outpatient services, and (5) cost of care. The results indicate that GEM was significantly more effective than UPC in reducing mortality, increasing patient satisfaction, and improving the quality of health and social care. However, it was not effective in reducing health care use or the cost of care.

The impact of a spouse-caregiver support group on care recipient health care costs.

Frail elderly veterans who received care at a Department of Veterans Affairs medical center and whose spouse-caregivers participated in support groups to which they had been randomly assigned had lower health care costs over a 1-year period than did control participants. The greatest impact was observed for participants perceived by their spouse-caregivers to be in the poorest health. What is important to consider about this result in terms of health care policymaking is that support groups targeted for spouse-caregivers of elderly veterans in poor health produced significant outpatient, inpatient, and total cost savings for the care recipients, and were cost effective.

A problem solving intervention for caregivers of cancer patients.

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Long-term effectiveness of a group program for caregivers of frail elderly veterans.

Long-term results of an evaluation of a multicomponent support-group program for spouses caring for frail elderly veterans indicated that participants experienced significant reductions in subjective burden. As compared to those of the control group, caregivers' perceptions of their husbands' health improved significantly from pretest to one year, while perceptions of their husbands' functioning on measures of instrumental daily activities showed significantly less deterioration in the period from pretest to posttest.

An evaluation of a group program for spouses of frail elderly veterans.

We examined the effectiveness of a multicomponent group program for spouses of frail aging veterans that included support, education, problem solving, and stress reduction. Compared with caregivers who received no intervention, those in the group program showed significant increases in use of active behavioral coping strategies, knowledge of community resources, perceived independence in the marital relationship, and personal changes in the caregiving relationship. They also experienced significant decreases in subjective burden and the stress and severity of caregiving problems.

Problems identified by family caregivers in counseling.

Content analysis of the problems that caregiving daughters and daughters-in-law (N = 51) elected to work on during counseling yielded seven categories: improving coping skills, meeting elder's care needs, responding to family issues, concern over the caregiver-recipient relationship, eliciting formal and informal supports, feelings of inadequacy and guilt, and planning for elder's future. Two global themes of maintaining control and increasing responsibility within the caregiver role were also evident. Case examples illustrate problems, and practice implications are considered.

Therapeutic processes in peer led and professionally led support groups for caregivers.

A comparison of peer led and professionally led support groups for caregivers of frail older persons living in the community demonstrates that both types of groups are effective. Findings reveal that it was the opportunity to ventilate pent-up feelings and emotions, the validation of caregiving experiences, the affirmation of coping abilities, the encouragement for continuing to provide care and cope with the situation, the exploration of alternative caregiving arrangements, the mutual support, and the mutual sharing of information about community resources and coping strategies that appeared to be the most helpful therapeutic ingredients of both types of groups. The greater attention to problem solving work and the learning of specific coping skills in the professionally led groups was not reflected in differential outcomes in the two support group conditions.

Effectiveness of individual counseling by professional and peer helpers for family caregivers of the elderly.

This study of the effectiveness of individual counseling for daughters and daughters-in-law (N = 87) who were the primary caregivers for frail elderly parents revealed that participants who received professional counseling demonstrated significantly better outcomes than a no-treatment control group in regard to subjective well-being, level of psychiatric symptomatology, and perceived change in aspects of the caregiver-care-receiver relationship. Participants who received peer counseling demonstrated similar gains but did not improve significantly more than did control subjects in subjective well-being. Both forms of counseling had no significant effect on caregivers' formal and informal social support networks.

Comparative effectiveness of individual and group interventions to support family caregivers.

The comparative effectiveness of individual and group interventions in supporting family caregivers of frail older people was examined. An individual intervention produced more positive effects on caregiver psychological functioning and well-being than did a group intervention, whereas a group intervention produced greater improvements in caregivers' social supports. Participants in both interventions experienced significant improvements in coping with caregiving stress. Process differences are proposed as an explanation for the differential effects of the two intervention modalities. Psychological issues respond best to individual intervention, and social support issues respond best to group intervention. Therefore, the most appropriate type of intervention might be determined by the types of problems and issues specific to an individual caregiver.