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Summarized
by Robert W. Griffith, MD
June 3, 2005Introduction
Members of the family who
care for Alzheimer's
patients are at great risk
of developing depression.
This risk persists even
after caregiving ends with
the death of the patient.
Although it's obvious that
psychological support would
benefit such caregivers,
it's not always easy to get
this paid for under most
medical payment systems.
Moreover, some caregivers
may resist, saying they
don't need support, or that
it wouldn't do any good. A
study published in the
American Journal of
Psychiatry provides the
necessary evidence that
shows the need for this kind
of assistance. Here's a
summary of the study.
What was
done
The participants, located in
the New York area, were
spouses of Alzheimer's
patients who had primary
responsibility for the
patient's care. The patients
were living at home with
their caregiver at baseline.
There were two enrollment
phases - 206 spouses were
recruited between 1987 and
1990, and another 200
between 1991 and 1996.
After assessment at
baseline, the caregivers
were randomly assigned to
one of two groups. The first
group received special
psychosocial counseling and
support, and the other group
received the usual care
offered to caregivers at the
University Alzheimer's
Disease Center.
All the caregivers were
interviewed every 4 months
during the first year and
every six months after that.
They were followed for 2
years after the patient's
death.
The special counseling given
to the first group consisted
of two individual and four
family-group sessions
(without the patient); the
sessions included education
about the disease and how to
communicate within the
family effectively. After
this, these caregivers were
encouraged to join a support
group that met weekly.
Additional counseling was
available on an as-needed
basis.
Depression was assessed in
every participant at
baseline, and again at every
follow-up visit, using the
Geriatric Depression Scale
(similar to the self-test we
have on this site - see the
first link below).
What was
found
At baseline, the average age
of the participants was 71;
they consisted of 244 wives
and 162 husbands. The wives
had higher baseline
depression scores than the
husbands; 43% of the
caregivers overall had
scores suggestive of
possible clinical
depression. Only 7% of the
caregivers voluntarily
dropped out of the study
during follow-up, which
averaged 3.1 years.
In the first year of the
study, there was a gradual
decrease in the symptoms of
depression in the group of
caregivers receiving the
special counseling, while
there was an increase in the
usual-care group. By the end
of the first year, only 30%
of the special counseling
group had scores suggesting
clinical depression,
compared with 45% of those
getting usual care.
During years 2 to 5 the
difference between the two
groups decreased. The
percentage of people with
depression in the special
counseling group fell
further - it was 26% at year
3 and 27% at year 5 - but so
did that in the usual-care
group - 32% at year 3, and
30% at year 5. Depressive
symptoms decreased
significantly after nursing
home placement or death of
the patient, but the special
counseling group continued
to experience a beneficial
effect even after these
events.
What this
means
Clearly, specialized
counseling and support is
effective in improving
depression in caregivers for
Alzheimer's patients. But a
more important finding in
this study was the high
frequency of depression in
these caregivers.
It's not uncommon for
caregivers to be offered
counseling and support at
the time of diagnosis of
Alzheimer's, or if a crisis
occurs. If the first
opportunity is missed, it
may be harder to achieve
benefit when this support is
only instituted in an
emergency.
It's also important to
ensure that psychosocial
support is continued
throughout the patient's
illness and after its
resolution (death or nursing
home placement). Further
studies will clarify if the
regime used (a short period
of intensive counseling
followed by readily
available supportive
maintenance) is the ideal,
or if another approach can
produce equally good
results.
Source
Sustained benefit of
supportive intervention for
depressive symptoms in
caregivers of patients with
Alzheimer's disease. MS.
Mittelman, DL. Roth, DW.
Coon, WE. Haley, Am J
Psychiatry, 2004, vol. 161,
pp. 8850--8856
Article courtesy of
www.healthandage.com
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