Objective: To determine the efficacy of counseling and support for family caregivers in conjunction with pharmacologic treatment for patients with AD.
Design: The 3 Country Study, which began in 1999, was designed to determine whether a psychosocial intervention for caregivers, in combination with drug treatment (donepezil) for patients with AD, would be more effective than drug treatment alone. This was a randomized control trial with regular follow-ups for 2 years after baseline assessment. Interventions were conducted in the USA, Great Britain and Australia simultaneously using a uniform assessment and treatment protocol. More than fifty caregiver/patient dyads were enrolled in each country.
Materials and Methods: Spouse caregivers in the treatment group received individual and family counseling within 3 months of a comprehensive baseline assessment of caregivers and patients. Caregivers in the treatment group also were able to receive telephone counseling, as needed, for the duration of the study.. There were regular follow-up assessments of both caregivers and patients every 3 months for the first year and every 6 months for the second year after baseline. Multivariate analyses and multiple linear regression analyses were conducted to assess the impact of the intervention on outcomes for caregivers and patients. Outcomes analyzed included change from baseline in formal and informal support, reaction to patient behavior and symptoms of depression in caregivers, as well as change in patient functioning and nursing home placement.
Results: We report, for the first time, the long-term (2 years after baseline) results of the study. Differential treatment effects in the 3 countries will also be examined. In addition, retention in the study and length of time patients continue use of donepezil will be analyzed as indicators of the impact of psychosocial intervention on compliance with the drug regimen. Evaluation of baseline data suggests that symptoms of depression in spouse caregivers are not alleviated by patient use of donepezil. However, counseling and support for caregivers has a significant salutary effect on symptoms of depression as early as one year after baseline. Data analyses suggest that this is due to improvement in formal and informal support for the caregiver. While nursing home placement was not common in this group of patients, who entered the study in the mild stage of dementia, patients who were placed in nursing homes remained at home significantly longer if they were in the treatment group in which their caregivers received psychosocial intervention.
Conclusion: Psychosocial intervention for family caregivers is an important component of an effective disease management plan for people with Alzheimer’s disease.
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