BEHAVIORAL CASE MANAGEMENT FOR ALZHEIMER'S DISEASE CAREGIVERS

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Theoretical models and empirical studies of caregiving suggest that caregiving stressors place families at increased risk for high levels of burden and poorer well-being in such areas as psychological, social, and physical health outcomes. A review of the literature indicates that dementia caregivers' physical and psychological well-being appear to be compromised specifically by (1) lack of caregiver social support and (2) challenging patient problem behaviors, including disengagement, behavioral excesses such as wandering, and behavioral deficits such as difficulty performing basic and instrumental activities of daily living (ADLs/IADLs). Previous caregiver intervention studies suggest that support groups, caregiver social support, and behavior management each can have a positive impact on caregivers' psychiatric and physical morbidity. Predictably, however, the most effective interventions involve comprehensive treatment components that address multiple caregiving stressors. Treatment effectiveness appears to be enhanced when treatment is individualized to the caregiver's needs and delivered via face-to-face and telephone contacts. We propose to conduct a Behavioral Case Management (BCM) intervention consisting both patient-focused intervention programs to address patient disengagement and problems behaviors, and also a caregiver-focused intervention program to enhance the positive impact of caregiver social support. Aim 1 of the study is to evaluate the effects of the BCM's intervention programs on caregiver well-being through the use of a comprehensive set of measures. The specific BCM programs that we employ are based on a well-developed stress process model and proven behavioral approaches to dementia care. Aim 2 of the study is to assess the effects of the BCM intervention programs on the behaviors of the dementia patients themselves. We wish to investigate the impact of the programs on behavioral deficits (ADLs/ADLs), behavioral excesses such as disruptive localization, and patient depression. Aim 3 of the study is to foster the positive impact of specific types (instrumental and affective) and domains (social network and satisfaction) of social support and study their influence on caregiver outcomes. Appraisal and coping skills will be taught to increase caregivers acceptance of and satisfaction with support. The BCM intervention will be implemented through a series of strategically sequenced in-home and telephone-based contacts with the caregiver/patient dyad. The effects of the BCM intervention will be compared with those of a telephone-based Minimal Telephone Support (MTS).