Dementia Caregiver Treatment for Nursing Home Transition

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DESCRIPTION (provided by applicant): The goal of the proposed study is to determine the efficacy of a telephone-based psychosocial intervention (Family Intervention: Telephone Tracking-Nursing Home; FITT-NH) to improve informal dementia caregiver adjustment and caregiver-staff interactions during the transition from community to long-term care. The intervention is theoretically derived and includes education, active problem-solving, and support techniques to improve coping and adaptation during transitions. Preliminary findings from a randomized pilot study of FITT-Dementia (R21 MH62561; G. Tremont, Principal Investigator), support efficacy of the intervention for reducing perceived burden, situational anxiety, and reaction to memory and behavior problems in the care recipient, increasing use of community resources, and improving health-related quality of life in home caregivers compared to usual care. The proposed study is a randomized, controlled 3-month trial of FITT-NH compared to standard care. Treatment strategies are based on assessment of key areas (e.g., emotional adjustment, health, family life, social support, and caregiver-staff communication) during each contact to individualize the intervention to caregivers' needs. Eighty informal dementia caregivers will be enrolled following admission of the care recipient to a long-term care facility. Treatment will be delivered for 3 months, and outcome measures will be obtained at baseline, immediately following treatment, and at a 3-month follow-up. Primary caregiver outcomes are burden, mood, anticipatory grief, perceptions of staff-caregiver interactions, perceived quality of visitation, and satisfaction with the facility. Resource utilization is a secondary outcome. It is hypothesized that caregivers receiving FITT-NH will demonstrate (1) better emotional adjustment (e.g., less anticipatory grief, fewer depressive and anxiety symptoms, less perceived burden, and better health-related quality of life, and (2) better staff-caregiver relationships (e.g., more positive perceptions of staff-caregiver interactions, fewer hassles and disagreements with staff, and better perceived quality of visitations). This low-cost intervention may be useful as part of routine care for dementia caregivers transitioning their family member to long-term care facilities.