Steven H. Belle, PhD; Louis Burgio, PhD; Robert Burns, MD; David Coon, PhD; Sara J. Czaja, PhD; Dolores Gallagher-Thompson, PhD; Laura N. Gitlin, PhD; Julie Klinger, MA; Kathy Mann Koepke, PhD; Chin Chin Lee, MS; Jennifer Martindale-Adams, EdD; Linda Nichols, PhD; Richard Schulz, PhD; Sidney Stahl, PhD; Alan Stevens, PhD; Laraine Winter, PhD; Song Zhang, MS; for the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II Investigators
Note: A detailed description of the REACH II study design, methods, assessment instruments, and original de-identified data are available to the public at the National Archive of Computerized Data on Aging (webapp.icpsr.umich.edu/cocoon/NACDA-STUDY/04354.xml). The Study Manual of Operations, which contains detailed information about the intervention, including resource and training materials, is also available at www.edc.pitt.edu/reach2/public/manuals.html.
Grant Support: In part by the National Institute on Aging and the National Institute of Nursing Research (AG13305, AG13289, AG13313, AG20277, AG13265, and NR004261).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Richard Schulz, PhD, University of Pittsburgh, 121 University Place, 6th Floor, Pittsburgh, PA 15260; e-mail, email@example.com.
Current Author Addresses: Dr. Belle: University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261.
Dr. Burgio: University of Alabama, Box 870315, Tuscaloosa, AL 35487-0315.
Drs. Burns, Martindale-Adams, and Nichols: University of Tennessee, Veterans Affairs Medical Center, 1030 Jefferson, Memphis, TN 38104.
Dr. Coon: Department of Social and Behavioral Sciences, Arizona State University, 4701 West Thunderbird Road, MC 3051, Glendale, AZ 85346.
Dr. Czaja and Ms. Lee: University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Miami, FL 33136.
Dr. Gallagher-Thompson: Stanford University, 795 Willow Road (182C/MP), Menlo Park, CA 94025.
Drs. Gitlin and Winter: Thomas Jefferson University, 130 South 9th Street, Philadelphia, PA 19107.
Ms. Klinger: University of Pittsburgh, 121 University Place, Pittsburgh, PA 15260.
Dr. Koepke: National Institutes of Health, National Center for Research Resources, 6701 Democracy Boulevard, Suite 710, Bethesda, MD 20892-4870.
Dr. Schulz: University of Pittsburgh, 121 University Place, 6th Floor, Pittsburgh, PA 15260.
Dr. Stahl: National Institute on Aging, 7201 Wisconsin Avenue, #533, Bethesda, MA 20892.
Dr. Stevens: Scott & White Memorial Hospital, 2401 South 31st Street, Temple, TX 76508.
Ms. Zhang: Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15281.
Author Contributions: Conception and design: S.H. Belle, L. Burgio, R. Burns, D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, J. Martindale-Adams, L. Nichols, R. Schulz, S. Stahl, A. Stevens.
Analysis and interpretation of the data: S.H. Belle, L. Burgio, R. Burns, S.J. Czaja, L.N. Gitlin, R. Schulz, S. Stahl, S. Zhang.
Drafting of the article: S.H. Belle, L. Burgio, D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, J. Klinger, R. Schulz.
Critical revision of the article for important intellectual content: S.H. Belle, L. Burgio, D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, J. Klinger, K.M. Koepke, R. Schulz, S. Zhang.
Final approval of the article: S.H. Belle, L. Burgio, R. Burns, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, K.M. Koepke, J. Martindale-Adams, L. Nichols, R. Schulz, S. Stahl, S. Zhang.
Provision of study materials or patients: L. Burgio, R. Burns, D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, J. Klinger, J. Martindale-Adams, L. Nichols, R. Schulz, A. Stevens,
Statistical expertise: S.H. Belle, R. Schulz, S. Zhang.
Obtaining of funding: S.H. Belle, L. Burgio, R. Burns, D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, K.M. Koepke, J. Martindale-Adams, L. Nichols, R. Schulz, S. Stahl.
Administrative, technical, or logistic support: D. Coon, D. Gallagher-Thompson, L.N. Gitlin, J. Klinger, C.C. Lee, R. Schulz, S. Stahl, L. Winter.
Collection and assembly of data: D. Coon, S.J. Czaja, D. Gallagher-Thompson, L.N. Gitlin, J. Martindale-Adams, L. Nichols, R. Schulz, A. Stevens, L. Winter, S. Zhang.
Caring for a family member with dementia is extremely stressful, contributes to psychiatric and physical illness among caregivers, and increases the risk for caregiver death. Finding better ways to support family caregivers is a major public health challenge.
To test the effects of a structured multicomponent intervention on quality of life and clinical depression in caregivers and on rates of institutional placement of care recipients in 3 diverse racial or ethnic groups.
Randomized, controlled trial.
In-home caregivers in 5 U.S. cities.
212 Hispanic or Latino, 219 white or Caucasian, and 211 black or African-American caregivers and their care recipients with Alzheimer disease or related disorders.
Caregivers within each racial or ethnic group were randomly assigned to an intervention or to a control group. The intervention addressed caregiver depression, burden, self-care, and social support and care recipient problem behaviors through 12 in-home and telephone sessions over 6 months. Caregivers in the control group received 2 brief “check-in” telephone calls during the 6-month intervention.
The primary outcome was a quality-of-life indicator comprising measures of 6-month caregiver depression, burden, self-care, and social support and care recipient problem behaviors. Secondary outcomes were caregiver clinical depression and institutional placement of the care recipient at 6 months.
Hispanic or Latino and white or Caucasian caregivers in the intervention group experienced significantly greater improvement in quality of life than those in the control group (P < 0.001 and P = 0.037, respectively). Black or African-American spouse caregivers also improved significantly more (P = 0.003). Prevalence of clinical depression was lower among caregivers in the intervention group (12.6% vs. 22.7%; P = 0.001). There were no statistically significant differences in institutionalization at 6 months.
The study used only a single 6-month follow-up assessment, combined heterogeneous cultures and ethnicities into a single group, and excluded some ethnic groups.
A structured multicomponent intervention adapted to individual risk profiles can increase the quality of life of ethnically diverse dementia caregivers.
ClinicalTrials.gov identifier: NCT00177489.
Steven H. Belle, Louis Burgio, Robert Burns, David Coon, Sara J. Czaja, Dolores Gallagher-Thompson, et al. Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups: A Randomized, Controlled Trial. Ann Intern Med. 2006;145:727–738. doi: 10.7326/0003-4819-145-10-200611210-00005
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Published: Ann Intern Med. 2006;145(10):727-738.
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