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      Effectiveness of Family Meetings for Family Caregivers on Delaying Time to Nursing Home Placement of Dementia Patients: A Randomized Trial

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          Abstract

          Background

          Interventions relieving the burden of caregiving may postpone or prevent patient institutionalization. The objective of this study was to determine whether a family meetings intervention was superior to usual care in postponing nursing home placement of patients with dementia.

          Methods

          A randomized multicenter trial was conducted among 192 patients with a clinical diagnosis of dementia living at home at enrolment and their primary family caregiver. Dyads of caregivers and patients were randomized to the family meetings intervention (n = 96) or usual care (n = 96) condition. The intervention consisted of two individual sessions with the primary caregiver and four family counseling sessions that included family members and friends. The primary outcome measure was the time until institutionalization of the patient. Intention-to-treat as well as per protocol analyses were performed. Survival analyses were carried out to evaluate the effectiveness of the intervention.

          Results

          During 18 months follow-up 23 of 96 relatives with dementia of caregivers in the intervention group and 18 of 96 relatives with dementia of caregivers in the usual care group were institutionalized. No significant difference between the intervention and the usual care group was found in time until institutionalization (adjusted hazard ratio (HR) 1.46, 95% confidence interval (CI) 0.78 to 2.74). The per-protocol analysis revealed no significant effect either (adjusted HR 0.57, 95% CI 0.21 to 1.57), although the number of placements among the adherers was relatively low (9.4%). A subgroup effect was found for patients’ age, with a significantly higher risk of institutionalization for ‘younger’ patients in the intervention group compared with the usual care group (adjusted HR = 4.94, 95% CI 1.10 to 22.13).

          Conclusion

          This family meetings intervention for primary caregivers of patients with dementia did not postpone patient institutionalization more than usual care.

          Trial Registration: Controlled-Trials.com ISRCTN90163486

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          Most cited references 8

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          The worldwide societal costs of dementia: Estimates for 2009.

          The purpose of this study was to update the previous estimate of the worldwide cost of dementia in 2005 to 2009. The cost model is based on prevalence estimates, country and region-specific data on Gross Domestic Product per person and average wage, with results from previously published cost-of-illness studies in different countries. Prevalence figures are updated to 2009 and costs were adjusted to 2009 constant US dollars ($). The total worldwide societal cost of dementia, based on a dementia population of 34.4 million demented persons, was estimated to $422 billion in 2009, including $142 billion for informal care (34%). The worldwide cost of dementia has increased by 34% (18% in fixed prices) between 2005 and 2009. 2010. Published by Elsevier Inc.
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            Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial.

            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.
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              A controlled study of respite service for caregivers of Alzheimer's patients.

              After a baseline interview of 642 caregivers of aged Alzheimer's disease victims, half were offered formal respite care. Over 12 months, families with respite care maintained their impaired relative significantly longer in the community (22 days). Although respite was ineffective for caregiver burden and mental health, satisfaction was very high. Although not a strong intervention, respite care can increase caregivers' quality of life.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                2 August 2012
                : 7
                : 8
                Affiliations
                [1 ]Department of General Practice and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
                [2 ]Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands
                [3 ]Department of Epidemiology and Biostatistics, EMGO Institute for Health and Health Care Research, VU University Medical Center, Amsterdam, The Netherlands
                [4 ]Medical Psychology, Slotervaart Hospital, Amsterdam, The Netherlands
                Federal University of Rio de Janeiro, Brazil
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KJJ HPJvH HWJvM. Performed the experiments: KJJ. Analyzed the data: KJJ PMvdV. Wrote the paper: KJJ HWJvM HPJvH HEvdH BAA PMvdV PS.

                Article
                PONE-D-12-08282
                10.1371/journal.pone.0042145
                3410917
                22876304

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 7
                Funding
                Funding for this study was provided by the Netherlands Organization for Health Research and Development (ZonMw), grant number 62300040 ( www.zonmw.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine
                Diagnostic Medicine
                Epidemiology
                Epidemiology of Aging
                Geriatrics
                Long-Term Care
                Neurology
                Dementia
                Non-Clinical Medicine
                Health Care Policy
                Elderly Care
                Long-Term Care
                Health Care Providers
                Social and Behavioral Sciences
                Psychology
                Psychological Stress

                Uncategorized

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