Family caregiving for patients with dementia is characterized by several challenges that seriously compromise the quality of life for millions of family members in the United States. We believe that our study is the first to systematically assess the efficacy for a multicomponent caregiver intervention compared with a control group in ethnically diverse populations. Compared with minimal support, a multicomponent intervention led to statistically significantly greater improvements in quality of life (as measured by indicators of depression, burden, social support, self-care, and patient problem behaviors) for white or Caucasian and Hispanic or Latino caregivers but not for black or African-American caregivers. We did observe, however, statistically significant quality-of-life changes for black or African-American spouse caregivers. Although the improvement in treatment conditions compared with control conditions on our multivariate outcome was modest (approximately 0.3 SD among Hispanic or Latino participants and 0.2 SD among white or Caucasian participants), we found clinically meaningful differences for specific components of our multivariate outcome. Among Hispanic or Latino persons, caregivers in the intervention group were more likely to report improvement in depression symptoms and problem behaviors. White or Caucasian caregivers in the intervention group reported higher levels of social support. We also found that the rate of clinical depression among caregivers in the intervention group was statistically significantly lower than that of the control group. Institutionalization of care recipients did not statistically significantly differ, although rates of placement were higher in the control group than in the intervention group. Caregivers in the intervention group reported that study participation helped them feel more confident in dealing with the care recipient, made life easier for them, improved their ability to care for the care recipient, improved the care recipient's life, and helped them keep the care recipient at home. Of note, many participants in the control group reported that they benefited “some” or “a great deal” from participating in the study, suggesting that even minimal support and attention may have positive effects on caregivers.
Our study has several limitations. First, we had only 1 follow-up assessment available, which makes the long-term effect of the intervention difficult to assess. Assessing the effects of the intervention on institutional placement, for example, typically requires follow-up of 1 year or longer. Second, although our study is unusual in that we included many ethnic minorities, all 3 ethnic or racial groups are quite heterogeneous. For example, the Hispanic or Latino sample includes both Mexican-American and Cuban-American persons—2 groups with very different cultural backgrounds. Other minority groups, such as Asian-American persons, were left out altogether. Finally, some researchers might question our choice of the control condition. The most appropriate control condition for the type of intervention that we used is under considerable debate. Options include treatment as usual, minimal support, or attention control. For ethical reasons and to motivate control participants to remain in the study, we offered participants something minimal but meaningful, and we thus opted for a minimal support control condition in which caregivers received basic written educational material and 2 brief telephone calls. We had also considered an attention control condition that would engage participants in an activity unrelated to the goals of the intervention but decided against this because we could not identify an activity that would be both meaningful and distinct from the intervention.
Making the intervention available in Spanish for Hispanic or Latino caregivers who may have had limited access to community resources probably contributed to the relatively larger effects obtained for this group. We designed the intervention to be culturally sensitive, flexible, and modularized to facilitate easy transfer to applied settings. Inasmuch as many of the health-related problems of late life present several interrelated challenges, this approach to intervention may also be effective in other contexts and could be useful in reducing physical and mental health disparities among individuals from different cultural groups (30
The materials and protocols developed for our study can feasibly be adapted for widescale implementation in community settings. Learning the intervention requires approximately 80 hours of training, and it can be delivered by an individual with a bachelor's degree in psychology, social work, nursing, occupational therapy, or other related disciplines. Future research should focus on ways in which multicomponent interventions, such as REACH II, can be implemented at the community level within the existing health and aging services networks.
Because of their frequent contact with patients with dementia and their family members, health professionals are in a unique position to identify family members whose quality of life has been seriously compromised by caregiving demands. Future availability of community-based intervention services modeled after the REACH II intervention would be a valuable referral resource for family caregivers. Although multifaceted programs are currently not available, referral to community resources, such as local area agencies on aging or the Alzheimer's Association, may be beneficial to some caregivers.