Family caregivers play a significant role in the long-term care of dementia patients. Although providing care can be rewarding, it often places caregivers at great risk for negative outcomes that also compromise the well-being of dementia patients and heighten their risk for placement in institutional settings. In most clinical and service settings, caregiver needs are overlooked and systematic assessment is restricted to the patient, especially among racial/ethnic minorities (5
). Given that the success of most care plans rests largely on the caregiver, effective care outcomes depend on understanding the needs and risks of both the caregiver and patient.
The Risk Appraisal Measure (RAM) developed and tested in this study has promise for identifying specific areas of caregiver risk for which appropriate interventions can be provided either directly or through a referral process. For example, the RAM can be used in primary care/geriatric physician offices, geriatric care assessment centers, or community agencies, such as the Alzheimer’s Association, that provide support to AD caregivers. It could also be a useful assessment tool for home health care providers. In the span of 5 7 minutes, key areas of potential risk can be identified, and a targeted treatment plan can be developed so that caregivers can quickly and efficiently receive the help they need (see ). A strength of the RAM is that it taps multiple dimensions that have known links to caregiver risk and adverse outcomes in 6 areas: depression, burden, self-care and healthy behaviors, social support, safety, and patient problem behaviors. As shown in REACH II (9
), evidenced-based strategies exist to improve caregiver outcomes within each of these areas. In fact, each risk area maps onto an evidence-based intervention program (28
For example, if a caregiver reports frequent problems with depression, this may signal a need for referral for further evaluation to determine the severity of the problem and if services from a trained mental health professional are warranted. If caregivers only occasionally experience problems with depression, the intervention might involve instruction on strategies to increase involvement in everyday pleasant events. Caregivers who report being “burdened” can be referred to a support group or taught stress management techniques. If a caregiver indicates problems with self care, a wide range of strategies such as helping the caregiver obtain respite to attend medical appointments or other medically-based interventions could be initiated. Interventions to help caregivers deal with health issues are different from interventions to address depression or lack of social support. Effective caregiver treatment plans cannot be algorithmic and rest solely on the basis of the RAM but require more in-depth probing once a problem area is identified.
The data also indicate that the RAM has similar measurement properties across ethnic and racial groups. This is important given the increasing number of minority caregivers and recent findings that intervention needs vary among racial/ethnic groups due to differences in attitudes, patterns of caregiving, levels of support, coping strategies, and distress (30
In sum, the RAM is an efficient and easily administered tool that can provide a “road map” for intervention, and increase the likelihood that a caregiver will receive the specific forms of assistance needed to effectively maintain the caregiving role. From a public health perspective, early identification and intervention for caregivers at risk may prevent or delay costly institutional placement and conserve long-term care resources. The RAM can also be used as an outcome to assess the effectiveness of intervention or treatment strategies.
A limitation of the RAM is that it does not assess other domains such as financial strain or social activities that can also be sources of stress for caregivers (5
). We selected areas for inclusion that are most often highlighted in the caregiving literature as placing a caregiver at risk for adverse outcomes or impacting the dementia patient and for which evidence-based interventions are available (9
). Future studies are needed to examine the reliability and validity of the RAM with other ethnic groups and to evaluate the effect of the caregiver risk assessment on caregiver and patient quality of life. Studies are also needed to further identify links between risk domains and effective intervention programs.