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Counseling leading to improved well-being for the spouse caregivers of Alzheimer's Disease patients can result in a substantial delay in nursing home placement for their loved ones with AD, according to researchers from the University of South Florida, New York University School of Medicine and the University of Alabama at Birmingham. The authors, whose work appears in the November issue of the journal Neurology, found a median delay of nursing home placement of 1.5 years per patient when compared with a control group that did not receive the same intervention. "Dementia increases the risk of nursing home placement," says co-author William Haley, Ph.D., director of the University of South Florida School of Aging Studies. "Family caregivers often want to avoid or delay placement, but they can wear out under the long-term strain of caregiving. Appropriate counseling and support can help empower the caregiver, reduce their distress, and give them the strength to continue providing care at home. " Researchers recruited caregivers of patients who had been diagnosed with AD and who were living with their spouse and had one other relative living in the area. The caregivers received two individual and four family counseling sessions, each tailored to the caregiver's needs. Caregivers were also able to receive later telephone counseling and encouraged to go to support group meetings. The researchers then followed the caregivers for up to 17 years to assess the long-term impact of the intervention. "The caregivers were given instruction on managing troublesome behaviors and promoting better communication between family members," explains Haley. "Caregivers assigned to the control group received services normally provided, but did not participate in formal counseling sessions." After analyzing data, researchers found that the enhanced caregiver support not only led to a 28.3 percent reduction in the rate of nursing home placement, but also long-lasting improvements in caregiver depression, burden, and social support. "The delay in nursing home placement did not come at the expense of the caregivers," Haley points out. "The improvements were largely achieved through improvement in caregiver well-being." The authors suggest that, given the average annual cost of nursing home care is $60,000, interventions to support caregivers that help reduce or delay nursing home admissions will become increasingly important as cases of Alzheimer's Disease escalate and the Baby Boom population ages. They add that this kind of social support provided by the interventions used in this study may be important not only to caregivers of AD patients but also for families taking care of relatives with stroke, cancer, heart disease, and other chronic conditions. "Specialized and individualized caregiver intervention programs are not widely available," concludes Haley. "Typically, those who seek services are only provided referrals to support groups, which may be far less effective than structured interventions. From a policy perspective, it is important that we do more to give caregivers access to individualized counseling, which can have long-lasting and life-changing impacts that benefit patients, caregivers, and society.
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