Counseling Alzheimer's caregivers postpones the nursing home

November 13, 2006

NEW YORK, Nov. 13, 2006 -- A program of individual and family counseling sessions and ongoing support for people who are caring for a husband or wife with Alzheimer's disease has a major impact on how long they can keep their spouses at home with them. Alzheimer's disease and other dementias are a major reason why people are placed in nursing homes in the United States.

According to new findings from a long-term study led by an NYU School of Medicine researcher, a psychosocial support program delays by an average of 1.5 years the time when people with dementia are usually put in nursing homes. The study, the longest running of its kind, is published in the November 14, 2006, issue of the journal Neurology.

"Comprehensive medical treatment, particularly for the elderly, has got to include more than just using a prescription pad," says Mary S. Mittelman, Dr. P.H., the lead author of the study and Research Professor in the Department of Psychiatry. "Counseling and support for family members, with no time limits, can benefit the family and the person with dementia," says Dr. Mittelman, "and this has been shown in a major way in our latest report."

The findings have financial as well as medical implications, says Dr. Mittelman, since the average annual cost of nursing home care in the United States was more than $65,000 a year, as reported by the MetLife survey in 2006. She estimates that a delay in placement of 1.5 years represents a savings of at least $100,000 per patient. Other researchers have estimated previously that only a one month delay in institutionalizing people with Alzheimer's could save as much as $1.12 billion annually in the United States.

According to the Alzheimer's Association, some 4.5 million people in the United States have Alzheimer's disease. The meaning of support

The study found that the counseling program helped caregivers gain more support from family and friends, alleviating depression among caregivers and helping them understand and tolerate the memory and behavioral problems that accompany Alzheimer's.

"Spouse caregivers are often very isolated," says Dr. Mittelman. "Managing the care of a relative with dementia is very lonely, time consuming and difficult. Nevertheless, most of these caregivers would prefer to keep their spouses at home with them as long as possible."

In the late 1980s, Dr Mittelman began a randomized control trial to find out whether counseling and support could lengthen the time that caregivers are able to keep their spouses with Alzheimer's disease at home with them, while simultaneously improving the well-being of these caregivers. The study, which began in 1987 with funding by the National Institutes of Health, and is still ongoing, is based on a group of 406 people caring for a spouse with dementia. The study took place at the Aging and Dementia Research Center of the NYU Silberstein Institute.

Half of the caregivers were assigned at random to the special counseling program, which consisted of two individual and four family counseling sessions that were tailored to a caregivers' specific situation, and occurred in the first months after enrollment. These caregivers also were encouraged to participate in long-term weekly support groups, and they and their family members could contact a counselor for telephone counseling any time for support, information, or advice. The counseling sessions could help caregivers manage troublesome behaviors, for example, or promote better communication between concerned family members.

The remaining caregivers were assigned to usual care, which meant that they received resource information and help upon request, but didn't participate in formal counseling sessions, and their family members did not have any contact with counselors.

Using sophisticated statistical analyses, Dr. Mittelman and colleagues William E. Haley, Ph.D., from the University of South Florida, and biostatisticians Olivio J. Clay, M.A., and David L. Roth, Ph.D., from the University of Alabama at Birmingham, evaluated the outcomes for the two groups and established that dementia patients whose spouses were in the counseling and support group were typically placed in nursing homes 557 days, or about 1.5 years, later than patients whose caregivers received usual care.

"The value of social support for family caregivers isn't restricted to Alzheimer's disease," says Dr. Mittelman. For example, family support has been found to have positive effects on quality of life of caregivers for patients recovering from stroke. Nevertheless, Dr. Mittelman points out that such specialized and individualized caregiver programs aren't widely available.
EMBARGOED FOR RELEASE UNTIL Monday, November 13, 2006, at 4 p.m. ET

Pamela McDonnell
Office of Communications & Public Affairs
NYU School of Medicine

For more information about new programs for caregivers, call the Psychosocial Research and Support Program of the Silberstein Institute at 212-263-5728 or 212-263-5710.

Links for further reading and information:

The William and Sylvia Silberstein Institute for Aging and Dementia at NYU School of Medicine

The National Institute on Again

The Alzheimer's Association

NYU Langone Medical Center / New York University School of Medicine

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