psychosocial intervention

The Role of Psychosocial Intervention in the Treatment of Alzheimer’s Disease: 

The Role of Psychosocial Intervention in the Treatment of Alzheimer’s Disease Mary S. Mittelman, Dr.PH Director, Psychosocial Research and Support Program William and Sylvia Silberstein Institute for Aging and Dementia Research Associate Professor, Department of Psychiatry New York University School of Medicine New York, New York

Why Will Treating the CaregiverHelp the Patient? : 

Why Will Treating the Caregiver Help the Patient? As the patient’s dementia becomes more severe, family members play an increasingly important part in their care Family caregivers are at risk of depression Lack of sufficient support has been linked to depression in caregivers Troublesome patient behavior has been linked to depression in caregivers Caregiver depression may affect patient care Counseling and support for the caregiver can help keep patients from premature institutionalization

The NYU Caregiver Intervention Study: 

The NYU Caregiver Intervention Study A Randomized Controlled Trial to Test the Efficacy of Counseling and Support for Spouse Caregivers

Design of the NYU Intervention Study: 

Design of the NYU Intervention Study Comprehensive baseline interview Random assignment to the treatment or control groups Regular comprehensive follow-up interviews All participating caregivers receive the services routinely available at the NYU-ADC

Goals of Intervention : 

Goals of Intervention To help the caregiver survive the illness To postpone or prevent nursing home placement of the person with AD

Study Subjects: 

Study Subjects 406 spouse-caregivers of people with Alzheimer’s disease Enrollment began in 1987 Enrollment ended in 1997

Components of the Intervention: 

Components of the Intervention Scheduled individual counseling sessions Scheduled family counseling sessions Support group participation Unlimited consultation on request (“ad hoc” counseling)

Treatment Given to All Study Subjects: 

Treatment Given to All Study Subjects Regular follow-up interviews. Resource information on request. Help in an emergency. Routine services normally provided to patients and family members .

Differences Between the Treatment and Control Groups: 

Differences Between the Treatment and Control Groups Who receives formal counseling Caregivers and families in the treatment group No one in the control group. Who the counselors know Caregivers and families in the treatment group Caregivers in the control group.

Psychosocial Intervention Improves Caregiver Satisfaction With Social Network : 

Psychosocial Intervention Improves Caregiver Satisfaction With Social Network Mittelman MS, et al. In: Heston LL, ed. Progress in Alzheimer’s Disease and Similar Conditions. Washington, DC: American Psychiatric Publishing; 1997:259. N = 206

Psychosocial Intervention Has No Effect on Frequency of Problem Patient Behavior: 

Psychosocial Intervention Has No Effect on Frequency of Problem Patient Behavior Mittelman MS. Presented at: 8th International Conference on Alzheimer’s Disease and Related Disorders; July 20, 2002; Stockholm, Sweden. Months from intake 0 12 24 36 1.78 Frequency (log base 10) 1.76 1.74 1.72 1.70 1.68 1.66 1.64 1.62 1.60 1.58 1.56 Control group Treatment group 0 N = 406

Psychosocial Intervention Improves Caregiver Reaction to Patient Behavior: 

Psychosocial Intervention Improves Caregiver Reaction to Patient Behavior Mittelman MS. Presented at: 8th International Conference on Alzheimer’s Disease and Related Disorders; July 20, 2002; Stockholm, Sweden. 1.26 1.28 1.30 1.32 1.34 1.36 1.38 1.40 Reaction (log base 10) 0 0 12 24 36 Control group Treatment group Months from intake N = 406

Psychosocial Intervention Reduces Caregiver Symptoms of Depression: 

Psychosocial Intervention Reduces Caregiver Symptoms of Depression Mittelman MS, et al. Gerontologist. 1995;35:792. N = 206

Effect of Psychosocial Intervention on Symptoms of Caregiver Depression Continues Over Time: 

Effect of Psychosocial Intervention on Symptoms of Caregiver Depression Continues Over Time Depression (Years 1-5) Number of symptoms Weeks Mittelman MS. Presented at: 8th International Conference on Alzheimer’s Disease and Related Disorders; July 20, 2002; Stockholm, Sweden. N = 406

Caregivers Are Able to Keep their Spouses with AD at Home Longer: 

Caregivers Are Able to Keep their Spouses with AD at Home Longer Mittelman MS, et al. JAMA. 1996;276:1725. Mittelman MS. Presented at: 8th International Conference on Alzheimer’s Disease and Related Disorders; July 20, 2002; Stockholm, Sweden. Cumulative survival 1.00 0.75 0.50 0.25 0 0 1 2 3 4 5 6 7 8 Years from baseline N = 206

Conclusions : 

Conclusions A long-term program of family counseling and support Prevents increasing caregiver depression Reduces severity of caregiver reaction to patient behavior Helps spouse caregivers keep patients at home

The NYU-ADC Caregiver Core: 

The NYU-ADC Caregiver Core Mary Mittelman, Dr.P.H. Core Leader Gertrude Steinberg, M.S. Emma Shulman, C.S.W. Cynthia Epstein, A.C.S.W. Alicia Pierzchala, C.S.W

Research Facilitated by the Caregiver Core: 

Research Facilitated by the Caregiver Core 3 Country Study Counseling for caregivers + Aricept for patients vs Aricept for patients Acute hospitalization Improving care for patients and family members New intervention for adult child caregivers Workshops, written material and counseling

Research Facilitated by the Caregiver Core: 

Research Facilitated by the Caregiver Core Development of an intervention for people with MCI Individual and group interviews with patients and spouses Memory training and support Minority supplement to Spouse Caregiver Intervention Study Perceptions of early symptoms of MCI and AD among Latino and non Latino caregivers

The 3 Country Study: 

The 3 Country Study New York, USA Randwick, Australia Manchester, England

Goals of the 3 Country Study: 

Goals of the 3 Country Study To answer two questions: Does psychosocial support for the family caregiver have benefits over and above the effects of drug treatment for Alzheimer's disease? Is the effect of psychosocial support the same in all 3 countries?

Design of 3-Country Study: 

Design of 3-Country Study Single-blind, prospective randomized trial Primary caregiver is patient’s spouse 150 patient/caregiver pairs (50 in each country) 2 groups of subjects in each country Drug treatment for patient + psychosocial intervention for caregiver Drug treatment for patient

Treatment Given to All Study Subjects: 

Treatment Given to All Study Subjects All participating patients received Ariceptâ at no cost. Regular follow-up interviews. Resource information on request. Help in an emergency. Routine services normally provided to patients and family members at each site.

Psychosocial Intervention has a Significant Effect on Caregiver Depression: 

Psychosocial Intervention has a Significant Effect on Caregiver Depression * * *

Time to Dropping Out of the Study was Different in the 3 Countries: 

Time to Dropping Out of the Study was Different in the 3 Countries

Probability of Nursing Home Placement was Different in the 3 Countries: 

Probability of Nursing Home Placement was Different in the 3 Countries

Conclusions : 

Conclusions Counseling and support can alleviate symptoms of depression in caregivers Medical and social care policies affect outcomes of psychosocial intervention Caregivers in the 3 countries responded differently to intervention. The challenge will be to explain why. Psychosocial intervention, in combination with pharmacologic intervention, can be of substantial value to caregiver and patient.

Psychosocial Interventions for Individuals with MCI : 

Psychosocial Interventions for Individuals with MCI Funded by Fan Fox Foundation

A Pilot Study of Psychosocial Interventions for Individuals with MCI : 

A Pilot Study of Psychosocial Interventions for Individuals with MCI Phase I Individual interviews Group discussions Find out what kind of help people with MCI wanted Phase II Pilot study of intervention requested by subjects in Phase 1

Results of Phase I: 

Results of Phase I In individual interviews, most people with MCI in this study felt their memory impairment was no worse than other people their age. Subjects were more able to admit to memory problems in a group setting with others like themselves than in individual interviews. Subjects wanted memory training in groups, but not support groups.

Results of Phase II : 

Results of Phase II A significant increase in ability to recognize faces, as evidenced by performance on the Face Recognition subtest of the Wechsler Memory Scale Subjects in combined intervention had no difference in results compared to those in memory enhancement classes.

Improving Care for Patients and Family Members: 

Improving Care for Patients and Family Members

An Innovative Psychosocial Intervention for Adult-Child Caregivers of Parents with Alzheimer’s Disease : 

An Innovative Psychosocial Intervention for Adult-Child Caregivers of Parents with Alzheimer’s Disease Funded by the Langeloth Foundation July 2003

Goals: 

Goals Goal of Intervention To reduce negative effects of caregiving - stress, anxiety, and depression Goal of Study To compare a written intervention coupled with ad hoc counseling to a more intensive intervention that includes personal and group counseling as well.

Basis for Intervention : 

Basis for Intervention There are no interventions designed specifically for adult child caregivers The middle stages of AD are extremely difficult for caregivers A pilot study funded by Fan Fox Foundation had promising results.

Design of Study: 

Design of Study Randomized control design Two levels of intervention Two follow-up interviews Subjects 100 adult child caregivers Parents in middle stages of AD

Intervention: 

Intervention Control group Workbook especially prepared for this study Ad hoc counseling Treatment group Two workshops One individual counseling session Workbook especially prepared for this study Ad hoc counseling

Summary: 

Summary Psychosocial interventions are an essential element in patient care. Research is needed to develop new and improved interventions Please participate in our studies to help yourselves and others.