A FAMILY INTERVENTION TO DELAY NURSING-HOME PLACEMENT OF PATIENTS WITH ALZHEIMER-DISEASE - A RANDOMIZED CONTROLLED TRIAL

Objective.-To determine the long-term effectiveness of comprehensive s upport and counseling for spouse-caregivers and families in postponing or preventing nursing home placement of patients with Alzheimer disea se (AD). Design.-Randomized controlled intervention study. Setting.-Ou tpatient research clinic in the New York City metropolitan area. Parti cipants.-Referred, volunteer sample of 206 spouse-caregivers of AD pat ients who enrolled in the study during a 31/2-year period. All patient s were living at home at baseline and had at least 1 relative living i n the area. Intervention.-Caregivers in the treatment group were provi ded with 6 sessions of individual and family counseling within 4 month s of enrollment in the study and were required to join support groups. In addition, counselors were available for further counseling at any time. Main Outcome Measure.-Time from enrollment of caregivers in the study to placement of the AD patients in a nursing home. Results.-Usin g Kaplan-Meier survival analysis, we estimated that the median time (w eighted average of estimates for male and female caregivers) from base line to nursing home placement of AD patients was 329 days longer in t he treatment group than in the control group (z=2.29; P=.02). The rela tive risk (RR) from a Cox proportional hazard model of nursing home pl acement (intent-to-treat estimate) after adjusting for caregiver sex, patient age, and patient income was 0.65 (95% confidence interval [CI] , 0.45 to 0.94; P=.02), indicating that caregivers were approximately two thirds as likely to place their spouses in nursing homes at any po int in time if they were in the treatment group than if they were in t he control group. Treatment had the greatest effect on risk of placeme nt for patients who were mildly demented (RR, 0.18; 95% CI, 0.04 to 0. 77) or moderately demented (RR, 0.38; 95% CI, 0.17 to 0.82). Conclusio ns.-A program of counseling and support can substantially increase the time spouse-caregivers are able to care for AD patients at home, part icularly during the early to middle stages of dementia when nursing ho me placement is generally least appropriate.