Problem-solving counseling for caregivers of the cognitively impaired: Effective for whom?

Background: Individualized problem-solving counseling for caregivers of cog nitively impaired relatives is thought to help caregivers cope with the str ess and burden of caregiving. Few studies have shown the effectiveness of c ounseling for these caregivers. Objectives: To determine the effectiveness of individualized problem-solvin g counseling by nurses for caregivers and the expenditures of health care u tilization. Method: Caregivers (n = 77) of the cognitively impaired living at home were randomized to receive nurse counseling or not. Psychosocial adjustment to their relative's illness, psychological distress, burden, coping skills, an d expenditures were measured after 6 months and 1 year. Results: Although on average, all caregivers receiving nurse counseling ind icated no improvement in psychosocial adjustment to their relative's illnes s, psychological distress, or caregiver burden, they found counseling very helpful and it was effective for a subgroup of caregivers. Those with poor logical analysis coping skills at baseline had decreased psychological dist ress (F-1,F-53 = 9.7, p = .003) and improved psychosocial adjustment (F-1,F -53 = 4.7, p = .035) after 1 year. Caregivers in control and counseling gro ups whose relatives entered a nursing home improved their psychosocial adju stment 23% on average whereas those continuing to live in the community dec reased by 8%. Almost half as many relatives entered nursing homes in the co unseling group (n = 9 vs. n = 5) but these compared to control group relati ves had greater annualized per person expenditures for health and social se rvices (Cdn$23,437 vs. Cdn$15,151). Conclusions: Caregivers found nurse counseling most helpful. Those indicati ng infrequent use of logical analysis coping skills showed benefits.