Supporting caregivers of frail older adults in an HMO setting

Citation Toseland, R. W., McCallion, P., Smith, T., & Banks, S. (2004). Supporting caregivers of frail older adults in an HMO setting. American Journal of Orthopsychiatry , 74 (3), 349-364.

Design Experiment

Purpose The long-term effectiveness of a structured health education program (HEP) for spouses and frail older adults was evaluated in a staff model health maintenance organization

Hypothesis HEP will have a positive effect on caregiver depression, knowledge of community services, and feelings of competence (dealing with cg duties).

Participants The participants of this study were N=105 caregiver/patient dyads, randomly assigned to HEP (n=58) or usual care (n=47). To be eligible for participating in this experiments, caregivers had to have: A score of at least 7 on the Caregiver Strain Index. Scored higher than 8 on the Short Portable Mental Status Questionnaire. Eligible care recipients had to have at least two impairments in ADLs or IADLs.

Outcome / Dependent Variables The dependent variables in this study were:knowledge of the aging process, knowledge of the process of their spouse's illness, knowledge of community resources, the way caregivers felt about the caregiving situation, the way caregivers thought about the caregiving situation, the way caregivers acted in the caregiving situation, the quality of their relationship with their spouse, and their competence in handling the care of their spouse.

Procedure The treatment condition was applied to the caregivers only. Groups of 5 to 8 participants met for 8 weekly 2 hr sessions, followed by 10 monthly 2 hr sessions. The dyads were interviewed at baseline, within 2 weeks after the 8th group meeting and within 2 weeks of the 10th monthly follow up meeting. The major components of the HEP groups included:emotion-focused coping strategies, problem-focused coping strategies, education about resources and sources of support for caregiving, and support.

Outcomes For caregivers, HEP was more effective than usual care (UC) in reducing depression, increasing knowledge of community services and how to access them, and changing caregivers' feelings of competence and the way they respond to the caregiving situation. One other significant finding from this experiment suggests that long term interventions may be more beneficial/have a greater impact to caregivers.

Author Toseland, R. W., McCallion, P., Smith, T., & Banks, S.