Principal Investigator (s): Mary Mittelman, DrPH
Institutional Affiliation: NYU School of Medicine
The treatment consists of four components: (1) Two individual counseling sessions tailored to each caregiver’s specific situation; (2) four family counseling sessions with the primary caregiver and family members selected by that caregiver; (3) participation in a weekly support group; and (4) “ad-hoc counseling,” meaning the continuous availability, by telephone, of counselors to caregivers and families to help them deal with crises and the changing nature of the patient’s symptoms over the course of the disease. We provided the first two components within four months after entering the study. Counselors also supply resource information and referrals for auxiliary help, financial planning, and management of patient behavior problems. Each caregiver receives all the interventions, and each caregiver is given support for an unlimited period of time. Counselors interviewed caregivers, completing a set of structured questionnaires when they enrolled and at regular intervals afterwards. Many caregivers commented that they found these interviews to be helpful because they provided additional contact with the counselors and an opportunity to talk about their feelings and needs and to receive advice and information about resources.
The impact of this intervention on depression, caregiver appraisals of behavior problems, and delay in nursing home placement is long-lasting and both clinically and statistically significant.
Alzheimer’s disease caregiver consulting, Alzheimer’s disease caregiver counseling, psychosocial support and counseling for family caregivers
Resource information was provided to each caregiver and family as needed. General information, in the form of handouts prepared by ADEAR and other publicly available information were also provided.
Contact information for further information, materials, and training.Mary Mittelman, DrPH
Training qualifications and guidelines for those delivering the intervention.
Training includes reading the book, Counseling the Alzheimer’s Caregiver: A Resource for Health Care Professionals, a thorough knowledge of Alzheimer’s disease and how it affects the family and the person with the illness, and in-person or telephone consulting with one of the counselors at the NYU-ADC who have experience implementing the intervention
While we have no specific cost data, we know that the program for 406 recipient was implemented by 4 counselors, each working .6 time (or 2.4 full time equivalent counselors) each with Masters degrees in a health area such as social work. If each counselor earned $65,000 a year, the program would cost ($65,000*2.4)/406 = $385 per recipient per year.
Start-up cost or cost to implement the program include purchase of manuals plus training time. All counselors should know about Alzheimer’s disease, its effects on the person with the illness, the caregiver, and the rest of the family, how to counsel families, and the resources and services available in their communities.
Cost of guides for users to purchase program materials, training, evaluation materials:
Counseling the Alzheimer's Caregiver: A Resource for Health Care Professionals (Paperback) by Mary S. Mittelman (Author), Cynthia Epstein (Author), Alicia Pierzchala (Author) is available online from Amazon.com or Barnes&Noble.com or directly from the publisher (AMA-press.com) for $35.22-$39.99.
Caveats/ other considerations about the implementation of this intervention
This intervention has currently only been tested on spouse caregivers, about 88% of whom are Caucasians.
The structure of the intervention allows for flexibility, and should be adaptable to different cultures and ethnicities
Mittelman, M., Ferris, S., Shulman, E., Steinberg, G., Ambinder, A., Mackell, J., & Cohen, J. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist, 35, 792-802.
Mittelman, M.S. & Gallagher-Thompson, D. (1996). Valuing intervention research. Journal of Gerontology: Social Sciences, 51B, S268.
Mittelman, M.S., Ferris, S.H., Shulman, E., Steinberg, G. & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer disease. Journal of the American Medical Association, 276, 1725-1731.
Ferris, S.H. & Mittelman, M.S. (1996). Behavioral treatment of Alzheimer's disease. International Psychogeriatrics, 8. Suppl. 1, 87 90.
Mittelman, M.S. & Ferris, S.H. (1996). Psychosocial interventions. In Z.S. Khachaturian & T.S. Radebaugh (Eds.), Alzheimer's Disease: Cause(s), Diagnosis, Treatment and Care. Boca Raton: CRC Press, Inc., 279-282.
Mittelman, M.S., Ferris, S.H., Shulman, E., Steinberg, G., Ambinder, A. & Mackell, J. (1997). The effects of a multicomponent support program on spouse-caregivers of Alzheimer's disease patients: Results of a treatment/control study. In L.L. Heston (Ed.), Progress in Alzheimer's Disease and Similar Conditions. Washington (DC): American Psychiatric Press.
Mittelman, M.S., (2002). Family caregiving for people with Alzheimer’s disease: Results of the NYU spouse caregiver intervention study. Generations, 26 (1).
Mittelman, M.S. (2003). Psychosocial intervention for dementia caregivers: What can it accomplish? International Psychogeriatrics, 15, Suppl. 1, 243-249.
Mittelman, M. (2003). Community caregiving. Alzheimer’s Care Quarterly, 4(4), 273-285.
Mittelman, M.S., Roth, D.L., Haley, W.E. & Zarit, S.H. (2004). Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s disease: Results of a randomized trial. Journals of Gerontology, Psychological Sciences, 59B(1), P27-P34.
Mittelman, M.S., Roth, D.L., Coon D.W. and Haley, W.E. (2004). Sustained benefit of supportive intervention for depressive symptoms in Alzheimer’s caregivers. American Journal of Psychiatry, 161(5), 850-856.
Jang,Y., Clay, O.J., Roth, D.L., Haley, W.E. &. Mittelman, M.S. (2004). Neuroticism and longitudinal change in caregiver depression: Impact of a spouse-caregiver intervention program. The Gerontologist, 44, 311-317.
Roth, D.R., Mittelman, M.S., Clay, O.J., Madan, A., Haley, W.E. (2005). Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer’s disease. Psychology and Aging, 20(4), 634-644.
Mittelman, M. (2005) Taking care of the caregivers. Current Opinion in Psychiatry. 18(6), 633-639.
Mittelman, M.S. (2005). Counseling and support needs of dementia caregivers. In B. J. Sadock & V. A. Sadock (Eds.), Comprehensive textbook of psychiatry, (8th Ed.). Baltimore: Lippincott, Williams & Wilkins, 3839-3844.
Drentea, P., Clay, O.J., Roth, D.L., Mittelman, M.S. (2006). Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer’s disease. Social Science & Medicine, 63, 957-967.
Mittelman, M., Haley, W.E., Clay, O., Roth, D.L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67, 1592-1599.
Mittelman, M.S., Roth, D.L., Clay, O.J., Haley, W.E. (in press). Preserving health of Alzheimer’s caregivers: Impact of a spouse caregiver intervention. American Journal of Geriatric Psychiatry.