BACKGROUND/RATIONALE:
This study was designed to evaluate the impact of a Telehealth Education Program (TEP) on outpatient veterans with moderate to severe dementia and their spouse caregivers. The TEP is a program of education, coping skills, problem solving and support presented to caregivers of veterans with dementia by teleconference in 10 weekly, one-hour sessions. The TEP was based on a stress and coping model aimed to enhance the knowledge, skills and feelings of support of the caregivers who participated.

OBJECTIVE(S):
The objectives of this study were to: 1) evaluate the impact of TEP on outpatient veterans with dementia; and 2) to help spousal caregivers gain the knowledge and skills necessary to provide the highest quality of care possible for their spouse in order to prevent unnecessary healthcare utilization and premature institutionalization. In addition, a second objective was to develop a TEP training manual for VA clinical staff and a TEP workbook for family members.

METHODS:
This study employed a 2x3x2x4 randomized control group design. The design had two levels of intervention, TEP verus usual care(UC), three times of measurement (baseline, 3 months and 12 months), two sites of educational group intervention, (Albany VAMC and Buffalo VAMC) and four leaders (two nestled at each of the two sites). Veterans were included into the study if: 1) they were community dwelling; 2) had been diagnosed with Alzheimer's disease, or a related dementing disorder, and 3) scored three or higher on the Global Deterioration Scale. Caregivers were included if they: 1) were the primary care providers for the veterans, 2) had cohabitated with the veteran for more than one year, 3) reported at least a moderate level of strain, (score a seven or higher on the Caregiver Strain Index), and (4) had not participated in any other individual or group intervention program designed to support caregivers of demented persons.
There were ten TEP caregiver groups that received the educational program in one-hour sessions for 10 weeks. Demographic data were collected on the veterans and caregivers at baseline. Psychosocial outcome data were collected within two weeks prior to the intervention(baseline) and then again at three and twelve months. These were collected to evaluate whether TEP veterans would experience a reduction in behavioral problems, agitation and symptoms of depression and whether caregivers would experience a significant increase in dementia management skills, as well as, a perceived ability to care for their spouse. Outcome variables were analyzed using mixed effect regression models. Healthcare cost and utilization data were extracted from the VISTA databases and included outpatient, inpatient and nursing home data within the VA.

FINDINGS/RESULTS:
There were 158 caregiver-veteran dyads that agreed to participate. There were 83 in the TEP group and 75 in the UC group. There were no significant baseline differences in demographic variables across the groups. Results showed that TEP caregivers perceived significant changes in some outcome variables as compared to the UC caregivers. Healthcare cost data showed a significant (p=0.039) cost savings of $2,768 at six months for TEP as compared to UC but these were not significant at one year. Inpatient, outpatient and nursing home costs were assessed but only TEP nursing home costs reached significance (p=0.009) with a savings of $1,057 at six months.

IMPACT:
The TEP intervention resulted in short-term cost savings and perceived improvements of the caregivers in coping skills, problem solving skills, knowledge of this veteran's illness, feelings thinking and actions, taking care of their own needs, and feeling of overall goal competence. A leader manual was developed that could be used by VA and non-VA employees to lead TEP groups in the future. Also, there was a workbook created for participants so that they could follow along at home while the program was being delivered by telephone. These could serve as an important resource to assist VA and other program developers in designing telephone-based caregiver support programs throughout the country.

Key Words: Telehealth groups, caregivers, dementia.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Wray LO, Shulan MD, Toseland RW, Freeman KE, Vásquez BE, Gao J. The effect of telephone support groups on costs of care for veterans with dementia. The Gerontologist. 2010 Oct 1; 50(5):623-31. [view]

Conference Presentations

1. Shulan M, Wray L, Toseland R, Freeman K, Vasquez B, Gao J. A Telehealth Education Program for Caregivers of Veterans with Dementia. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD. [view]
2. Shulan M, Wray L, Toseland R, Freeman K, Vasquez B, Gao J. A Telehealth Education Program for Caregivers of Veterans with Dementia. Poster session presented at: American Geriatrics Society Annual Meeting; 2008 May 1; Washington, DC. [view]
3. Shulan MS. Telehealth Education Program for Caregivers of Veterans with Dementia. Paper presented at: VA Care Coordination and Caregivers Annual Forum; 2004 Nov 18; Washington, DC. [view]
4. Shulan M, Wray L, Toseland R, Freeman K, Vasquez B, Gao J. Telephone Education Groups: A Strategy for Caregivers of Veterans with Dementia. Poster session presented at: Alzheimer's Association Education Annual Conference; 2008 Jul 1; Chicago, IL. [view]

DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: none
Keywords: Caregivers – not professionals, Dementia, Telemedicine
MeSH Terms: none