BACKGROUND/RATIONALE:
This study evaluates the effectiveness of a nurse-managed interdisciplinary (nursing and occupational therapy) clinic serving community dwelling dementia patients and their spouse caregivers. It is grounded in a nursing self-care model that guides nurses to identify interventions that fit with the capabilities of individual patients and compensate for their specific deficits. The occupational therapy assessment uses the Allen Cognitive Levels that identify the abilities and deficits of a particular functional level so that the strategies and approaches taught to caregivers can be tailored to the specific needs of the patient.

OBJECTIVE(S):
The ultimate objective of the study is to increase caregiver competence, maintain optimal function of dementia patients, and show that this nurse managed clinical model can improve the quality of life for both the Alzheimer patients and their caregivers in a cost-effective manner.

METHODS:
The study is being conducted as a block design, randomized trial of the Dementia Care Clinic (DCC) compared with the standard interdisciplinary GRECC care. A total of 120 dementia patient/spouse caregiver dyads will be enrolled in the study. Twelve dyads are enrolled in each seven-week block during which a clinic visit and four weekly caregiver education sessions are held for each of the two cohort groups. Follow up clinic visits are made at six months and one year. Data collection interviews are conducted before the first clinic visit, and at three, six, and twelve months. Patient depressed mood is measured by the Yesavage Geriatric Depression Scale (GDS). The Revised Memory and Behavior Problems Checklist is used to measure patient behavior changes and the effect of the behaviors on the caregiver. Positive and negative effects of caregiving are measured by the Zarit Burden Interview, the Center of Epidemiological Studies Depression Scale (CES-D), Phillips Beliefs about Caregiving Scale, and brief scales of perceived mastery, preparedness, and competence in caregiving.
The project will employ multiple independent repeated measures analyses of covariance (RMANCOVA) in which pre-intervention levels of the dependent measures under consideration will be controlled as covariates. Group x time interaction effects will also be examined to test for changing effects of the intervention over the study period. Multiple regression analyses will be used to examine the relationship of cost data to subject and experimental factors.

FINDINGS/RESULTS:
Since the study is ongoing, there are no findings to date.

IMPACT:
It is expected that mental status and functional level will decline with progression of disease. The study will evaluate the differences in behavior changes and activity participation between patients in the two types of interventions. Characteristics and changes in the caregivers’ attitudes and beliefs are being recorded at four data points during the year of follow up for both groups. Techniques and strategies found effective in the study will be included in materials for replication of the model by other health care professionals. The study will also evaluate the characteristics of caregivers that respond to the different types of educational information.

---

External Links for this Project

---

PUBLICATIONS:

Conference Presentations

1. Maddox M. Assessment and care for early stage dementia. Paper presented at: Alzheimer's Association Education Annual Conference; 2001 Mar 3; Minneapolis, MN. [view]
2. Maddox M, Kuskowski M, Bauer M. Characteristics and perceptions of dementia patients and spouse caregivers. Paper presented at: VA HSR&D National Meeting; 2000 Mar 23; Washington, DC. [view]
3. Maddox M. Maintaining quality of life in progressive dementia. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2000 Nov 30; Washington, DC. [view]
4. Jonk Y, Maddox M, Bauer M, Kirk L, Nugent S. Utilization and cost of caring for dementia patients enrolled in nurse managed clinics. Paper presented at: AcademyHealth Annual Research Meeting; 2002 Feb 1; Washington, DC. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems
DRE: Treatment - Observational
Keywords: Functional status, Nursing, Organizational issues
MeSH Terms: Caregivers, Dementia, Health Status, Nursing, Mental Health Services, Models, Organizational