Study Assesses VA/Alzheimer's Association Care Coordination Program for Informal Caregivers of Veterans with Dementia
BACKGROUND:
VA is now developing a comprehensive system of caregiver support for Veterans. One new initiative targeting caregivers of Veterans with dementia is "Partners in Dementia Care" (PDC) — a care-coordination program delivered via a partnership between VA and Alzheimer's Association chapters. The PDC program integrates and improves access to medical and non-medical services for both caregivers and Veterans and has three major components: 1) initial assessment, 2) development of an action plan, and 3) ongoing monitoring and reassessment. The key facilitator of ongoing monitoring is care coordinators, who represent both the VA facility (healthcare side) and the Alzheimer's Association chapter (community service side) and have frequent contact with participants. This study assessed the effectiveness of the PDC program. Caregivers for Veterans with dementia were recruited from VA facilities in five communities: four VAMCs, and one VA community-based outpatient clinic. Both intervention (n=299) and comparison caregivers (n=187) participated for 12 months and completed 3 telephone interviews (baseline, 6 months, and 12 months). Caregiver outcomes measured included unmet needs (i.e., accessing VA and other services, organizing family care, understanding dementia); caregiver strains (i.e., role captivity, physical strain, relationship strain); depression; and support resources (i.e., number of informal helpers, use of caregiver support services).
FINDINGS:
- Results suggest the PDC program is a promising model that improves linkages between VA healthcare services and community services for informal caregivers of Veterans with dementia.
- Compared to comparison caregivers, those who participated in the PDC program had significant improvement in outcomes representing unmet needs, all three types of caregiver strains, depression, and both support resources.
- Most improvements were evident after six months, with more limited improvements from months 6 - 12. However, improvements after the first six months were maintained during the entire study.
- Some outcomes improved for all caregivers, while others improved for caregivers with more initial difficulties - or those who were caring for Veterans with more severe impairments.
LIMITATIONS:
- There is some uncertainty that the intervention and comparison groups were equivalent at baseline.
- This analysis was restricted to measures of outcomes of the psychosocial well-being of primary caregivers, excluding, for example, the psychosocial well-being of Veterans. Other outcomes not examined included healthcare utilization by Veterans and caregivers, and healthcare costs.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 04-238). Dr. Kunik and Ms. Wilson are part of HSR&D's Center for Innovations in Quality, Effectiveness, and Safety in Houston.
Bass D, Judge K, Snow A, Wilson N…and Kunik M. Caregiver Outcomes of Partners in Dementia Care: Impact of a Care Coordination Program for Veterans with Dementia and their Family Members and Friends. Journal of the American Geriatrics Society August 2013;61(8):1377-86.
