Care for Alzheimer caregivers keeps blues away

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Counseling and support can help cut the long-term risk of depression among spouses who care for their husband or wife with Alzheimer’s disease, new research shows.

The study of 406 men and women caring for a spouse with Alzheimer’s found that those who received counseling and help from a support group had lower rates of depression over three years.

The program, offered at the New York University Alzheimer’s Disease Center, involved six counseling sessions with caregivers, weekly support group meetings, and access to a counselor over the course of the patient’s illness. In earlier work, the study authors found that the intervention helped ease caregivers’ depression in the first year.

The new findings show that the benefits last over the long term, and seem to hang on even after the spouse dies or enters a nursing home, according to lead study author Dr. Mary S. Mittelman of the Silberstein Institute for Aging and Dementia at the NYU School of Medicine.

In an interview with Reuters Health, she credited the success of the support program to some unique features—such as the inclusion of other family members in some of the initial counseling sessions, and the fact that after these sessions were over, caregivers and their family members could call on their counselors when they needed to.

According to Mittelman, including other family members in counseling sessions can prove key when there are disagreements about care; for example, a husband or wife may want to care for a spouse with Alzheimer’s at home, but their adult children think nursing home care would be best. A counselor can help ease such family conflict.

The study, reported in the American Journal of Psychiatry, compared the enhanced counseling program with typical support for caregivers at the NYU center. Those in the latter group could join the same support groups or get advice from counselors if they chose to, but they did not have formal counseling sessions, and their families were not in contact with the counselors.

One year into the study, Mittelman and her colleagues found the rate of “clinically significant” depression among caregivers in the enhanced program had fallen from 40 percent to just under 30 percent. In contrast, this rate held steady, at about 45 percent, among caregivers in the standard-care group.

And after three years, the two groups still showed differences in depression symptoms.

Alzheimer’s disease involves an irreversible process of brain degeneration, causing a progressive loss of memory and other mental functions that eventually robs patients of the ability to reason, communicate, perform basic tasks such as dressing, or to recognize family members—all of which can put great stress on caregivers.

In the U.S., more than 4 million people have Alzheimer’s, and it’s estimated that 25 million families provide care for such patients.

If the counseling program used in this study were widely available, the researchers note, it could have a “major impact” on the emotional distress caregivers suffer, and on health care costs.

“I would like to see all parts of this intervention available everywhere,” Mittelman said.

SOURCE: American Journal of Psychiatry, May 2004.

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