WASHINGTON—While dementia patients typically receive the bulk of their clinical care in hospitals and nursing facilities, it is often the family members and other at-home caregivers who bear the brunt of the stress created by their loved ones’ disease. One question that the Department of Veterans Affairs would like answered is what is the best way it can support these caregivers.

Focus on the Caregiver

Although most dementia caregivers express a desire to provide care in the home, the emotional and physical costs often create a serious impediment. The REACH-VA (Resources for Enhancing Alzheimer’s Caregiver Health) caregiver pilot project, which began in 2007 out of the Martindale-Adams VA Medical Center in Memphis, is attempting to find ways in which VA can ease that burden. Adapted from two earlier trials originally funded by the National Institutes of Health and which included VA investigators, the six-month intervention uses individual in-home visits and group telephone support sessions to help caregivers manage their own stress and improve their coping skills.

“It’s the first national clinical application of a proven dementia intervention that focuses on information, safety, caregiver health and behavior management for the veteran receiving care,” explained VA’s chief of geriatric care and dementia initiatives, Susan Cooley, Ph.D. “It’s an innovative approach that builds on something that began with the NIH, now adapted to our use and being tried in multiple VA settings.”

The study is ongoing at the home-based primary care programs of 24 VA medical centers in 15 states, with volunteers from the programs learning to deliver the intervention to stressed caregivers. The intervention is designed to provide education, support and skills building to help caregivers manage patient behaviors and their own stress. It includes 12 individual sessions in the home and by telephone and five telephone support group sessions over six months.

The two-year pilot project has received considerable attention, even more so since it was awarded the 2008 Rosalynn Carter Institute Leadership in Caregiving Award. The $10,000 award will be used to help fund continuation of the project.

The hope is that the results of this trial will provide data on how best to provide caregiver support not only in the area of dementia care, but in other areas as well. “There is a growing body of literature on caregiver support interventions, and we certainly hope that the lessons learned from this type of caregiver support can be applied in other groups,” Dr. Cooley said.