Support for caregivers delayed time to nursing home placement in Alzheimer disease

Calvin H Hirsch, M. S. Mittelman

Research output: Contribution to journalArticlepeer-review


Objective To determine the long-term effectiveness of counseling for caregivers of patients with Alzheimer disease (AD). Design Randomized controlled trial with up to 8-years of follow-up. Setting Research center in New York, United States. Patients 206 caregivers (58% women) who had spouses with AD living at home and had primary responsibility for their care. Patients or caregivers had to have ≥ 1 relative living in the metropolitan New York area and could not be participating in another caregiver counseling or support group. Intervention Caregivers were allocated to an intervention group (H = 103) or a control group (n = 103). The intervention consisted of individual and family counseling sessions, weekly support group meetings, and continuous availability of counselors for helping caregivers deal with crises and the changing symptoms of the patients. Main outcome measures Time to nursing home placement of patients with AD and predictors of placement. Main results The unie to placement in a nursing home was longer for patients whose caregivers received the intervention than for patients whose caregivers received the usual services (median time at home adjusted for caregiver sex 1203 d vs 874 d, 95% CI for the median 329-d difference 47 to 611, P = 0.02). Univariate intention-to-treat analysis showed that female caregivers were more likely to place their spouses in nursing homes than male caregivers (relative hazard [RH] 1.48, CI 1.03 to 2.14, P = 0.04). Other predictors of placement were increasing patient age (RH 1.33, CI 1.05 to 1.68, P = 0.02); severity of dementia (RH for severe dementia 25.6, CI 3.53 to 185, P = 0.001); increasing depression in the caregiver (RH 1.05 CI 1.02 to 1.07, P = 0.001); and increased negativity of the caregiver toward troublesome behavior of the patient (RH 1.11, CI 1.08 to 1.14, P < 0.001). Patients with incomes of U.S. $100 000 were 62% less likely to be placed in nursing homes than patients with incomes of $10 000. Cox proportional hazard models that included the explanatory variables showed reductions in risk for nursing home placement with mild dementia (RH 0.19, CI 0.05 to 0.82, P = 0.03) and moderate dementia (RH 0.43, CI 0.20 to 0.96, P = 0.04) but a trend toward increased risk for placement with severe dementia (RH 2.26, CI 0.97 to 5.27, P = 0.06). Conclusion A program of educational counseling, support, and as-needed advice to family caregivers was effective in delaying time to nursing home placement in patients with mild-to-moderate Alzheimer disease.

Original languageEnglish (US)
Pages (from-to)85
Number of pages1
JournalEvidence-Based Medicine
Issue number3
StatePublished - 1997

ASJC Scopus subject areas

  • Medicine(all)


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