Successful Translation of Behavioral Intervention for Caregivers of Veterans with Dementia
In its 2008 report “Retooling for an Aging America: Building the Health Care Workforce,” the Institute of Medicine argues that family members are an integral part of the healthcare workforce and must have the essential data, knowledge, and tools to provide high-quality care. Caregiving interventions can help caregivers acquire the skills and knowledge to better manage patient behaviors, as well as their own stress. This study assessed the translation of the NIA/NINR Resources for Enhancing Alzheimer’s Caregivers Health (REACH II) intervention into REACH VA – a behavioral intervention for caregivers of Veterans with dementia that ran from 9/07 through 8/09. REACH VA was implemented in response to a Congressional mandate to test caregiver interventions in the VA healthcare system. Clinical staff from 24 VA Medical Center Home-Based Primary Care Programs in 15 states delivered this home- and telephone-based intervention to 127 caregivers of Veterans with dementia. The intervention included education, support, and skills training to address five areas of risk for caregivers: safety, social support, problem behaviors, depression, and caregiver health. Investigators compared data at baseline and six months on issues related to these areas of risk.
- The REACH VA intervention provided clinically significant benefits for caregivers of Veterans with progressive dementia.
- Caregivers reported significantly decreased burden, depression, impact of depression on daily life, frustrations associated with caregiving, and number of troubling dementia-related behaviors. Also, a decrease of two hours per day "on duty" trended toward significance.
- Of the caregivers who participated in the REACH VA intervention, 96% believed that the program should be provided by VA to caregivers.
- The number of dyads (127 caregiver and patient pairings) was relatively small.
- Costs associated with patient care and REACH VA have not yet been analyzed.
- In May 2010, the Caregivers and Veterans Omnibus Health Services Act was signed into law, which will allow VA to provide unprecedented benefits to Veteran caregivers. VA is discussing the feasibility of implementing national options, including REACH VA, for all caregivers.
- REACH VA also may be appropriate for primary care, particularly geriatrics primary care, where there is an ongoing relationship between patient, family, and provider.
This study was funded through VA’s Office of Care Coordination, Patient Care Services. Dr. Nichols is an HSR&D Investigator with the Memphis VA Medical Center.
Nichols L, Martindale-Adams J, Burns R, et al. Translation of a Dementia Caregiver Support Program in a Health Care System: REACH VA. Archives of Internal Medicine February 28, 2011;171(4):353-59.