title: Problem-solving counseling for caregivers of the cognitively impaired: effective for whom?
abstract: BACKGROUND
  Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving. Few studies have shown the effectiveness of counseling for these caregivers.
  
  
  OBJECTIVE
  To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization.
  
  
  METHODS
  Caregivers (n = 77) of the cognitively impaired living at home were randomized to receive nurse counseling or not. Psychosocial adjustment to their relative's illness, psychological distress, burden, coping skills, and expenditures were measured after 6 months and 1 year.
  
  
  RESULTS
  Although on average, all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative's illness, psychological distress, or caregiver burden, they found counseling very helpful and it was effective for a subgroup of caregivers. Those with poor logical analysis coping skills at baseline had decreased psychological distress (F(1,53) = 9.7, p = .003) and improved psychosocial adjustment (F(1,53) = 4.7, p = .035) after 1 year. Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23% on average whereas those continuing to live in the community decreased by 8%. Almost half as many relatives entered nursing homes in the counseling group (n = 9 vs. n = 5) but these compared to control group relatives had greater annualized per person expenditures for health and social services (Cdn$23,437 vs. Cdn$15,151).
  
  
  CONCLUSIONS
  Caregivers found nurse counseling most helpful. Those indicating infrequent use of logical analysis coping skills showed benefits.
authors.affiliation: System-Linked Research Unit (Health & Social Service Utilization), School of Nursing, McMaster University, Hamilton, Ontario, Canada. robertsj@fhs.csu.mcmaster.ca
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.forename: G
authors.initials: G
authors.lastname: Browne
authors.forename: C
authors.initials: C
authors.lastname: Milne
authors.forename: L
authors.initials: L
authors.lastname: Spooner
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.forename: M
authors.initials: M
authors.lastname: Drummond-Young
authors.forename: J
authors.initials: J
authors.lastname: LeGris
authors.forename: S
authors.initials: S
authors.lastname: Watt
authors.forename: K
authors.initials: K
authors.lastname: LeClair
authors.forename: L
authors.initials: L
authors.lastname: Beaumont
authors.forename: J
authors.initials: J
authors.lastname: Roberts
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017028:Caregivers / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000191:economics / Q000451:nursing*; D003152:Community Health Nursing / Q000191:economics / Q000706:statistics & numerical data; D003376:Counseling / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011340:Problem Solving; D011593:Psychology, Social; D011897:Random Allocation; D018709:Statistics, Nonparametric