title: Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative.
abstract: OBJECTIVE
  We examine 6-month effects of the Environmental Skill-Building Program on caregiver well-being and care recipient functioning and whether effects vary by caregiver gender, race (White or non-White), and relationship (spouse or nonspouse).
  
  
  METHODS
  We enrolled 255 family caregivers of community-residing persons with Alzheimer's disease or related disorders, of whom 190 participated in a follow-up interview. Caregivers were randomized to a usual care control group or intervention group that received five home contacts and one telephone contact by occupational therapists, who provided education, problem-solving training, and adaptive equipment. Baseline and 6-month follow-up included self-report measures of caregiver objective and subjective burden, caregiver well-being, and care recipient problem behaviors and physical function.
  
  
  RESULTS
  Compared with controls (n = 101), intervention caregivers (n = 89) reported less upset with memory-related behaviors, less need for assistance from others, and better affect. Intervention spouses reported less upset with disruptive behaviors; men reported spending less time in daily oversight; and women reported less need for help from others, better affect, and enhanced management ability, overall well-being, and mastery relative to control group counterparts. Statistically significant treatment differences were not found for hours helping with instrumental activities of daily living, upset with providing assistance with instrumental activities of daily living and activities of daily living, perceived change in somatic symptoms, White versus non-White caregivers, or care recipient outcomes.
  
  
  CONCLUSIONS
  The Environmental Skill-Building Program reduces burden and enhances caregiver well-being in select domains and has added benefit for women and spouses.
authors.affiliation: Community and Homecare Research Division, 130 South 9th Street, Suite 513, Philadelphia, PA 19107, USA. laura.gitlin@jefferson.edu
authors.forename: Laura N
authors.initials: LN
authors.lastname: Gitlin
authors.forename: Laraine
authors.initials: L
authors.lastname: Winter
authors.forename: Mary
authors.initials: M
authors.lastname: Corcoran
authors.forename: Marie P
authors.initials: MP
authors.lastname: Dennis
authors.forename: Sandy
authors.initials: S
authors.lastname: Schinfeld
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000451:nursing*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006266:Health Education; D006701:Home Nursing / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D012944:Social Support; D013315:Stress, Psychological