title: Preserving health of Alzheimer caregivers: impact of a spouse caregiver intervention.
abstract: OBJECTIVE
  The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease.
  
  
  METHODS
  A randomized controlled trial, conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care. Structured questionnaires were administered at baseline and regular follow-ups. A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period. Enhanced counseling and support consisted of six sessions of individual and family counseling, support group participation, and continuous availability of ad-hoc telephone counseling. Indicators of physical health included self-rated health (SRH) of caregivers and the number of reported illnesses.
  
  
  RESULTS
  Controlling for baseline SRH (mean: 7.24), intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline (6.87 versus 7.21), and this significant difference was maintained for two years (6.70 versus 7.01). The effect of the intervention on SRH remained significant after controlling for the effects of patient death, nursing home placement, caregiver depressive symptoms and social support satisfaction. Similar benefits of intervention were found for number of illnesses.
  
  
  CONCLUSIONS
  Counseling and support preserved SRH in vulnerable caregivers. Enhancing caregivers' social support, fostering more benign appraisals of stressors, and reducing depressive symptoms may yield indirect health benefits. Psychosocial intervention studies with biological measures of physical health outcomes are warranted.
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA. mary.mittelman@med.nyu.edu
authors.forename: Mary S
authors.initials: MS
authors.lastname: Mittelman
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Olivio J
authors.initials: OJ
authors.lastname: Clay
authors.forename: William E
authors.initials: WE
authors.lastname: Haley
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D003131:Combined Modality Therapy; D017281:Cost of Illness; D003376:Counseling; D005190:Family; D005196:Family Therapy; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009518:New York; D011615:Psychotherapy, Group; D012657:Self-Help Groups; D012803:Sick Role; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D013689:Telephone