The effects of counseling spouse caregivers of people with Alzheimer disease taking donepezil and of country of residence on rates of admission to nursing homes and mortality.
OBJECTIVE
Does psychosocial intervention for caregivers whose spouses with Alzheimer disease (AD) are taking donepezil delay nursing home (NH) placement or death of patients?


METHODS
Randomized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up (mean: 5.4 years, SD: 2.4).


METHODS
Outpatients of research clinics in Australia, the United Kingdom, and the United States.


METHODS
One hundred and fifty-five persons with AD and their spouses.


METHODS
Five sessions of individual and family counseling (+ prn ad hoc counseling) or usual care.


METHODS
Time to institutionalization and death using Cox proportional hazards methods.


RESULTS
Over a mean of 5.4 years (SD: 2.4), there were no differences in NH placement or mortality by intervention group, but there were by country, with Australian patients admitted to NHs earlier than U.S. than U.K. patients.


CONCLUSIONS
Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care, NH systems, availability, and affordability.
Brodaty
Henry
H
Primary Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia. h.brodaty@unsw.edu.au
Mittelman
Mary
M
Gibson
Louisa
L
Seeher
Katrin
K
Burns
Alistair
A
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy / Q000401:mortality* / Q000451:nursing / Q000523:psychology; D001315:Australia; D017028:Caregivers / Q000523:psychology*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003376:Counseling / Q000379:methods*; D000077265:Donepezil; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010880:Piperidines / Q000627:therapeutic use; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014481:United States
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil
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