title: Supporting Caregivers of Rural Veterans Electronically (SCORE).
abstract: The increasing prevalence of dementia, including among rural veterans, highlights the improved outcomes possible for caregivers who receive effective support. However, providing these complex interventions in rural areas presents challenges. Internet-based and telephone-based caregiver support can potentially expand access to effective support.
  
  
  
  We designed a multisite intervention for caregivers of veterans with dementia. Caregivers were stratified into 2 cohorts based on their use or nonuse of the Internet. Each cohort was then randomized to either a technology or telephone-delivered support group within each cohort. All groups had a care manager who monitored the 4- to 6-month multicomponent program of assessments, educational content, and skills training. Caregiver outcome measures included burden, anticipatory grief, depression, family conflict, and a desire to institutionalize the care recipient.
  
  
  
  The majority of comparative effectiveness outcomes were not different between caregivers receiving technology interventions versus those receiving telephone-delivered support. This was true for the 68% of caregivers using home Internet and the 32% nonusers, as well as the 53% rural versus 47% urban caregivers. For experienced Internet users, a meaningful difference in the Marwit Grief Inventory was noted for caregivers receiving Internet versus telephone support, particularly for the Isolation Subscale.
  
  
  
  This study demonstrates the feasibility and acceptability of using a variety of modalities to deliver caregiver support to a group of largely older, rural, spousal caregivers of veterans with dementia. The potential for reducing isolation for caregivers capable of receiving this intervention through the Internet is a promising finding.
authors.affiliation: Veterans Rural Health Resource Center, Salt Lake City, Utah.
authors.forename: Bret L
authors.initials: BL
authors.lastname: Hicken
authors.affiliation: Salt Lake Department of Veterans Affairs Health Care System, Salt Lake City, Utah.
authors.forename: Candice
authors.initials: C
authors.lastname: Daniel
authors.affiliation: Department of Social Work, University of Utah, Salt Lake City, Utah.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Luptak
authors.affiliation: Veterans Rural Health Resource Center, Salt Lake City, Utah.
authors.forename: Marren
authors.initials: M
authors.lastname: Grant
authors.affiliation: Loma Linda Department of Veterans Affairs Healthcare System, Loma Linda, California.
authors.forename: Shirley
authors.initials: S
authors.lastname: Kilian
authors.affiliation: VA Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah.|Division of Geriatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Rupper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods; D003704:Dementia / Q000150:complications / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006117:Grief; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods; D015397:Program Evaluation / Q000379:methods; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods; D012424:Rural Population / Q000706:statistics & numerical data; D012944:Social Support; D011795:Surveys and Questionnaires; D014728:Veterans / Q000706:statistics & numerical data*
keywords: access to care; geography; geriatrics; technology; veterans