Individual (in-person, telephone) and support-group education and skill building intervention for caregivers of individuals with dementia
Based on the stress health process model the multisite National Institute on Aging/National Institute of Nursing Research randomized controlled trial (RCT), Resources for Enhancing Alzheimer’s Care- giver Health (REACH II) is a multicomponent psychosocial and behavioral training intervention for caregivers (21 years and older) of patients with Alzheimer’s disease or dementia. The intervention is designed to reduce caregiver burden and depression, improve caregivers’ ability to provide self-care, provide caregivers with social support, and help caregivers learn how to manage difficult behaviors in care recipients. REACH II participants are provided with educational information, skills to manage care recipient behaviors, social support, cognitive strategies for reframing negative emotional responses, and strategies for enhancing healthy behaviors and managing stress. Methods used in the intervention include didactic instruction, role-playing, problem-solving tasks, skills training, stress management techniques, and telephone support groups.
Intervention materials and assessment instruments have been translated in Spanish and allow for regional variation in language expression. Bilingual and bicultural staff were employed for the evaluation, and all assessors and interventionists received cultural-sensitivity training
Caregivers of individuals with dementia and/or Alzheimer’s
REACH II has been conducted at numerous sites through the funding from the VA, state aging programs, AAAs, and implemented internationally in Korea, Hong Kong, and Germany.
Improve caregivers’ health and well-being, safety, social support; and handling of problem behaviors of care recipients with dementia.
Evidence of Outcomes
Randomized control studies support decreased burden and depression, enhanced self-care, and social support of caregivers; reduced behavioral problems of individuals with dementia receiving care.
In the randomized controlled trial of REACH, the intervention was delivered over 6 months by certified interventionists holding at least a bachelor’s degree. The protocol included 12 individual sessions (9 at home and 3 by telephone) and 5 structured support-group sessions by telephone. Participants were supplied with resource notebooks that contained educational materials and telephones with visual display screens linked to a computer-integrated telephone system to support conference calling.
The intervention was implemented with 642 in-home caregivers at 5 sites in 5 cities (Birmingham, Alabama; Memphis, Tennessee; Miami, Florida; Palo Alto, California; and Philadelphia, Pennsylvania). All five sites were evaluated for outcomes. REACH II also was implemented within the Veterans Health Administration in 29 sites from 24 facilities in 15 States, with a total of 127 caregiving dyads participating, and was implemented by 2 Area Agencies on Aging in Kentucky and Illinois. The intervention is also being used by the Rosalynn Carter Institute at Georgia Southwestern State University with rural dementia caregivers through an Administration on Aging grant. Approximately 900 individuals have participated in this intervention.
The program makes it possible for people with dementia to live in their own homes longer by addressing problems related to caregiver health that often force people to move their loved ones to long term care facilities. If the caregiver is better able to manage the challenges of caregiving, the person he or she cares for will benefit as well.
Burgio and colleagues (2009) founded positive pre-post effects for caregiver health, social support, subjective burden, frustration, and depression, and care recipient behavior problems and mood.
Nichols and colleagues (2009) adapted the REACH II intervention for use in Veterans Administration Medical Centers as part of clinical practice. From baseline to six months, caregivers reported significantly decreased burden, depression, and frustration, and fewer troubling dementia-related behaviors.
Czaja and colleagues (2013) tested an adapted version of the program using video technology with one hundred ten (56 Latino and 54 African American) caregivers of patients with dementia in the greater Miami area. Caregivers who received the intervention reported a decrease in burden, an increase in perceived social support and positive perceptions of the caregiving experience. No effect was observed for depression. Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use.
Belle, S. H., Burgio, L., Burns, R., Coon, D., Czaja, S. J., Gallagher-Thompson, D., . . . Zhang, S. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, 145, 727-738.
Burgio, L. D., Collins, I. B., Schmid, B., Wharton, T., McCallum, D., & DeCoster, J. (2009). Translating the REACH caregiver intervention for use by Area Agency on Aging personnel: The REACH OUT program. The Gerontologist, 49(1), 103-116.
Burgio, L., Corcoran, M., Lichstein, K. L., Nichols, L., Czaja, S., Gallagher-Thompson, D., . . . Schulz, R. (2001). Judging outcomes in psychosocial interventions for dementia caregivers: The problem of treatment implementation. The Gerontologist, 41(4), 481-489.
Cho, J., Ory, M., & Stevens, A. (2016). Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention. Aging Mental Health, 20(11), 1190-1201.
Czaja S. J., Loewenstein D., Schulz R., Nair S.N., Perdomo D. (2013). A videophone psychosocial intervention for dementia caregivers. Am J Geriatr Psychiatry, 21(11), 1071-81.
Czaja, S. J., Schulz, R., Belle, S. H., Burgio, L. D., Armstrong, N., Gitlin, L. N., . . . Stahl, S. (2006). Data and safety monitoring in social behavioral intervention trials: The REACH II experience. Clinical Trials, 3(2), 107-118.
Gitlin, L. N., Belle, S. H., Burgio, L. D., Czaja, S. J., Mahoney, D., Gallagher-Thompson, D., . . . Ory, M. (2003). Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up. Psychology and Aging, 18(3), 361-374.
Nichols, L. O., Martindale-Adams, J., Burns, R., Graney, M. J., & Zuber, J. (2011). Translation of a dementia caregiver support program in a healthcare system-REACH VA. Archives of Internal Medicine, 171(4), 353-359.
Schulz, R., Burgio, L., Burns, R., Eisdorfer, C., Gallagher-Thompson, D., Gitlin, L., & Mahoney, D. (2003). Resources for Enhancing Alzheimer’s Caregiver Health (REACH): Overview, Site-Specific Outcomes, and Future Directions. Gerontologist, 43(4), 514-520.