Translation of a Dementia Caregiver Support Program in a Health Care System-REACH VA

Memphis Veterans Affairs Medical Center, Tennessee, USA.
Archives of internal medicine (Impact Factor: 17.33). 02/2011; 171(4):353-9. DOI: 10.1001/archinternmed.2010.548
Source: PubMed


Based on the National Institute on Aging/National Institute of Nursing Research Resources for Enhancing Alzheimer's Caregiver Health (REACH) randomized controlled trial (REACH II), REACH VA (Department of Veterans Affairs) was the first national clinical translation of a proven behavioral intervention for dementia caregivers, running from September 2007 through August 2009. This article describes the population and outcomes of the REACH VA translation of REACH II into the VA.
Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia. Like REACH II, the 6-month REACH VA intervention, structured through a protocol and individualized through a risk assessment, targeted education, support, and skills training to address caregiving risk areas of safety, social support, problem behaviors, depression, and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions. Staff members of the Memphis VA Medical Center, Memphis, Tennessee, collected data on burden, depression, health and healthy behaviors, caregiving frustrations, social support, dementia-related behaviors, and time spent providing care and on duty.
From baseline to 6 months, caregivers reported significantly decreased burden, depression, impact of depression on daily life, caregiving frustrations, and number of troubling dementia-related behaviors. A 2-hour decrease in hours per day on duty approached significance. Caregivers (96%) believed that the program should be provided by the VA to caregivers.
This clinical translation achieved outcomes similar to the REACH II randomized controlled trial, providing clinically significant benefits for caregivers of a veteran with a progressive dementing disease. This model of caregiver support can inform public policy in providing assistance to caregivers.

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Available from: Jennifer Martindale-Adams, Jul 29, 2015
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    • "The included studies investigated the effects of the interventions upon a number of carer outcomes including depression and or depressive symptoms29303132; caregiving difficulties and frustrations[29,30,32]; carer knowledge of dementia293031; burden303132; time spent providing care[30]; social support[30]; quality of life[32]; well-being[29]; physical health[30]and mental health[32]. These outcomes were measured in a variety of ways making comparison of the findings difficult (Table 4). "
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    ABSTRACT: Background Particularly with ageing populations, dementia and stroke and their resultant disability are worldwide concerns. Much of the support for people with these conditions comes from unpaid carers or caregivers. The carers’ role is often challenging and carers themselves may need support. General practice is often the first point of contact for people with these conditions and their carers, making it potentially an important source of support. This systematic review therefore synthesised the available evidence for the impact of supportive interventions for carers provided in general practice. Methods PRISMA guidelines were adopted and the following databases were searched: MEDLINE; EMBASE; the Cochrane Library; PsycINFO; CINAHL Plus; Applied Social Sciences Index and Abstracts and Healthcare Management Information Consortium. Results Two thousand four hundred eighty nine results were identified. Four studies, involving 447 carers, fitted the inclusion criteria. Three of these came from the United States of America. None investigated supportive interventions for carers of people with stroke. Primarily by the provision of information and educational materials, the interventions focussed on improving carer mental health, dementia knowledge, caregiving competence and reducing burden, difficulties and frustrations. Overall the evidence suggests that these interventions may improve carer well-being and emotional health but the impact on physical health and social variables was less clear. However, the diversity of the carer outcomes and the measures used means that the findings must be viewed with caution. Conclusions Unpaid carers pay an essential role in caring for people with stroke and dementia and the dearth of literature investigating the impact of supportive interventions for these carers of is surprising. The available evidence suggests that it may be possible to offer support for these carers in general practice but future research should consider focussing on the same outcome measures in order to allow comparisons across interventions.
    Full-text · Article · Dec 2016 · BMC Family Practice
    • "For example, the VHA's Resources for Enhancing Alzheimer Caregivers' Health (REACH VA) program, originally based in Tennessee, offers in-home support to caregivers of veterans with dementia and has been effective in decreasing perceived caregiver burden (Glasgow, 2011; Nichols, Martindale-Adams, Burns, Graney, & Zuber, 2011; Widera & Covinsky, 2011). However, because the REACH VA program was specifically designed for caregivers of veterans with dementia, all the information, support, and services are targeted specifically to dementia caregivers (Nichols et al., 2011). There are no published studies on programs similar to HBPC with a time limited approach to decreasing caregiver burden that are not disease specific. "
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    ABSTRACT: The Veterans Health Administration offers multiple programs to support veteran's caregivers. This study examines one such program, modeled after the national VHA Home Based Primary Care Program (HBPC). A retrospective secondary data analysis was conducted on the VHA GAP program, examining the impact on reducing caregiver burden. Findings from examination of 48 veteran/caregiver dyads indicated the program had a clinically and statistically significant impact on decreasing caregiver role strain. These findings were compared to the national evidence-based HBPC program, finding no significant differences in decrease of caregiver burden between the recipients of the GAP program and the national HBPC programs.
    No preview · Article · May 2015 · Social Work in Health Care
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    • "Informal care also facilitates the aims of the 1999 Millennium Act, which expanded LTC coverage for Veterans and stipulated that Veterans receive care in the least restrictive setting possible—their homes. And yet, there can be unintended negative consequences for the caregivers, including caregiver strain, burden, burnout and depression, which can increase patients' risk of institutionalization [5] [6] [7] [8]. Caregivers need clinical, psychological and support seeking skills to effectively navigate their role as a caregiver (Fig. 1), which could be attained through skills training. "
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    ABSTRACT: Within the Veterans Health Administration (VHA), the largest integrated health care system in the US, approximately 8.5 million Veteran patients receive informal care. Despite a need for training, half of VHA caregivers report that they have not received training that they deemed necessary. Rigorous study is needed to identify effective ways of providing caregivers with the skills they need. This paper describes the Helping Invested Families Improve Veterans’ Experience Study (HI-FIVES), an ongoing randomized controlled trial that is evaluating a skills training program designed to support caregivers of cognitively and/or functionally impaired, community-dwelling Veterans who have been referred to receive additional formal home care services. This two-arm randomized controlled trial will enroll a total of 240 caregiver-patient dyads. For caregivers in the HI-FIVES group, weekly individual phone training occurs for 3 weeks, followed by 4 weekly group training sessions, and two additional individual phone training calls. Caregivers in usual care receive information about the VA Caregiver Support Services Program services, including a hotline number. The primary outcomes is the number of days a veteran patient spends at home in the 12 months following randomization (e.g. not in the emergency department, inpatient or nursing home setting). Secondary outcomes include patient VHA health care costs, patient and caregiver satisfaction with VHA health care, and caregiver depressive symptoms. Outcomes from HI-FIVES have the potential to improve our knowledge of how to maximize the ability to maintain patients safely at home for caregivers while preventing poor mental health outcomes among caregivers.
    Full-text · Article · Jul 2014 · Contemporary Clinical Trials
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