Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Drentea, P., Clay, O. J., Roth, D. L., & Mittelman, M. S. (2006). Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease. Social Science and Medicine, 63, 957-967. 
Jang, Y., Clay, O. J., Roth, D. L., Haley, W. E., & Mittelman, M. S. (2004). Neuroticism and longitudinal change in caregiver depression: Impact of a spouse-caregiver intervention program. The Gerontologist, 44(3), 311-317.
Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., Ambinder, A., Mackell, J. A., et al. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist, 35(6), 792-802.
Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer's disease: A randomized controlled trial. Journal of the American Medical Association, 276(21), 1725-1731.
Mittelman, M. S., Ferris, S. H., Steinberg, G., Shulman, E., Mackell, J. A., Ambinder, A., et al. (1993). An intervention that delays institutionalization of Alzheimer's disease patients: Treatment of spouse-caregivers. The Gerontologist, 33(6), 730-740.
Mittelman, M. S., Haley, W. E., Clay, O. J., & Roth, D. L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67, 1592-1599.
Mittelman, M. S., Roth, D. L., Clay, O. J., & Haley, W. E. (2007). Preserving health of Alzheimer's caregivers: Impact of a spouse caregiver intervention. American Journal of Geriatric Psychiatry, 15, 780-789.
Mittelman, M. S., Roth, D. L., Coon, D. W., & Haley, W. E. (2004). Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. American Journal of Psychiatry, 161, 850-856.
Mittelman, M. S., Roth, D. L., Haley, W. E., & Zarit, S. H. (2004). Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: Results of a randomized trial. Journal of Gerontology, Series B, Psychological Sciences and Social Sciences, 59(1), P27-P34.
Roth, D. L., Mittelman, M. S., Clay, O. J., Madan, A., & Haley, W. E. (2005). Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease. Psychology and Aging, 20(4), 634-644.
Supplementary Materials Mittelman, M. S. (2003). Community caregiving. Alzheimer's Care Quarterly, 4(4), 273-285.
Mittelman, M. S. (2003). Psychosocial intervention for dementia caregivers: What can it accomplish? International Psychogeriatrics, 15(Suppl. 1), 247-249.
Outcomes
| Outcome 1: Caregiver physical health |
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Description of Measures
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Caregivers were asked 3 questions adapted from the Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire to assess their physical health. Using 3- and 4-point scales, caregivers rated their current physical health, compared their current health to their health 5 years ago, and indicated how much their physical health problems hindered their activities.
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Key Findings
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Caregivers who received the intervention reported better physical health than members of the comparison group, who received resource information on request but did not receive individual and family counseling (p < .001). The effect was maintained for 2 years.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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| Outcome 2: Caregiver depressive symptoms |
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Description of Measures
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The depressive symptoms of caregivers were assessed with the Geriatric Depression Scale, a 30-item, self-report questionnaire with a yes/no format that was developed specifically for use with older adults.
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Key Findings
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Caregivers who received the intervention averaged fewer depressive symptoms than members of the comparison group, who received resource information on request but did not receive individual and family counseling (p < .05). The effect was maintained for 3 years.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.7
(0.0-4.0 scale)
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| Outcome 3: Caregiver social support |
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Description of Measures
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The social support of caregivers was measured using 3 questions from the Stokes Social Network Questionnaire. Using a 6-point Likert scale (from very dissatisfied to very satisfied), caregivers assessed their general satisfaction as well as their satisfaction with the assistance and emotional support they received from family and friends.
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Key Findings
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Caregivers who received the intervention reported higher levels of satisfaction with their social support network than members of the comparison group, who received resource information on request but did not receive individual and family counseling (p < .001). This effect was maintained for 5 years.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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| Outcome 4: Caregiver appraisal of patient memory and behavior |
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Description of Measures
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The Memory and Behavior Problems Checklist (MBPC) was used to assess the caregivers' understanding of and reaction to the patients' problems with memory and behavior. Caregivers reported on the frequency of 30 memory and behavior problems and on the degree to which they found each of these problems upsetting or troublesome.
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Key Findings
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Caregivers in the intervention group reported being significantly less troubled by their spouses' memory and behavior problems than caregivers in the comparison group, who received resource information on request but did not receive individual and family counseling (p < .05). This group difference became significantly stronger across increasingly longer follow-up intervals.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.4
(0.0-4.0 scale)
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| Outcome 5: Length of time to nursing home placement of care recipient |
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Description of Measures
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The length of time to nursing home placement was measured in days from enrollment in the intervention to nursing home placement of the care recipient. Dates of permanent nursing home placement and death were monitored throughout the project during regular follow-up interviews and telephone contacts with caregivers and family members. Dates of death were subsequently confirmed through the Social Security Death Index.
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Key Findings
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The average time from enrollment to nursing home placement of care recipients was 557 days longer with caregivers who received the intervention than with those from the comparison group, who received resource information on request but did not receive individual and family counseling (p = .02). Caregivers who received the intervention experienced a 28.3% reduction in the rate of nursing home placement compared with usual care controls (p = .025).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.6
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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55+ (Older adult)
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60.1% Female
39.9% Male
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90.9% White
6.4% Black or African American
2.5% Hispanic or Latino
0.2% Asian
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Caregiver physical health
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4.0
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3.3
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3.0
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4.0
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4.0
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3.0
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3.5
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2: Caregiver depressive symptoms
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4.0
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4.0
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3.0
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4.0
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4.0
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3.0
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3.7
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3: Caregiver social support
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4.0
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3.0
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3.0
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4.0
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4.0
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3.0
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3.5
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4: Caregiver appraisal of patient memory and behavior
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3.5
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3.0
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3.0
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4.0
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4.0
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3.0
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3.4
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5: Length of time to nursing home placement of care recipient
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4.0
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3.5
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3.0
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4.0
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3.5
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3.5
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3.6
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Study Strengths The study design was a rigorous randomized controlled trial. The retention rate was remarkably good. Confounding variables were controlled through the design and statistical analysis. The measures used have high reliability scores.
Study Weaknesses The dataset was analyzed several different times, each time for a separate paper. Thus, the results must be interpreted with some level of uncertainty (i.e., there were no statistical corrections for multiple comparisons across all outcomes). Although the study used good measures, some were not optimal. In addition, the outcome measure for social support is not commonly used.
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Data collection forms:
- Caregiver Evaluation of Ad Hoc Counseling
- Caregiver Evaluation of Individual and Family Counseling Sessions
- Caregiver Evaluation of Support Group
- Caregiver Telephone Contact Log
- Family Counseling First Caregiver Interview
- Family Counseling Second Caregiver Interview
- Family Counseling Summary Form
Description of enactment, adherence, and delivery of services
Explanation of evaluation forms
Mittelman, M., Epstein, C., & Pierzchala, A. (2003). Counseling the Alzheimer's caregiver: A resource for health care professionals. Chicago, IL: American Medical Association Press.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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2.0
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0.8
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1.5
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1.4
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Dissemination Strengths The book recommended for counselors provides an excellent overview of issues and challenges faced by those caring for someone with Alzheimer's disease. Counselors from the research team implementing the program are available for consultation. Some good instruments are provided to collect feedback from caregivers and counselors.
Dissemination Weaknesses Though the book does provide an educational foundation for the intervention, it does not provide sufficient implementation guidance. The relationship between assessment and intervention strategies is unclear. The intervention requires a high degree of clinical skill, knowledge about Alzheimer's disease, and competence in both individual and family treatment modes, but no formal training or coaching is available to ensure counselor confidence, competence, or treatment effectiveness. No outcome or fidelity measures are provided to support quality assurance.
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