Northern-Manhattan Hispanic Caregiver Intervention Effectiveness Study
Condition: Depressive Symptoms; Burden
MeSH terms: Depression
Study type: Interventional

Summary: 
      The primary research question is which of the 2 best known dementia caregiver interventions,
      the New York University Caregiver intervention (NYUCI) and Resources for Enhancing Caregivers
      Health Offering Useful Treatments (REACH OUT), is more effective in alleviating depressive
      symptoms and caregiver burden among Hispanic caregivers in New York City. The investigators
      hypothesize that the NYUCI will be more effective than REACH OUT in reducing caregiver
      depressive symptoms and burden among Hispanics because of its focus on family-centered
      counseling, which is posited to be more important among Hispanic caregivers because of a
      cultural emphasis among Hispanics on family interactions in interventions. In order to answer
      the primary question, the investigators will conduct a pragmatic randomized trial comparing
      the NYUCI vs. REACH OUT in 200 Hispanic caregivers of persons with dementia in the community
      of Northern Manhattan. The total time of the intervention will be 6 months.

      Our research question is which intervention, NYUCI or REACH OUT, is better in Hispanic
      relative (any relative) caregivers of persons with dementia. Our objective is to obtain
      effectiveness information that will help caregivers and health providers to make decisions
      about which intervention to choose. Our primary aim is to compare the effectiveness of the
      implementation of the NYUCI and REACH OUT in reducing depressive symptoms and burden. Our
      exploratory aims are to examine and compare the predictors of effectiveness of the NYUCI and
      REACH OUT and to examine additional outcomes such as caregiver stress and physical health,
      and outcomes related to the person with dementia. METHODS. We will conduct a pragmatic
      randomized trial of 200 relative caregivers of persons with dementia. Participants will be
      randomized to the NYUCI or REACH OUT. The total duration of the intervention will be 6
      months, with assessments at baseline and follow-up. All interventions and questionnaires will
      be conducted in both English and Spanish. The study duration will be 3 years. The primary
      outcomes will be changes in caregiver depressive symptoms, measured with the Geriatric
      Depression Scale, and in caregiver burden using the Zarit caregiver burden interview.
    

Detailed description: 
      The prevalence of dementia is increasing with the aging of the population and the absence of
      prevention or cure. Thus, the burden of dementia on caregivers is also increasing. Hispanics
      have a higher prevalence of dementia than non-Hispanic Whites (NHW), have higher caregiving
      burden, and may have less economic resources to cope with the caregiving burden. However,
      there is a paucity of evidence on the effectiveness of caregiver interventions in Hispanics.
      We propose to compare 2 interventions with evidence of efficacy, the New York University
      Caregiver intervention (NYUCI) and the translated Resources for Enhancing Caregivers Health
      Offering Useful Treatments (REACH OUT). The NYUCI is a family centered counseling
      intervention that focuses on reducing negative family interactions and improving family
      support of the primary caregiver. REACH OUT focuses on caregiver skills training through
      action-oriented formal problem solving, goal setting, and written action plans. The
      effectiveness of the NYUCI and the REACH OUT has never been compared. Thus, there is no way
      for caregivers to decide which intervention to choose. In addition, there is a paucity of
      data on the effectiveness of both interventions in Hispanics.
    

Intervention name(s): Social work support; Educational material; NYU caregiver counseling intervention; REACH OUT counseling intervention
Intervention type(s): Other; Other; Behavioral; Behavioral
Intervention description(s): All study participants were provided access to social support services at Riverstone Senior Life services; All participants received educational material about dementia and caregiving in addition to information about resources for persons with dementia and their caregivers, including resources at the Alzheimer's Association such as support groups, and clinical and service resources available citywide.; The first component consists of 2 individual and 4 family counseling sessions. These sessions last between 1 and 1.5 hours. The second component of the intervention is participation in a caregiver support group . The third component of the treatment is "ad hoc" counseling. New psychiatric and behavioral problems of patients, which are generally more stressful than the need for assistance with activities of daily living or physical limitations, often precipitate ad hoc calls from caregivers.; All aspects of the REACH OUT Intervention involve problem solving techniques and the development of written action plans. The goal of this intervention is to engage the caregiver in joint problem-solving with the objective of creating a written action plan targeting specific caregiving problems. The basic steps of problem solving are: 1.Define the problem. 2. Set goals 3. Brainstorm with caregiver and List possible solutions on a pad of paper, 4. Select solutions, 5. Develop an action plan based on these solutions, 6. Implement the action plan, track progress, and make adjustments as needed
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Other
Keywords: Hispanic; Dementia; Caregivers; Depressive symptoms; Burden; Pragmatic randomized trial