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Dementia Alzheimers Caregivers: A Comprehensive
Review of Interventions and Therapy
Dementia of the Alzheimers type is a disease that presents various
continuing and debilitating challenges to the life of the individual
diagnosed. With no cure available, people diagnosed with Dementia
struggle in daily routine. Mostly all individuals with Dementia of the
Alzheimers Type will need some kind of assistance. Many of those
diagnosed must rely on family to provide the prominent source of
caregiving. These family caregivers are placed in a unique
circumstance of obligation in which they undertake a significant
amount of stress, burden, and grief. This situation is different from
the role of the paid caregiver. Family caregivers live the situation
every hour of the day and go through a mental strain unlike those
who facilitate caregiving as a career. The purpose of this literature
review is to examine the significant current forms of interventions and
care available to mitigate adverse effects assumed by family
caregivers of those with AD.

Caregiver Needs
Wackerbarth and Johnson (2002) identified essential need for
caregivers is information including:
respite and nursing home care
services to help with caregiving
assistance from health professionals
support groups
legal protection
assistance with constant supervision
educational and social support
health plan coverage and best available care
Support needs that were most important to caregivers included
support for the one diagnosed with AD rather than support for the
caregivers themselves
Need for information greater than caregiver support needs

Results revealed the following benefits of counseling and other
interventions for non-professional caregivers:
Stress relief
Physiological improvements
Reduced caregiver burden
A common thread of success in relieving caregiver burden appeared
to be human interaction.
All of the literature researched showed subjects achieving benefits
when having social interaction and actively working on health,
behavior solutions, or betterment of knowledge.
Example of Castro et al. exercise study

Now that we know human interaction is crucial, what are the best
interventions for specific needs?
Needs of information vs. social support self-efficacy (e.g.)
Narrow scope of interventions
Technological interventions (e.g. internet or video-based)
Group counseling
Individual counseling types
Counseling combined with pharmacotherapy
Further narrowing of select therapy
Formulate system to generalize results in categories
Large scale collaboration needed/use of similar stress scales

American Psychiatric Association (2002). Diagnostic and statistical manual of mental disorders
(4th ed., Text Revision). Washington, DC: Author
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical
review. Clinical Psychology: Science and Practice, 10(2), 125143.
Castro, C. M, Wilcox, S., OSullivan, P., Baumann, K., and King, A. C. (2002). An exercise
program for women who are caring for relatives with dementia. Psychosomatic Medicine 64(3),
Gaugler, J. E., Roth, D. L., Haley, W. E., and Mittelman, M. S. (2008). Can counseling and
support reduce burden and depressive symptoms in caregivers of people with alzheimers
disease during the transition to institutionalization? Results from the New York University
caregiver intervention study. Journal of the American Geriatrics Society 56(3), 421428.
Glueckauf, R. L., Ketterson, T. U., Loomis, J. S., and Dages, P. (2004). Online support and
education for dementia caregivers: Overview, utilization, and initial program evaluation.
Telemedicine Journal and e-Health 10(2), 223232.
Mittelman, M. S., Brodaty, H., Wallen, A. S., and Burns, A. (2008). A three-country randomized
controlled trial of a psychosocial intervention for caregivers combined with pharmacological
treatment for patients with alzheimer disease: Effects on caregiver depression. The American
Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric
Psychiatry 16(11), 893904.
Oken, B. S., Fonareva, I., Haas, M., Wahbeh, H., Lane, J. B., Zajdel, D., and Amen, A. (2010).
Pilot controlled trial of mindfulness meditation and education for dementia caregivers. The
Journal of Alternative and Complementary Medicine 16(10), 10311038.
Theis, W., and Bleiler, L. (2012). 2012 Alzheimers disease facts and figures. Alzheimers &
Dementia 8(2), 131168.
Rabinowitz, Y. G., Mausbach, B. T., Thompson, L. W., and Gallagher-Thompson, D. (2007). The
relationship between self-efficacy and cumulative health risk associated with health behavior
patterns in female caregivers of elderly relatives with alzheimers dementia. Journal of Aging
and Health 19(6), 946964.
Schulz, R., OBrien, A., Czaja, S., Ory, M., Norris, R., Martire, L. M., . . . Belle, S. H. (2002).
Dementia caregiver intervention research: In search of clinical significance. The Gerontologist
42(5), 589602.
Teasdale, J. D., Segal, Z. V., & Williams, J. M. G. (2003). Mindfulness training and problem
formulation. Clinical Psychology: Science and Practice, 10(2), 157-160.
Wackerbarth, S. B., and Johnson, M. S. (2002). Essential information and support needs of
family caregivers. Patient Education and Counseling 47(2), 95100.
Williams, V. P., Bishop-Fitzpatrick, L., Lane, J. D., Gwyther, L. P., Ballard, E. L., Vendittelli, A. P.,
. . . Williams, R. B. (2010). Video-based coping skills to reduce health risk and improve
psychological and physical well-being in alzheimers disease family caregivers. Psychosomatic
Medicine 72(9), 897904.

Sean Sandag
Wake Forest University Department of Counseling
Counseling/Group Therapy study (Gaugler, Roth, Haley, & Mittelman,
Experimental study conducted on 406 spouse caregivers over 9.5
Research Question: Does counseling relieve caregiver burden
during institutionalization stage?
Six individual and family counseling sessions and ad hoc
counseling given based on caregiver needs of information.
Experimental and control group experienced immediate relief of
burden symptoms upon institutionalization, but the experimental
group had lower symptoms before and lasted long after.
Counseling Combined with Pharmacotherapy study (Mittelman,
Brodaty, Wallen, & Burns, 2008):
158 spouse caregivers from three countries given anti-depressant
Experimental group given 5 individual/group counseling sessions
and unlimited ad hoc counseling by telephone.
Beck Depression scores disparity small at first but gap continued
to widen between experimental and control group throughout five
years of follow-up.
Study demonstrated effective multinational psychosocial
interventions for caregivers are achievable and practical and can
provide significant benefits when the patient is taking drugs such
as donepezil.
Samples resided in United States, Australia, and the United
Kingdom in attempt to make study generalizable. Does this study
reasonably account for multicultural differences?

The Diagnostic and Statistical Manual-IV-TR characterizes Dementia
as the development of multiple cognitive deficits (including memory
impairment) that are due to the direct physiological effects of a
general medical condition, to the persisting effects of a substance, or
to multiple etiologies (American Psychiatric Association (APA), 2002,
p. 147).
More specifically to Alzheimers, the onset of Dementia of the
Alzheimers Type is gradual and involves continuing cognitive
decline (APA, 2002, p. 148).
Diagnosis of Alzheimers can only be made after other etiologies are
ruled out including:
Central nervous system conditions (i.e. Parkinsons Disease)
Systematic conditions (i.e. hypothyroidism, HIV infection)
Substance abuse or head trauma
Warning signs and symptoms of Dementia Alzheimers:
Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks at home, at work, or at leisure
Confusion with time or place
Trouble understanding visual images or spatial relationships
Changes in mood and personality
Withdrawal from work or social activities
Misplacing things and losing the ability to retrace steps
No treatment is available to stop or slow the Dementia of the
Alzheimers type, but five drugs have been approved to temporarily
improve systems although effectiveness varies across the population
(Theis & Bleiler, 2012).

Interventions used measurements of self-efficacy to determine the
mental health of caregivers.
Self-efficacy is the belief of being able to produce desired results
through ones own actions.
Positive correlation between caregiver health benefits and
controlling upsetting thoughts (Robinowitz, 2010).
Caregivers want to feel a source of control in their own lives
considering the lack of control associated with caregiving.
Mindfulness--teaching people to pay attention in a particular way
--has benefits across a wide range of disorders (Baer, 2003).
Mindfulness study (Oken et al., 2010):
Three groups were studied for seven weeks: a.) 90-minute
Mindfulness-Based Cognitive Therapy sessions group b.)
dementia education classes group, and c.) respite only care group
RMBPC tests showed that the MBTC group and education group
had improved self-efficacy and lower stress than the respite only
Results did not show improvement of secondary outcomes
including mood, fatigue, salivary cortisols, and cytokines.
Enhancements of mindfulness were not observed despite MBTC

Search conducted over two weeks using the access to databases provided by the Wake Forest Z. Smith Reynolds Library.
The Diagnostic Statistics Manual of Mental Disorder IV-TR was referenced to gain insight about the disease.
Databases searched: PubMed, PsycInfo, ERIC
Key words searched separately and together in database searches: Dementia Alzheimers, caregivers, interventions, counseling, mindfulness,
Teasley, Segal, therapy, caregiver needs, self-efficacy
Criteria of search:
Dementia of the Alzheimers type
Articles published from year 2000 to present
Studies in which caregivers were limited to unpaid family members, as opposed to paid caregivers working privately or within institutions

Internet-Based Therapy study (Glueckauf, Ketterson, Loomis, &
Dages, 2004):
Alzheimers Caregiver Support Online also known as AlzOnline
21 participants completed six 45-minute live, interactive classes that
focus on managing stress, enhancing interpersonal communication
and family relationships, promoting emotional well-being, and setting
and implementing personal caregiving goals.
Results showed significant improvements in caregiver self-efficacy
involving their ability to manage caregiver duties and difficult care
recipient behavior, but little or no change in the caregiver experience
including time burden, stress and positive caregiver appraisal
Video-Based Coping Skills study (Williams et al., 2010):
116 family caregivers given five weeks of training through two video
modules per week plus weekly coaching phone call
The video modules consisted of coping techniques and ways to
handle stressful situations in caregiving illustrated by dramatized
examples of an effective way and a non-effective way to handle a
Improved psychological and first phone physiological improvement
(based on blood pressure)

Exercise study (Castro, Wilcox, OSullivan, Baumann, & King, 2002):
12-month at home exercise program/four sessions per week for 30
min. per session
Both the experimental and control group received nutrition wellness
Social engagement and active participation in bettering their health
may have produced enough benefits to reduce stress.

5.4 million people have AD
AD is the sixth leading cause of death in the United States and the
fifth leading cause of death in Americans age 65 years and older
(Theis & Bleiler, 2012)
In 2011, the average annual cost of a private nursing home room
was $87, 235. This amounts to $239 a day.
In 2011, more than 15 million family members and other unpaid
caregivers provided an estimated 17.4 billion hours of care to people
with AD.
The physical and emotional impact of caregivers was shown to
cause $8.7 billion in additional health care costs (Theis & Beiler,
Caregiver Risks:
Chronic disease and adverse health related physiological change
which could result in death.
Hypertension, reduced immune function, coronary heart disease,
and cardiovascular disease.
High amount of stress experienced by caregivers can elicit sleep
deprivation, personality change, and loss of judgment.