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Purpose of the Study: The economic burden of dementia is substantially borne by state Medicaid programs. We estimated savings, from the state payer perspective, from offering the New York University Caregiver Intervention (NYUCI), a well-studied caregiver support and counseling program, to eligible Minnesota Medicaid enrollees., Design and Methods: A population-based microsimulation Markov model predicted and compared costs over 15 years with and without implementation of the NYUCI for family caregivers of community-based Medicaid eligibles with dementia. The model was informed by primary analysis of Minnesota Department of Human Services (MN DHS) data, and literature on the epidemiology, natural history, costs, and evidence-based management of the disease. Primary outcomes were predicted cumulative total direct costs, including medical, facility, and waiver-program payments for eligibles, and estimated costs of providing the NYUCI., Results: Approximately 5-6% more eligibles with dementia would remain in the community annually from year 3 (2014) on, so that over 15 years 17% fewer would die in nursing homes (NH) if their caregivers received the NYUCI. After 15 years, MN DHS could realize savings of $40.4 million (2011 dollars, discounted at 3%) if all eligibles/caregivers enrolled. Savings were expected 5 years after implementation. Multiple sensitivity analyses, including best-and worst-case scenarios, estimated results ranging from 15-year cumulative savings of $178.9 million to a cumulative loss of $7.3 million, respectively, driven largely by assumed program effectiveness., Implications: State payers can use enhanced caregiver support to moderate the growing tax burden of dementia, even without a breakthrough in the pharmacologic treatment of the disease.

Purpose of the Study: A noted limitation of dementia caregiver intervention research is a lack of focus on the mechanisms of successful programs. The purpose of this study was to conduct a process evaluation of the New York University Caregiver Intervention-Adult Child (NYUCI-AC) to describe its delivery and determine which of its components were associated with key outcomes (caregiver stress and well-being; care recipient residential care admission)., Design and Methods: Adult child caregivers randomly assigned to receive the NYUCI-AC intervention (n = 54) were included. Detailed data on the frequency and duration of each intervention component received, 4-month review checklists, and regular caregiver assessments were collected. Quantitative (descriptive, logistic regression, Cox proportional hazards models, growth curve models) and qualitative thematic analyses were performed., Results: Adult children receiving the NYUCI-AC completed a mean of 5.19 individual and family counseling sessions; it took on average a little over 11 months to do so. All NYUCI-AC counseling components were generally well-received and improved caregivers' management of care-related stress. The individual counseling sessions' clinical benefits in reducing primary subjective stress were most apparent in the first year of the intervention. Caregivers who experienced negative outcomes over time used more family sessions., Implications: A key mechanism of benefit for adult child caregivers in the NYUCI-AC was the frequent use of individual counseling sessions. The qualitative and quantitative results emphasize the value of the NYUCI-AC's flexibility in allowing adult child caregivers to choose the timing and use of specific intervention components.

Purpose of the Study: This study determined whether the NYU Caregiver Intervention for Adult Children (the NYUCI-AC) significantly reduced primary subjective stress for adult child caregivers of persons with dementia., Design and Methods: The NYUCI-AC was evaluated within a single-blinded randomized controlled trial. The sample included 107 adult child caregivers of persons with dementia (n = 54 assigned to the multicomponent treatment group; n = 53 assigned to a contact control group). Participants completed comprehensive assessments at baseline and at 4-month intervals during the first year and every 6 months thereafter. The focus of the current analysis was on the effects of the NYUCI-AC on change in primary subjective stress over 8, 12, and 18 months., Results: Individual growth curve models found that caregivers in the NYUCI-AC treatment condition indicated statistically significant (p < .05) linear declines in overall negative reactions to behavior problems over a 1-year period when compared with controls. Adult child caregivers in the NYUCI-AC also indicated greater decreases in negative reactions to disruptive behavior problems when compared with controls over 8, 12, and 18 months., Implications: The NYUCI-AC offered adult child caregivers counseling and support that improved their ability to manage their reactions to disruptive behaviors. This occurred despite the fact that other primary subjective stressors, such as role captivity and role overload, were not reduced., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: This study determined whether the NYU Caregiver Intervention, adapted in Minnesota for adult child caregivers (NYUCI-AC), prevented or delayed residential care placement for persons with dementia., Design and Methods: A single-blinded randomized controlled trial design was used. One hundred and seven adult child caregivers of persons with dementia were randomly assigned to the NYUCI-AC treatment group who received individual and family counseling, support group referral, and ad hoc consultation or a contact control group. Participants were asked to complete structured assessments quarterly during Year 1 and every 6 months thereafter for a minimum of 2 years., Results: Two thirds (66%) of adult child caregivers in the control condition admitted their parent to a residential care setting compared with 37% in the treatment condition. Logistic regression and Cox proportional hazards models found that NYUCI-AC participants were significantly less likely (p < .05) to admit their parents to a residential care setting and delayed their parents' time to admission significantly longer (228.36 days longer on average) than those in the control group., Implications: The multicomponent NYUCI-AC offered adult children the psychosocial support required to continue providing care to cognitively impaired parents at home.

Purpose: The stigma experienced by the family members of an individual with a stigmatized illness is defined by 3 dimensions: caregiver stigma, lay public stigma, and structural stigma. Research in the area of mental illness suggests that caregivers' perception of stigma is associated with increased burden. However, the effect of stigma on caregiver burden among those caring for a relative with Alzheimer's disease (AD) has yet to undergo theoretical and empirical testing. The aim of this study was to examine whether family stigma is a predictor of caregiver burden in the case of Alzheimer's disease., Design and Methods: Structured face-to-face interviews were conducted with 185 adult child caregivers (75% female; mean age = 53 years) for persons with Alzheimer's disease., Results: Caregiver stigma variables improved the prediction of caregiver burden by adding an additional 18% to the explained variance over and above the other covariates. The 2 caregiver stigma variables of shame and decreased involvement with caregiving were found to be the major contributing factors., Implications: Our findings show that caregiver stigma increases caregiver burden in the case of Alzheimer's disease. Using this knowledge, psychosocial interventions should target stigmatic beliefs in order to reduce caregiver burden.

Purpose: The purpose of this study was to examine the joint effects of bereavement and caregiver intervention on caregiver depressive symptoms., Design and Methods: Alzheimer's caregivers from a randomized trial of an enhanced caregiver support intervention versus usual care who had experienced the death of their spouse (n = 254) were repeatedly assessed with the Geriatric Depression Scale prior to and following bereavement. Random effects regression growth curve analyses examined the effects of treatment group and bereavement while controlling for other variables., Results: The death of the care recipient led to reductions in depressive symptoms for both caregiving groups. Enhanced support intervention led to lower depressive symptoms compared with controls both before and after bereavement. Post-bereavement group differences were stronger for caregivers of spouses who did not previously experience a nursing home placement. These caregivers maintained these differences for more than 1 year after bereavement. Caregivers who received the enhanced support intervention were more likely to show long-term patterns of fewer depressive symptoms before and after bereavement, suggesting resilience, whereas control caregivers were more likely to show chronic depressive symptoms before and after the death of their spouse., Implications: Caregiver intervention has the potential to alter the long-term course of the caregiving career. Such clinical strategies may also protect caregivers against chronic depressive symptoms that would otherwise persist long after caregiving ends.

Purpose: We examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention., Design and Methods: We analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. We used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention., Results: Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression., Implications: Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention like ours, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment., (Copyright 2004 The Gerontological Society of America)

Caregivers of Alzheimer's disease patients often suffer from depression. Using a longitudinal treatment/control study, we examined the effects of a comprehensive support program on depression in spouse-caregivers. This psychosocial intervention program treats the primary caregiver and family members over the entire course of the disease through individual and family counseling, the continuous availability of ad hoc counseling, and support group participation. In the first year after intake, the control group became increasingly more depressed, whereas the treatment group remained stable. By the eighth month, treated caregivers were significantly less depressed than those in the control group. These results suggest that enhancing long-term social support can have a significant impact on depression in caregivers.