Key Outcomes of a Manualized Psycho-Educational Group Intervention for Dementia Caregivers

Background and Purpose: Alzheimer's disease (AD) is a public health issue that creates serious strains on affected families. The Savvy Caregiver Program (SCP) (Hepburn, Lewis, Sherman & Tornatore, 2003) is a time-limited psycho-educational group approach designed to help family members manage and cope with caring for someone with AD or other dementia. One of the major themes of this approach is identifying the stage and abilities of the person with dementia, then planning appropriate activities and adjusting communication accordingly. Other topics include education about AD, making important decisions, self-care for the caregiver, and enlisting assistance from family and professionals. Prior research evaluating the impact of the SCP found that participating caregivers benefitted in terms of reduced distress and burden.

Methods: We received training to conduct these groups with treatment manuals developed by the SCP's originators. As part of the “Caregiver Knowledge and Skills Project,” we conducted 16 six-session, two-hour groups with three to seven members each. A total of 78 participants completed the group and pre- and post-questionnaires. Group leaders, one RN and three MSW/MAs with appropriate prior experience, received training and supervision throughout the project. Treatment fidelity to the spirit and contents of the original SCP was monitored through weekly checklists and frequent in-person observations. Participants consisted of spouse (45), adult child (27) or relative/friend (6) caregivers for ambulatory, community-dwelling dementia patients. These caregivers were black (12), white (64) and Asian (2); 16 were male and 62 were female, with a range of educational backgrounds. Participants attended an average of 5.2 group sessions. Written measures of stressors, resources and outcomes were administered to the caregivers before and after the series of group sessions. These included Pearlin's Role Overload, Role Captivity, Personal Mastery, and Competence, the Zarit Burden Scale, the 20-item CES-D measure of depressive symptoms, Positive and Negative Affect, and the Memory Problem and Behavior (MPB) Checklist, that measured occurrence, frequency and the amount of bother from each. Results: Paired t-tests compared baseline to post-treatment, revealing significant gains in Competence and reductions in MPB Total Bother, Overload, Negative Affect, and CES-D. Although frequency and occurrence of memory and behavior problems did not change, caregivers' reaction (bother) was significantly reduced. To ascertain whether participant characteristics moderated positive effects found, the post-test value of each outcome was regressed on gender, relationship status, age, education, and number of sessions attended, with the baseline value as a covariate. Relationship status moderated improvement in Role Overload, with adult children improving more than spouses or others. Conclusions and Implications: Despite the limited scope and duration of this psycho-educational group approach, several targeted areas improved in the short-term, across a range of caregivers of both genders with varied educational backgrounds. The knowledge, skills and support offered by the SCP increased caregivers' sense of competence and reduced the amount they were bothered by memory and behavior problems, as well as their sense of role overload, levels of negative affect, and depressive symptoms. This application of a manualized treatment approach successfully demonstrated its transportability to new settings.