Dementia: How to Help the Family Caregiver
Dementia ranks as a leading cause of disability for elderly patients, and the prevalence is expected to quadruple over the next three decades.1 The cognitive decline and accelerated physical decline associated with dementia erode patient safety and independence, increase healthcare costs, and reduce the wellbeing of family caregivers.1-4 On the other hand, studies show that elderly patients with dementia who live at home can improve verbal communication, cognition, behavior, and independence with activities of daily living.5
Additionally, despite the challenges presented by dementia, research shows that in-home rehab reduces fall risk an average of 32% and reverses even long-standing disability.6,7 In addition to direct patient care and rehabilitation, home health care plans for dementia often include caregiver training. It sounds like a good idea that couldn’t hurt, but how much difference does caregiver education really make? Recently, the Journal of Public Health Research published an answer to that question.8
Duration of Time Providing Alzheimer’s Care
Caregivers of people with Alzheimer’s and related dementias provide care for a longer duration than caregivers of people with other types of conditions. According to the Centers for Disease Control and Prevention (CDC), well over half of family caregivers of people with Alzheimer’s and other dementias provide care for four years or more. The CDC also reported that six in ten caregivers expect to continue with their responsibilities for the next five years, compared to caregivers of people without dementia.
Researchers recruited 40 families that had a senior living with dementia for less than five years. Then, they divided the families into a control group and an intervention group. The intervention consisted of eight weeks of home health visits. Half of the visits were for education and training. Half were for “accompaniment and mentorship,” wherein the nurse accompanied the family caregiver while performing caregiving tasks, and provided mentorship as needed.
Researchers used the Caregiver Outcomes Survey, which has a 25-to-100-point scale. They measured an 18-point improvement in perceived health, a 17-point improvement in perceived growth, and a 22-point improvement in well-being. Additionally, researchers used the Dementia Elderly Self-reliance Card, a 32-to-121-point scale used to detect improvement and decline among patients with dementia. The family-caregiver training was associated with a 9-point improvement in verbal communication, a 12-point improvement in independence with activities of daily living, a 12-point improvement in cognitive ability, and an 11-point improvement in aggressive behavior. For comparison, the control group receiving no intervention saw non-significant declines in all measures.
Medicare Pays 100%
The current study demonstrates how family caregivers can be empowered to better assist loved-ones with dementia while also lessening their own personal burdens. It also underscores the importance of prescribing home health when patients qualify. Medicare pays 100% for a home health agency to deliver family-caregiver training for homebound patients with dementia. To qualify, patients should have a recent medical occurrence such as a new diagnosis of dementia, a change in the stage of dementia, new medications where nurse teaching may be helpful, a possibility of medication non-adherence, newly documented declines, an accidental fall, etc.
- Arrighi HM, McLaughlin T, Leibman C. Prevalence and impact of dementia-related functional limitations . . ., 2001 to 2005. Alzheimer Disease & Associated Disorders. 2010 Jan 1;24(1):72-8.
- Poulos CJ, Bayer A, Beaupre L, Clare L, Poulos RG, Wang RH, Zuidema S, McGilton KS. A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2017 Sep 1;3(3):450-8.
- Pressley JC, Trott C, Tang M, Durkin M, Stern Y. Dementia in community-dwelling elderly patients: A comparison of survey data, Medicare claims, cognitive screening, reported symptoms, and activity limitations. Journal of Clinical Epidemiology. 2003 Sep 1;56(9):896-905.
- Weber SR, Pirraglia PA, Kunik ME. Use of services by community-dwelling patients with dementia: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias®. 2011 May;26(3):195-204.
- Boland L, Légaré F, Perez MM, Menear M, Garvelink MM, McIsaac DI, Painchaud Guérard G, Emond J, Brière N, Stacey D. Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews. BMC Geriatrics. 2017 Dec;17:1-5.
- Burton E, Cavalheri V, Adams R, et al. Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis. Clinical Interventions in Aging. 2015; 10: 421-434.
- Vries N, Ravensberg C, Hobbelen J, et al. Effects of physical exercise therapy on mobility, physical functioning, physical activity and quality of life in community-dwelling older adults with impaired mobility, physical disability and/or multi-morbidity: A meta-analysis. Ageing Research Reviews. 2012; 11: 136-149.
- Sya’diyah H, Nursalam, Mahmudah, Efendi F. Effectiveness of home care intervention on family ability to do caregiving at home and increase the independence among elderly with dementia. Journal of Public Health Research. 2022 Aug;11(3):22799036221115774.
- Suwa S, Yumoto A, Ueno M, Yamabe T, Hoshishiba Y, Sato M. Characteristics of care methods for daily life disabilities in Alzheimer’s type dementia that respect autonomy and independence. Nursing Open. 2019 Jul;6(3):930-41.