Programmes help demented patients and caregivers

NEW YORK, Nov 21 (Reuters) A guideline-based disease management programme and a structured multi-component intervention can improve quality of life and other outcomes for patients with dementia and their caregivers, according to the findings of two studies published this week.

In the first study, Dr Barbara G Vickrey, from the University of California at Los Angeles, and colleagues tested the effect of a disease management intervention on quality of life, social support, and other outcomes in 408 demented patients, each paired with a caregiver.

The goal of the programme, which was led by care managers and provided to roughly half of the patient/caregiver pairs, was to improve adherence to dementia guidelines.

The care manager helped prioritise problem areas, taught problem-solving skills and initiated care plan actions with ongoing follow-up. Subjects in this group received assistance from the managers in coordinating doctor visits and social services for more than 1 year, while those in the control group received no assistance.

The programme was associated with significant improvements in guideline adherence and community agency assistance. Moreover, patients in the intervention group had significantly higher quality of life, quality of care, caregiving quality, and social support than those in the control group. Caregiver quality of life, however, was similar in each group.

In the second study, Dr Steven H Belle, from the University of Pittsburgh, and colleagues assessed the outcomes of 518 caregivers who were randomized to an intervention that provided regular counseling on caregiver depression, burden, self-care, and other aspects or to a control group with only brief ''check in'' telephone calls over the 6-month study period.

Participation in the intervention was associated with significant improvement in caregiver quality of life, the team reports. The rate of clinical depression in the intervention group was 12.6 per cent, much lower than the 22.7 per cent rate noted in the control group.

No significant differences in rates of institutionalisation of care recipients were noted.

In a related editorial, Dr Kenneth E Covinsky and Dr C Bree Johnston, from the University of California in San Francisco, comment that ''more work will need to be done before we can know for certain how well these interventions will work in other settings and how durable their effects will be.'' ''Longer and larger trials,'' they add, ''are needed to determine whether these interventions delay nursing home placement.'' REUTERS SB VA RAI0922