In the United States, almost 11 million caregivers provide 12.5 billion hours of care yearly to people with Alzheimer's disease, in large part without the training or skills to manage the burden. As a result, these caregivers suffer adverse physical and psychological consequences, including feelings of isolation, anxiety, poor sleep, hospitalization, and even death. A recent report describes the translation of the National Institute on Aging and National Institute of Nursing Research's Resources for Enhancing Alzheimer's Caregiver Health (REACH) program into the Department of Veterans Affairs (VA) medical system. REACH VA is the first effort to offer structured support and education to this neglected population within the VA system, and on March 2 the VA announced that, as a result of the program's success, it was taking REACH VA nationwide.

Figure. For over a year, Erma Taylor provided in-home care for her husband, Robert Taylor, a Korean War veteran who suffered from dementia, while simultaneously caring for her bedbound brother. Ms. Taylor and her husband were participants in the REACH program research study at the VA Medical Center in Memphis, Tennessee, which aimed to reduce the stress and burden of dementia caregivers. Photo by Teresa L. Moerman.

Linda Olivia Nichols and Jennifer Martindale-Adams, a professor and an assistant professor, respectively, at the University of Tennessee Health Science Center and codirectors of the Caregiver Center at the Memphis VA Medical Center, led the intervention, which ran from September 2007 through August 2009. In a six-month intervention that involved home visits, one-on-one phone calls, and telephone support group sessions, clinical staff members (usually nurses, social workers, or psychologists) from 24 VA Medical Center Home-Based Primary Care programs in 15 states worked with caregivers of dementia patients. The interventions, structured to target individual caregiver needs, focused on safety, social support, problem behaviors, depression, and caregiver health. One of the primary tools was an easy-to-understand caregiver notebook that included practical, customizable strategies for addressing 30 behavioral and 18 stress and coping issues.

The program was a resounding success, with caregivers reporting significant decreases in caregiver burden, depression, the impact of depression on daily life, caregiving frustrations, and the number of troubling dementia-related behaviors experienced after going through the six-month intervention.

For nurses, the program offers a formalized way to do the work that many do as a matter of course. "This program is targeted for individual caregivers using a risk appraisal," says Nichols. "It's a perfect model for what nurses already do-taking interventions proven to promote good-quality care and individualizing them for each patient." What's more, says Martindale-Adams, the structure of the program helps caregivers remember questions they wanted to ask before the nurse walks out the door; sometimes just asking stressed family caregivers how they're doing can make all the difference. "They realize that someone cares," says Nichols, "and realizing that other people are having these issues normalizes what's going on."-Laura Wallis

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