Innovative Interventions to Reduce Dementia Caregiver Distress

Article excerpt

DAVID W. COON, DOLORES GALLAGHER-THOMPSON, LARRY W. THOMPSON (EDS.): Innovative Interventions to Reduce Dementia Caregiver Distress. Springer Publishing Company, Inc., New York, 2003, 316 pp., $43.95, ISBN No.: 0-8261-4801-8.

As psychotherapists, we are accustomed to learning about treatments directed at specific illnesses and syndromes. Conversely, most of the emotional distress and emotional burden in life come not from these illnesses and syndromes, but from various, frequently unavoidable life circumstances. Caregiving is one of those circumstances; especially for elders and those others who care for persons who are chronically ill. Caregiving is especially distressing when chronic illness erodes care recipients' cognition, their personality, and their function as part of a family unit. In the preface, the editors suggest that efforts to alleviate caregiver stress and strain may both improve the quality of life of the family unit and may also be cost-effective by delaying or obviating the need for institutionalization. The authors also indicate that Caregiving has an important impact on caregiver health. Older adults experiencing strain as a result of their caregiving role are 63 % more likely to die within four years than non-caregivers (p. 9).

This slim volume is a superb resource for techniques in helping caregivers deal with the issues related to caring for persons with dementing illnesses. Much of the core information comes from the REACH project, funded jointly by the National Institute on Aging and the National Institutes for Nursing Research. This project, involving six sites across the country, was an effort to test systematically well-specified and theory-based caregiver interventions that were tailored to meet the needs of racial and ethnic majority and minority caregivers. Unconfined by the traditional boundaries of the therapeutic relationship, these interventionists tested a range of strategies that integrate one-on-one sessions with group educational activities and a variety of community support services. They recommend multi-faceted approaches including information about the care recipient's illness, the development of problem-solving techniques, reframing the caregiving experience, and the use of family supports and community resources.

Interventionists connect with caregivers in interventionists' offices, at the homes of caregivers, and by telephone. They recognize that not all caregivers have the same needs and that the caregiving experience and caregiver needs change over the course of the care recipients' illness. One proposed model consists of the following steps: identification of a primary target person or entity, targeting a domain within that person or entity, determining the most desirable intensity of intervention, and personalizing the intervention to the particular person or circumstance. …