No abstract

The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator. However, by the end of the 2-year intervention, the number of patients institutionalized was similar in the intervention and control group. It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers. On the basis of our experiences, we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care.

OBJECTIVES: To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services. DESIGN: Randomized controlled trial. SETTING: Community-dwelling couples with one spouse caring for the other spouse with dementia. PARTICIPANTS: Couples with dementia (N 5 125) were allocated at random to the intervention (n 5 63) or control group (n 5 62). INTERVENTION: Intervention couples were provided with a multicomponent intervention program with a family care coordinator, a geriatrician, support groups for caregivers, and individualized services. MEASUREMENTS: Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples. RESULTS: At 1.6 years, a larger proportion in the control group than in the intervention group was in long-term institutional care (25.8% vs 11.1%, P 5.03). At 2 years, the difference was no longer statistically significant. The 2-year adjusted hazard ratio for the intervention group was 0.53 (95% confidence interval (CI) 5 0.23-1.19, P 5.12). Intervention led to reduction in use of community services and expenditures. The difference for the benefit of intervention group was À 7,985 Euro (95% CI 5 À 16,081 to À 1,499, P 5.03). When the intervention costs were included, the differences between the groups were not significant. CONCLUSION: Although the intervention did not result in a significant difference in the need for institutional care after 2 years, individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services.

The proportion of male caregivers is rapidly increasing. However, there are few large scale studies exploring gender differences in the burden or coping with caregiving. We investigated this among caregivers of patients with dementia. The study cohort consisted of 335 dyads of wife-husband couples from two studies including dementia patients and their spousal caregivers. Baseline mini-mental state examination (MMSE), clinical dementia rating scale (CDR), neuropsychiatric inventory (NPI), cornell depression scale and charlson comorbidity index (CCI) were used to describe patients with dementia, Zarit burden scale and geriatric depression scale were used to measure experienced burden and depression of caregivers. Mean age of caregivers was 78 years. There were no differences in depression, satisfaction with life, or loneliness according to caregivers' gender. Male caregivers had more comorbidities than females (CCI 1.9 versus 1.1, P < 0.001), and the wives of male caregivers had a more severe stage of dementia than husbands of female caregivers (CDR, P = 0.048; MMSE14.0 versus 17.7, P < 0.001). However, the mean Zarit burden scale was significantly lower among male than female caregivers (31.5 versus 37.5; P < 0.001). Lower education of male caregivers tended to be associated with less experienced burden. In conclusion, male caregivers of dementia experienced lower burden than female caregivers despite care recipients' more severe disease.