Veterans Rural Health Resource Center, Salt Lake City, Utah.
Salt Lake Department of Veterans Affairs Health Care System, Salt Lake City, Utah.
J Rural Health. 2017 Jun;33(3):305-313. doi: 10.1111/jrh.12195. Epub 2016 Jul 20.
The increasing prevalence of dementia, including among rural veterans, highlights the improved outcomes possible for caregivers who receive effective support. However, providing these complex interventions in rural areas presents challenges. Internet-based and telephone-based caregiver support can potentially expand access to effective support.
We designed a multisite intervention for caregivers of veterans with dementia. Caregivers were stratified into 2 cohorts based on their use or nonuse of the Internet. Each cohort was then randomized to either a technology or telephone-delivered support group within each cohort. All groups had a care manager who monitored the 4- to 6-month multicomponent program of assessments, educational content, and skills training. Caregiver outcome measures included burden, anticipatory grief, depression, family conflict, and a desire to institutionalize the care recipient.
The majority of comparative effectiveness outcomes were not different between caregivers receiving technology interventions versus those receiving telephone-delivered support. This was true for the 68% of caregivers using home Internet and the 32% nonusers, as well as the 53% rural versus 47% urban caregivers. For experienced Internet users, a meaningful difference in the Marwit Grief Inventory was noted for caregivers receiving Internet versus telephone support, particularly for the Isolation Subscale.
This study demonstrates the feasibility and acceptability of using a variety of modalities to deliver caregiver support to a group of largely older, rural, spousal caregivers of veterans with dementia. The potential for reducing isolation for caregivers capable of receiving this intervention through the Internet is a promising finding.
痴呆症的发病率不断上升，包括农村退伍军人中的痴呆症，这突显了接受有效支持的护理人员的改善结果是可能的。然而，在农村地区提供这些复杂的干预措施存在挑战。基于互联网和电话的护理人员支持有可能扩大获得有效支持的机会。
我们为患有痴呆症的退伍军人的护理人员设计了一项多地点干预措施。护理人员根据他们是否使用互联网分为两个队列。然后，每个队列被随机分配到技术或电话提供的支持组中。所有组都有一名护理经理，负责监测为期 4-6 个月的多组分评估、教育内容和技能培训计划。护理人员的结果测量包括负担、预期悲伤、抑郁、家庭冲突和希望将护理接受者送进机构。
在接受技术干预的护理人员与接受电话提供的支持的护理人员之间，大多数比较效果的结果没有差异。这对于使用家庭互联网的 68%的护理人员和不使用的 32%的护理人员以及 53%的农村护理人员和 47%的城市护理人员都是如此。对于经验丰富的互联网用户，接受互联网支持的护理人员在 Marwit 悲伤量表上的差异有意义，特别是在隔离量表上。
这项研究表明，使用各种方式为一组主要是老年、农村、配偶护理人员提供护理人员支持是可行和可接受的。对于能够通过互联网接受这种干预的护理人员来说，减少隔离的潜力是一个有希望的发现。
