TOPIC: ALZHEIMER'S PATIENTS

Keeping Alzheimer's Patients in Home Program comparison

Keeping Alzheimer's Patients in Home Program comparison

1. Introduction

All health services are confronted with the difficulty of caring for the older people suffering from senile dementia of the Alzheimer type and related disorders. This disease has a severe impact on the patient, who gradually loses cognitive and functional ability, but also on the family and friends involved in care. Alzheimer's disease brings about very stressful situations for informal caregivers, whose quality of life deteriorates along with their health. In a consensus statement of the American Association for Geriatrics. it is considered that half of the caregivers experience depression. A lot of publications underline how heavy the consequences of this disease are for the caregivers in terms of quality of life, frequency of diseases and increasing mortality. This situation has led medical, social and administrative professionals to look for more suitable methods of caring. Experiments concerning architectural conversion of institutions, as well as of caring methods, have been carried out during the past 15 years. At the same time, caring concepts have evolved. Programs now aim to take into account both the patient and the informal caregiver in the caring process. In particular, the theory according to which burden of the informal caregiver is positively linked to the well being of the patient has progressed.

Further to an action from the European Union Commission DGV, a survey on the 'condition of caregivers of patients with dementia of the Alzheimer type in eight European countries' was devised. In this article, the work burden and health of the primary informal caregivers (or referents) of patients cared for in five different existing programs in Europe are analysed.

2. Population and methods

The first phase of the research allowed us to identify, in eight European countries, those programs which take into account the patient and the informal caregiver, and to place them in their public health and social policy context. The 20 experiments listed were classified into five different categories representing the main alternative existing methods of caring for patients with their informal caregivers: (1) assistance in the framework of Home social service, (2) daily relief for caregivers, through Day centres, (3) follow-up by specialized medical centres (Expert centres), (4) special community housing (Group-living, Cantou) and (5) Respite hospitalization ( Table 1). One or two centres were selected in each category by the scientific committee, to be included into the second phase of the study.

Table 1. Description of the care programs included in the survey

In each of the selected centres, we conducted a survey on the informal caregivers. Considering that the proportion of depressed caregivers of Alzheimer's disease patients is estimated at 50%. the number of 50 subjects was chosen in order to detect a fall of 50% in the caregiver's burden indicators (with a probability of 95%; one side test; three controls for one tested). The protocol included the following specifications: (i) eligible patients must be 55 years old or over, their Mini Mental Status Examination (MMS) had ...