The effects of counseling spouse caregivers of people with Alzheimer disease taking donepezil and of country of residence on rates of admission to nursing homes and mortality.

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Abstract

OBJECTIVE: Does psychosocial intervention for caregivers whose spouses with Alzheimer disease (AD) are taking donepezil delay nursing home (NH) placement or death of patients? DESIGN: Randomized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up (mean: 5.4 years, SD: 2.4). SETTING: Outpatients of research clinics in Australia, the United Kingdom, and the United States. PARTICIPANTS: One hundred and fifty-five persons with AD and their spouses. INTERVENTION: Five sessions of individual and family counseling (+ prn ad hoc counseling) or usual care. MEASUREMENTS: Time to institutionalization and death using Cox proportional hazards methods. RESULTS: Over a mean of 5.4 years (SD: 2.4), there were no differences in NH placement or mortality by intervention group, but there were by country, with Australian patients admitted to NHs earlier than U.S. than U.K. patients. CONCLUSION: Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care, NH systems, availability, and affordability.

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