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

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. (Am J Geriatr Psychiatry 2009; 17: 734-743)