Randomized controlled trial of a telephone-delivered intervention (FITT-Caregiver) for dementia caregivers

Abstract

Dementia caregivers are at heightened risk for mental and physical health problems. Multi-component interventions are effective in reducing distress in dementia caregivers, although cost and accessibility are potential barriers to broad implementation of these interventions. We developed the Family Intervention: Telephone Tracking - Caregiver (FITT-C), which is entirely telephone delivered. The aim of the current study was to examine the efficacy of the FITT-C intervention for reducing distress in a large sample of dementia caregivers. Participants were 237 (M age = 62.82, SD = 13.10; 78% female; 95% Caucasian) distressed informal caregivers of individuals with dementia who were randomly assigned to receive the FITT-C or Telephone Support (TS). Participants in both treatments received a resource packet containing educational materials about dementia and local services/resources. Both groups received 16 telephone contacts from a trained master's level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem-solving, and other active therapeutic approaches based on assessment of key areas for caregivers (mood, family functioning, social support, health) and the care recipient (mood, behavior, cognition, health). TS provided non-directive therapeutic strategies (venting, reflective listening, validation). Primary outcomes were measured at baseline and immediately post-treatment and included depression (Centers for Epidemiologic Studies - Depression), burden (Zarit Burden Interview), reaction to memory and behavior problems (Revised Memory and Behavior Problem Checklist). Secondary outcomes were self-efficacy (Self Efficacy Questionnaire) and health related quality of life (EQ-5D). Overall attrition rate was 15.6%, with no significant difference between treatments. Repeated measures analysis revealed that individuals receiving the FITT-C (n =106) showed significantly improved depression (p=.002; Cohen's d = .45) and borderline significantly improved self-efficacy (p = .051; d =.28) at end of treatment compared to individuals receiving TS (n= 94). There were no treatment differences for reaction to problems, burden, or health-related QOL. An entirely telephone delivered intervention shows specific efficacy for reducing depression and improving self-efficacy in distressed dementia caregivers. The inclusion of a rigorous active comparison group argues against improvements due to nonspecific effects of attention or contact time. Findings provide promising evidence to consider translational initiatives to promote broad implementation of the intervention.