Caregiver Support Groups Lowered Care Costs for Veterans with Dementia Short-term; Savings Lost by 12 months

BUFFALO, N.Y. – A telephone-based group education and support intervention provided to spouses of veterans with mild to severe dementia saved an average of $2,768 per patient over six months compared to "usual care," a study conducted by a University at Buffalo researcher has show.

However, those savings dissipated during the following six months and by the one-year assessment the savings were lost.

The study appears in a recent issue of The Gerontologist. http://gerontologist.oxfordjournals.org/content/50/5/623.full. It is thought to be the first to examine the effects of caregiver telephone education and support groups on total VA health care costs for veterans with dementia.

Laura O. Wray, PhD, UB clinical assistant professor of medicine and director of education at the VA Center for Integrated Healthcare, is first author on the study.

"The goal of this study was to examine the effects of the Telehealth Education Program (TEP) on the use of health care by the dementia patients and the overall costs following caregiver training," says Wray.

"We hypoth¬esized that veterans whose caregivers participated in TEP would use less health care services while receiving excellent care, which would reduce health care costs compared to the costs of those receiving usual care (UC)," she says. Usual care was defined as receiving all the usual VA services.

The study involved 158 couples from across upstate New York who were assigned randomly to receive either TEP or UC. Eighty-three couples participated in the intervention and 75 couples received usual care.

The TEP content addressed four major areas that can be problematic for caregivers who want to take care of their spouses or partners with dementia at home: verbal and nonverbal communication; effective structuring of caregiver-patient interactions; managing challenging behavior problems; and assessing resources and planning for the future.

Four trained group leaders with geriatrics experience led the TEP groups through 10 weekly interactive one-hour telephone meetings. Participants received information about dementia and its symptoms, resources to address these symptoms, care-giving skills, and relaxation and self-care skills. Participants also helped each other solve difficult problems and provided group support.

Assessment of the program found that in the first six months, TEP resulted in a significant decrease in the overall cost of care for the veterans compared to those in usual care, but at the one-year assessment those savings had been eliminated.

Wray says the findings may have been different if support programs had continued, based on results of similar support programs.

"It's possible that the TEP cost savings could be maintained if there had been follow-up meetings or periodic care management calls to the caregivers," notes Wray. "We need to do further work to determine if this is the case."

Additional authors on the paper are Mollie D. Shulan, MD, and Kurt E. Freeman from Stratton VA Medical Center in Albany, NY; Ronald W. Toseland, PhD, from SUNY Albany; Bob Edward Vasquez, PhD, from Texas State University-San Marcos; and Jian Gao, PhD, from the Department of Veterans Affairs in Albany, NY.

The research was supported by the VA Health Services Research and Development Service.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.