Nursing outcomes for evaluations of caregiver outcomes in a rural Alzheimer demonstration project

PURPOSE To evaluate the effectiveness of the interventions of nurse care managers in the care of family members of people with dementia. METHODS Data were collected as part of a 3-year Administration on Aging–funded Alzheimer Demonstration Project to provide expanded in-home services to rural Iowans affected by Alzheimer disease and related disorders in 8 rural Iowa counties—randomly selected to have a nurse care manager and 4 designated control counties that had traditional case management service. Nurse care managers were trained in the care of people with dementia and their caregivers, the use of role transition theory, and the Progressively Lowered Stress Threshold model of care to provide and coordinate services for enrollees. All referred people with cognitive impairment and their families in the 8 study counties were eligible for inclusion. Three selected NOC outcomes were tested in clinical settings. Interrater reliability for the outcomes was good (87%–95%). The construct validity of Caregiver Stressors Outcome was .74 when correlated with the Caregiver Stress Index. FINDINGS Of the 142 subjects with cognitive impairment enrolled within the first year of the grant, 113 had a caregiver. The outcomes were used to evaluate differences in caregiver outcomes at baseline and at 6-month intervals. The majority of caregivers at follow-up was female and had been providing care for ≥5 years. For each of the outcomes the majority of caregivers had improved scores, with only 2–4 caregivers getting scores indicating worsening conditions or remaining the same. CONCLUSIONS Preliminary analysis shows a trend of improved outcomes with the use of a nurse care manager. The NOC caregiver outcomes showed good variability among caregivers at baseline, with caregiver responses distributed throughout the scales. The NOC outcomes also provide guidance for interventions of the nurse care managers. Further evaluation of the outcomes is needed, including examining the relationships of placement, health status, and service use of each outcome. The caregiver outcomes offer an effective and efficient means to evaluate services delivered to caregivers of people with dementia.