Caregivers of dementia patients have a precarious task; in order to keep their family member at home they place themselves at risk of depression, physical illness and social isolation. The high levels of stress involved in caring for a dementia patient and the widespread lack of training in such care can lead to a vicious cycle of ever-increasing health care dependency, first for the patient and secondly for informal caregivers. If a Telephone Support Group is offered to these caregivers—addressing their stress, isolation and education on dementia and its management—will caregivers experience an increase in well-being and a decrease in distress over patient behaviors, which then translate into sustainable informal caregiving and lower healthcare use and overall VHA expenditures for the veteran patient with dementia. A further question concerns whether a successful Telephone Support Group results in lower health costs and reduced use of health services by caregivers. The first objective is to establish the Telephone Support Groups’ effectiveness (improved caregiver general well being and distress about behaviors), then to determine whether Telephone Support results in decreases in VHA health care use and costs for the veteran, and decreased VHA and/or non-VHA use and costs for the caregiver. Our long-term objective is to develop and disseminate the protocol and materials for effective Telephone Support Groups that can be used across the VHA system. This randomized clinical trial of 150 caregivers (Black/African American, White/Caucasian, rural, urban) will compare dementia caregivers participating in Telephone Support Groups to caregivers whose veteran family members with dementia are receiving usual VHA care. Caregivers who are veterans may also be enrolled. In the treatment condition, there will be 13 support groups of 5 to 6 caregivers. Each support group will meet 14 times over a year. The hour calls will be semi-structured with an educational component and a support component, led by a trained Group Leader. Topics will include knowledge of dementia, safety, caregiver health and well being, communication, managing behavioral challenges and caregiver stress and coping. A workshop focusing on the same behavior management and stress topics will be offered to Usual Care caregivers at the end of their participation.

Data (including information on general well-being, caregiver distress, patient function and behaviors, non-VHA health use, and health costs) will be collected in caregivers'''' homes by trained Research Associates at baseline, six and twelve months. VHA health care use and data for the veteran patient will be based on the Patient Treatment File (PTF) and the Outpatient Clinic File (OPC) and costs data will use the Health Economics Resource Center (HERC) Average Cost Data Sets.

Caregiver

• Age: 21 years or older
• Family member of the care recipient
• Must live with care recipient or share cooking facilities
• Must have a telephone
• Must plan to remain in the area for the duration of the intervention and follow-up
• Caregiver role for more than 6 months
• Must provide an average of 4 hours of supervision or direct assistance per day for the care recipient
• Risk Screening Tool: must have a total score of at least 1 for question 36, and a total of at least 2 for questions 38-40 (on the Screening Form)

Care Recipient

• NINCDS (MD diagnosis) or cognitive impairment (raw score on MMSE of 23 or less)
• Must be a Veteran with dementia or being cared for by a Veteran who receives services at the Memphis VAMC