Family Care as Collaboration: Effectiveness of a Multicomponent Support Program for Elderly Couples with Dementia. Randomized Controlled Intervention Study

Authors

  • Ulla Eloniemi-Sulkava PhD, MSN,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Marja Saarenheimo PhD,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Marja-Liisa Laakkonen PhD,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Minna Pietilä PhD,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Niina Savikko PhD,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Hannu Kautiainen BA,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • Reijo S. Tilvis PhD, MD,

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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  • and , Kaisu H. Pitkälä PhD, MD

    1. From the *Central Union for the Welfare of the Aged, Helsinki, FinlandHelsinki Health Centre, Laakso Hospital, Helsinki, FinlandRheumatism Foundation Hospital, Heinola, Finland; Clinics of §Internal MedicineGeriatrics, Helsinki University Hospital, Helsinki, Finland#Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland**Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
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Address correspondence to Ulla Eloniemi-Sulkava, The Central Union for the Welfare of the Aged, Malmin kauppatie 26, FIN-00700 Helsinki. E-mail: ulla.eloniemi-sulkava@vtkl.fi

Abstract

OBJECTIVES: To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services.

DESIGN: Randomized controlled trial.

SETTING: Community-dwelling couples with one spouse caring for the other spouse with dementia.

PARTICIPANTS: Couples with dementia (N=125) were allocated at random to the intervention (n=63) or control group (n=62).

INTERVENTION: Intervention couples were provided with a multicomponent intervention program with a family care coordinator, a geriatrician, support groups for caregivers, and individualized services.

MEASUREMENTS: Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples.

RESULTS: At 1.6 years, a larger proportion in the control group than in the intervention group was in long-term institutional care (25.8% vs 11.1%, P=.03). At 2 years, the difference was no longer statistically significant. The 2-year adjusted hazard ratio for the intervention group was 0.53 (95% confidence interval (CI)=0.23–1.19, P=.12). Intervention led to reduction in use of community services and expenditures. The difference for the benefit of intervention group was −7,985 Euro (95% CI=−16,081 to −1,499, P=.03). When the intervention costs were included, the differences between the groups were not significant.

CONCLUSION: Although the intervention did not result in a significant difference in the need for institutional care after 2 years, individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services.

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