Psychosocial Interventions to Address the Emotional Needs of Caregivers of Individuals with Alzheimer’s Disease

Part of the Caregiving: Research • Practice • Policy book series (CARE)


Alzheimer’s disease (AD) poses unique difficulties for many families. The time from the onset of symptoms of the illness to death is typically 5–15 years. The person with the illness experiences increasing cognitive and functional impairments, and ultimately becomes entirely dependent on others for survival. While it is possible to describe the symptoms that generally accompany the disease as it progresses, it is not possible to predict when or if a specific symptom will arise in any individual, or how long it will be before the symptom disappears as the severity of the illness increases.


Psychosocial Intervention Family Caregiver Nursing Home Placement Caregiver Strain Spouse Caregiver 
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  1. Alspaugh, M. E. L., Stephens, M. A. P., Townsend, A. L., Zarit, S. H., & Greene, R. (1999). Longitudinal patterns of risk for depression in dementia caregivers: Objective and subjective primary stress as predictors. Psychology and Aging, 14, 34–43.PubMedCrossRefGoogle Scholar
  2. Baker, K. L., & Robertson, N. (2008). Coping with caring for someone with dementia: Reviewing the literature about men. Aging & Mental Health, 12(4), 413–422.CrossRefGoogle Scholar
  3. Baumgarten, M., Battista, R. N., Infante-Rivard, C., Hanley, J. A., Becker, R., & Gauthier, S. (1992). The psychological and physical health of family members caring for an elderly person with dementia. Journal of Clinical Epidemiology, 45, 61–70.PubMedCrossRefGoogle Scholar
  4. Belle, S. H., Burgio, L., Burns, R., Coon, D., Czaja, S. C., Gallagher-Thompson, D., et al. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, 145, 727–738.PubMedGoogle Scholar
  5. Bodnar, J. C., & Kiecolt-Glaser, J. K. (1994). Caregiver depression after bereavement: Chronic stress isn’t over when it’s over. Psychology and Aging, 9(3), 372–380.PubMedCrossRefGoogle Scholar
  6. Bookwala, J., & Schulz, R. (1998). The role of neuroticism and mastery in spouse-caregivers’ assessment of and response to a contextual stressor. Journal of Gerontology: Psychological Sciences, 53B, P155–P164.CrossRefGoogle Scholar
  7. Bourgeois, M. S., Schulz, R., & Burgio, L. (1996). Interventions for caregivers of patients with Alzheimer’s disease: A review and analysis of content, process, and outcomes. International Journal of Aging & Human Development, 43(1), 35–92.CrossRefGoogle Scholar
  8. Brink, T. L., Yesavage, J. A., Owen, L., Heersema, P. H., Adey, M., & Rose, T. L. (1982). Screening tests for geriatric depression. Clinical Gerontology, 1, 37–43.CrossRefGoogle Scholar
  9. Brodaty, H., & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), 217–228.PubMedGoogle Scholar
  10. Brodaty, H., & Gresham, M. (1989). Effect of a training programme to reduce stress in carers of patients with dementia. British Medical Journal, 299, 1375–1379.PubMedCrossRefGoogle Scholar
  11. Brodaty, H., McGilchrist, C., Harris, L., & Peters, K. (1993). Time until institutionalization and death in dementia patients: Role of caregiver training and risk factors. Archives of Neurology, 50, 643–650.PubMedCrossRefGoogle Scholar
  12. Chappell, N. L., & Penning, M. (1996). Behavioural problems and distress among caregivers of people with dementia. Ageing and Society, 16, 57–73.CrossRefGoogle Scholar
  13. Clyburn, L. D., Stones, M. J., Hadjistavropoulos, T., & Tuokko, H. (2000). Predicting caregiver burden and depression in Alzheimer’s disease. Journals of Gerontology, 55B, S2–S13.Google Scholar
  14. Coehlo, D. P., Hooker, K., & Bowman, S. (2007). Institutional placement of persons with dementia: What predicts occurrence and timing? Journal of Family Nursing, 13(2), 253–277.PubMedCrossRefGoogle Scholar
  15. Cohen, C. A., Gold, D. P., Shulman, K. I., Wortley, J. T., McDonald, G., & Wargon, M. (1993). Factors determining the decision to institutionalize dementing individuals: A prospective study. The Gerontologist, 33, 714–720.PubMedCrossRefGoogle Scholar
  16. Connell, C. M., & Gibson, G. D. (1997). Racial, ethnic, and cultural differences in dementia caregiving: Review and analysis. The Gerontologist, 37, 355–364.PubMedCrossRefGoogle Scholar
  17. Cooke, D. D., McNally, L., Mulligan, K. T., Harrison, M. J. G., & Newman, S. P. (2001). Psychosocial interventions for caregivers of people with dementia: A systematic review. Aging & Mental Health, 5, 120–135.CrossRefGoogle Scholar
  18. Costa, P. T., & McCrae, R. R. (1985). Hypochondriasis, neuroticism, and aging. The American Psychologist, 40, 19–28.PubMedCrossRefGoogle Scholar
  19. Costa, P. T., & McCrae, R. R. (1992). Revised NEO Personality Inventory and NEO Five Factor Inventory professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  20. Croog, S. H., Sudilovsky, A., Burleson, J. A., & Baume, R. M. (2001). Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors. Alzheimer Disease and Associated Disorders, 15, 201–210.PubMedCrossRefGoogle Scholar
  21. Cuijpers, P. (2005). Depressive disorders in caregivers of dementia patients: A systematic review. Aging & Mental Health, 9, 325–330.CrossRefGoogle Scholar
  22. Danhauer, S. C., McCann, J. J., Gilley, D. W., Beckett, L. A., Bienias, J. L., & Evans, D. A. (2004). Do behavioral disturbances in persons with Alzheimer’s disease predict caregiver depression over time? Psychology and Aging, 19(1), 198–202.PubMedCrossRefGoogle Scholar
  23. Donaldson, C., Tarrier, N., & Burns, A. (1998). Determinants of carer stress in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 13(4), 248–256.PubMedCrossRefGoogle Scholar
  24. Drentea, P., Clay, O. J., Roth, D. L., & Mittelman, M. S. (2006). Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer’s disease. Social Science & Medicine, 63, 957–967.CrossRefGoogle Scholar
  25. Dura, J. R., Stukenberg, K. W., & Kiecolt-Glaser, J. K. (1990). Chronic stress and depressive disorders in older adults. Journal of Abnormal Psychology, 3, 284–290.CrossRefGoogle Scholar
  26. Fisher, L., & Lieberman, M. A. (1999). A longitudinal study of predictors of nursing home placement for patients with dementia: The contribution of family characteristics. The Gerontologist, 39(6), 677–686.PubMedCrossRefGoogle Scholar
  27. Gallagher, D., Ni Mhaolain, A., Crosby, L., Ryan, D., Lacey, L., Coen, R. F., et al. (2011). Self-efficacy for managing dementia may protect against burden and depression in Alzheimer’s caregivers. Aging & Mental Health, 15(6), 663–670.CrossRefGoogle Scholar
  28. Gallagher-Thompson, D., & Steffen, A. M. (1994). Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. Journal of Consulting and Clinical Psychology, 62, 543–549.PubMedCrossRefGoogle Scholar
  29. Gallicchio, L., Siddiqi, N., Langenberg, P., & Baumgarten, M. (2002). Gender differences in burden and depression among informal caregivers of demented elders in the community. International Journal of Geriatric Psychiatry, 17(2), 154–163.PubMedCrossRefGoogle Scholar
  30. Gaugler, J. G., Roth, D. L., Haley, W. E., & Mittelman, M. S. (2008). Can counseling and support reduce Alzheimer’s caregivers’ burden and depressive symptoms during the transition to institutionalization? Results from the NYU Intervention Study. Journal of the American Geriatrics Society, 56, 421–442.PubMedCrossRefGoogle Scholar
  31. George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: A multidimensional examination of family caregivers of demented adults. The Gerontologist, 26, 253–259.PubMedCrossRefGoogle Scholar
  32. Goldberg, D. G. (1978). Manual of the General Health Questionnaire. Windsor: NFER Publishing.Google Scholar
  33. Haley, W. E., Bergman, E. J., Roth, D. L., McVie, T., Gaugler, J. E., & Mittelman, M. S. (2008). Long-term effects of bereavement and caregiver intervention on dementia caregiver depressive symptoms. The Gerontologist, 48, 732–740.PubMedCrossRefGoogle Scholar
  34. Haley, W. E., Levine, E. G., Brown, S. L., & Bartolucci, A. A. (1987). Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers. Psychology and Aging, 2, 323–330.PubMedCrossRefGoogle Scholar
  35. Haley, W. E., Roth, D. L., Howard, G., & Stafford, M. M. (2010). Caregiving strain estimated risk for stroke and coronary heart disease among spouse caregivers: Differential effects by race and sex. Stroke, 41, 331–336.PubMedCrossRefGoogle Scholar
  36. Harmell, A. L., Chattillion, E. A., Roepke, S. K., & Mausbach, B. T. (2011). A review of the psychobiology of dementia caregiving: A focus on resilience factors. Current Psychiatry Reports, 13(3), 219–224.PubMedCrossRefGoogle Scholar
  37. Hepburn, K. W., Tornatore, J., Center, B., & Ostwald, S. W. (2001). Dementia family caregiver training: Affecting beliefs about caregiving and caregiver outcomes. Journal of the American Geriatrics Society, 49, 450–457.PubMedCrossRefGoogle Scholar
  38. Hilgeman, M. M., Durkin, D. W., Sun, F., DeCoster, J., Allen, R. S., Gallagher-Thompson, D., et al. (2009). Testing a theoretical model of the stress process in Alzheimer’s caregivers with race as a moderator. The Gerontologist, 49, P248–P261.CrossRefGoogle Scholar
  39. Hooker, K., Manoogian-O’Dell, M., Monahan, D. J., Frazier, L. D., & Shifren, K. (2000). Does type of disease matter? Gender differences among Alzheimer’s and Parkinson’s disease spouse caregivers. The Gerontologist, 40, 568–573.PubMedCrossRefGoogle Scholar
  40. Hooker, K., Monahan, D. J., Bowman, S. R., Fraizer, L. D., & Shifren, K. (1998). Personality counts for a lot: Predictors of mental and physical health of spouse caregivers in two disease groups. Journal of Gerontology: Psychological Sciences, 53B, P73–P85.CrossRefGoogle Scholar
  41. Jang, Y., Clay, O. J., Roth, D. L., Haley, W. E., & Mittelman, M. S. (2004). Neuroticism and longitudinal change in caregiver depression: Impact of a spouse-caregiver intervention program. The Gerontologist, 44(3), 311–317.PubMedCrossRefGoogle Scholar
  42. Kennet, J., Burgio, L., & Schulz, R. (2000). Interventions for in-home caregivers: A review of research 1990 to present. In R. Schulz (Ed.), Handbook of dementia caregiving: Evidence-based interventions for family caregivers (pp. 61–125). New York: Springer.Google Scholar
  43. Lawton, M. P., Moss, M., Kleban, M. H., Glicksman, A., & Rovine, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. Journals of Gerontology: Series B, Psychological Sciences & Social Sciences, 46, 181–189.Google Scholar
  44. Lazarus, R. S., & Folkman, J. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  45. Livingston, G., Manela, M., & Katona, C. (1996). Depression and other psychiatric morbidity in carers of elderly people living at home. British Medical Journal, 312, 153–156.PubMedCrossRefGoogle Scholar
  46. Lyons, K. S., Zarit, S. H., Sayer, A. G., & Whitlach, C. J. (2002). Caregiving as a dyadic process: Perspectives from caregiver and care receiver. Journals of Gerontology: Series B, Psychological Sciences & Social Sciences, 57B, 195–204.CrossRefGoogle Scholar
  47. Marriott, A., Donaldson, C., Tarrier, N., & Burns, A. (2000). Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer’s disease. The British Journal of Psychiatry, 176, 557–562.PubMedCrossRefGoogle Scholar
  48. Mittelman, M. S., Epstein, C., & Pierzchala, A. (2003). Counseling the Alzheimer’s caregiver: A resource for health care professionals. Chicago, IL: AMA Press.Google Scholar
  49. Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., Ambinder, A., & Mackell, J. A. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist, 35, 792–802.PubMedCrossRefGoogle Scholar
  50. Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer disease: A randomized controlled trial. Journal of the American Medical Association, 276, 1725–1731.PubMedCrossRefGoogle Scholar
  51. Mittelman, M. S., Ferris, S. H., Steinberg, G., Shulman, E., Mackell, J. A., & Ambinder, A. (1993). An intervention that delays institutionalization of Alzheimer’s disease patients: Treatment of spouse-caregivers. The Gerontologist, 33, 730–740.PubMedCrossRefGoogle Scholar
  52. Mittelman, M. S., Haley, W. E., Clay, O., & Roth, D. L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67, 1592–1599.PubMedCrossRefGoogle Scholar
  53. Mittelman, M. S., Roth, D. L., Clay, O. J., & Haley, W. E. (2007). Preserving health of Alzheimer’s caregivers: Impact of a spouse caregiver intervention. The American Journal of Geriatric Psychiatry, 15, 780–789.PubMedCrossRefGoogle Scholar
  54. Mittelman, M. S., Roth, D. L., Coon, D. W., & Haley, W. E. (2004). Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disease. The American Journal of Psychiatry, 161, 850–856.PubMedCrossRefGoogle Scholar
  55. Mittelman, M. S., Roth, D. L., Haley, W. E., & Zarit, S. (2004). Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s disease: Results of a randomized trial. Journals of Gerontology: Series B, Psychological Sciences & Social Sciences, 59B, 27–34.CrossRefGoogle Scholar
  56. Ory, M. G., Hoffman, R. R., III, Yee, J. L., Tennstedt, S., & Schulz, R. (1999). Prevalence and impact of caregiving: A detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39, 177–185.PubMedCrossRefGoogle Scholar
  57. Pearlin, L. I., Mullin, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594.PubMedCrossRefGoogle Scholar
  58. Pinquart, M., & Sörensen, S. (2003a). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58, 112–128.CrossRefGoogle Scholar
  59. Pinquart, M., & Sörensen, S. (2003b). Differences between caregivers and noncaregivers in psychological health and physical health: A metaanalysis. Psychology and Aging, 18(2), 250–267.PubMedCrossRefGoogle Scholar
  60. Pinquart, M., & Sörensen, S. (2006). Helping caregivers of persons with dementia: Which interventions work and how large are their effects? International Psychogeriatrics, 18(4), 577–595.PubMedCrossRefGoogle Scholar
  61. Pruchno, R. A., & Resch, N. L. (1989). Husbands and wives as caregivers: Antecedents of depression and burden. The Gerontologist, 29, 159–164.PubMedCrossRefGoogle Scholar
  62. Redinbaugh, E. M., MacCallum, R. C., & Kiecolt-Glaser, J. K. (1995). Recurrent syndromal depression in caregivers. Psychology and Aging, 10, 358–368.PubMedCrossRefGoogle Scholar
  63. Roth, D. R., Mittelman, M. S., Clay, O. J., Madan, A., & Haley, W. E. (2005). Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer’s disease. Psychology and Aging, 20(4), 634–644.PubMedCrossRefGoogle Scholar
  64. Rudd, M. G., Viney, L. L., & Preston, C. A. (1999). The grief experienced by spousal caregivers of dementia patients: The role of place of care of patient and gender of caregiver. International Journal of Aging & Human Development, 48, 217–240.CrossRefGoogle Scholar
  65. Sayegh, P., & Knight, B. G. (2011). The effects of familism and cultural justification on the mental and physical health of family caregivers. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 66(1), 3–14.PubMedCrossRefGoogle Scholar
  66. Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The caregiver health effects study. Journal of the American Medical Association, 282, 2215–2219.PubMedCrossRefGoogle Scholar
  67. Schulz, R., Gallagher-Thompson, D., Haley, W., & Czaja, S. (2000). Understanding the interventions process: A theoretical/conceptual framework for intervention approaches to caregiving. In R. Schulz (Ed.), Handbook of dementia caregiving: Evidence-based interventions for family caregivers (pp. 33–60). New York: Springer.Google Scholar
  68. Schulz, R., O’Brien, A., Czaja, S., Ory, M., Norris, R., Martire, L. M., et al. (2002). Dementia caregiver intervention research: In search of clinical significance. The Gerontologist, 42, 589–602.PubMedCrossRefGoogle Scholar
  69. Schulz, R., O’Brien, A. T., Bookwala, J., & Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. The Gerontologist, 35, 771–791.PubMedCrossRefGoogle Scholar
  70. Schulz, R., Visintainer, P., & Williamson, G. M. (1990). Psychiatric and physical morbidity effects of caregiving. Journals of Gerontology: Series B, Psychological Sciences & Social Sciences, 45(5), 181–191.Google Scholar
  71. Schulz, R., & Williamson, G. M. (1991). A two-year longitudinal study of depression among Alzheimer’s caregivers. Psychology and Aging, 6, 569–578.PubMedCrossRefGoogle Scholar
  72. Skaff, M. M., Pearlin, L. I., & Mullan, J. T. (1996). Transitions in the caregiving career: Effects on sense of mastery. Psychology and Aging, 11, 247–257.PubMedCrossRefGoogle Scholar
  73. Smith, G. R., Williamson, G. M., Miller, L. S., & Schulz, R. (2011). Depression and quality of informal care: A longitudinal investigation of caregiving stressors. Psychology and Aging, 26(3), 584–591.PubMedCrossRefGoogle Scholar
  74. Sorensen, S., Duberstein, P., Gill, D., & Pinquart, M. (2006). Dementia care: Mental health effects, intervention strategies, and clinical implications. Lancet Neurology, 5(11), 961–973.PubMedCrossRefGoogle Scholar
  75. Sorensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. The Gerontologist, 42, 356–372.PubMedCrossRefGoogle Scholar
  76. Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. H., & Vitaliano, P. (1992). Assessment of behavior problems in dementia: The revised Memory and Behavior Problems Checklist. Psychology and Aging, 7, 622–631.PubMedCrossRefGoogle Scholar
  77. Vitaliano, P. P., Scanlon, Z., & Zhang, H. M. (2003). Is caregiving hazardous to one’s physical health? A meta-analysis. Psychological Bulletin, 6, 946–972.CrossRefGoogle Scholar
  78. Weimer, D. L., & Sager, M. A. (2009). Early identification and treatment of Alzheimer’s disease: Social and fiscal outcomes. Alzheimer’s & Dementia, 5, 215–226.CrossRefGoogle Scholar
  79. Whitlatch, C. J., Feinberg, L. F., & Stevens, E. J. (1999). Predictors of institutionalization for persons with Alzheimer’s disease and the impact on family caregivers. Journal of Mental Health and Aging, 5(3), 275–288.Google Scholar
  80. Whitlatch, C. J., Schur, D., Noelker, L. S., Ejaz, F. K., & Looman, W. J. (2001). The stress process of family caregiving in institutional settings. The Gerontologist, 41, 462–473.PubMedCrossRefGoogle Scholar
  81. Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K., Dane, K., et al. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. Journal of the American Medical Association, 287(16), 2090–2097.PubMedCrossRefGoogle Scholar
  82. Zarit, S. H., Orr, N. K., & Zarit, J. M. (1985). Families under stress: Caring for the patient with Alzheimer’s disease and related disorders. New York: New York University Press.Google Scholar
  83. Zarit, S. H., Todd, P. A., & Zarit, J. M. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. The Gerontologist, 17, 361–367.Google Scholar
  84. Zarit, S. H., & Whitlatch, C. J. (1993). The effects of placement in nursing homes on family caregivers: Short and long term consequences. Irish Journal of Psychology, 14(1), 25–37.CrossRefGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Comprehensive Center on Brain Aging, NYU Langone Medical CenterNew YorkUSA

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