111-113 In a 17-year longitudinal study of 406 spousal caregivers, an intervention program involving individual and family counseling, encouragement of support group participation and availability of ad-hoc telephone counseling was found to significantly delay time to nursing home placement by a median of 1.5 years.101 The intervention was also successful at improving caregiver wellbeing, as demonstrated Inhibitors,research,lifescience,medical by fewer symptoms of depression, improved reaction to memory and behavior

problems and greater satisfaction with support networks.101 Other studies have demonstrated up to 9 months’ delay in institutionalization.114,115 Interventions that were flexible, varied, and involved follow-up and an ongoing relationship between helper and caregiver were considered key to delaying nursing home placement.102 External factors may impinge on Inhibitors,research,lifescience,medical the efficacy of interventions. A randomized controlled trial of five sessions of family counseling conducted in Manchester, New York, and Sydney did not increase time to nursing

home placement across the whole sample compared Inhibitors,research,lifescience,medical with usual care, but did so at the Australian site. Possible reasons are differences in aged care systems and financial disincentives to institutionalization, and differences in the amount of counseling provided (more ad hoc counseling was provided in Sydney).116 Pinquart and Sorenson40 identified that multicomponent interventions were more likely delay time to nursing home placement. However, in the REACH trial, despite other positive outcomes, institutionalization of care recipients did not statistically significantly differ between the control and intervention groups.110 Recently, Inhibitors,research,lifescience,medical researchers have begun to examine the effectiveness of technology-based interventions for caregivers using computers,

telephones, e-mail, and the Internet to provide support and information to informal caregivers. Interventions include conference calling Inhibitors,research,lifescience,medical among familymembers of dementia patients; telephone support systems with automated messages; stress monitoring and advice; respite calls for care recipients; online discussion groups; electronic reminder services; computer based forums and question and answer sessions (Internet and non-Internet based networks); e-mail; electronic encyclopedias and libraries; and computer-based decision support modules.26,117 Eisdorfer and colleagues118 found that having access to technology-based interventions of resulted in a decrease in depression at 6 and 18 this website months for both white and Cuban- Americans compared with more traditional forms of support only. In a review of 15 papers describing five technology-based interventions for dementia caregivers, despite inconsistent outcomes and small studies, there were moderate effects on improving caregiver stress and depression.117 The obvious benefit of such interventions is that they can usually be accessed at all times of the day and night, at the caregiver’s convenience. Further research in this area would prove useful.