| Sumario: | BACKGROUND: Dementia prevalence and dementia caregiving are increasing. Caregiver burden leads to adverse health outcomes. Behavioral interventions designed to improve adverse health outcomes in caregivers are available. Two of the best-known caregiver interventions with demonstrated efficacy are the Resources for Enhancing Caregiver Health (REACH), and the New York University Caregiver Intervention (NYUCI). The effectiveness of these interventions has never been compared. Thus, caregivers of persons with dementia and caregiver service providers do not know if one intervention is better than the other. In addition, a paucity of data exists on the effectiveness of these interventions in urban Hispanic people, who have a higher risk of dementia caregiving burden compared with non-Hispanic White people. OBJECTIVES: Our primary objective was to compare the effectiveness of the NYUCI to a short adaptation of REACH (REACH-OUT [Offering Useful Treatment]), in improving depressive symptoms and caregiver burden among unpaid Hispanic caregivers of persons with dementia. Our exploratory objectives were to examine outcomes such as stress and physical health, and examine whether sociodemographic characteristics (eg, family position) predicted the comparative effectiveness of the interventions. METHODS: We conducted a 1:1 randomized trial comparing the NYUCI and REACH-OUT in 221 Hispanic unpaid caregivers of persons with dementia. The interventions lasted 6 months. Participants underwent a baseline evaluation before the interventions, and a follow-up assessment after the completion of interventions. All participants received referrals for social work services also. Our primary outcomes were depressive symptoms, measured with the Geriatric Depression Scale (GDS), and caregiver burden, measured with the Zarit Caregiver Burden Scale (ZCBS). We compared changes in outcomes from baseline to follow-up using mixed models with an intent-to-treat approach. RESULTS: The mean age of caregivers was 58 years; 82.8% were women, 63.3% were adult children, and 31.7% were spouses; 110 were randomized to the NYUCI and 111 to REACH-OUT. No differences in pertinent characteristics existed at baseline. For the ZCBS, a net reduction (improvement in burden) of about 5 points (maximum score = 88) occurred in each intervention group (P = .006). Using the model-based estimates, the effect size for REACH-OUT was a 5.18-point reduction (P = .0006) and for the NYUCI a 4.58-point reduction (P = .0022). For the GDS, no significant changes occurred from baseline to follow-up (0.03 points [P = .9529] for REACH-OUT; 0.19 points [P = .6991] for NYUCI). For our exploratory stress outcome (Perceived Stress Scale), a reduction of approximately 2 points (maximum score = 40) occurred in each group (P = .0296). The reduction of the ZCBS within spouse and child subgroups was significant among spouse caregivers (8.00 points, P = .0047 for REACH-OUT; 9.44, P = .0010 for NYUCI), but not among children (3.23, P = .0765 for REACH-OUT; 2.11, P = .2163 for NYUCI). The reduction of the ZCBS was also greater among persons aged 58 years and older than among persons less than 58 years old. Most persons younger than 58 years were adult children. CONCLUSIONS: No differences in the effectiveness for REACH-OUT and the NYUCI existed for any outcome. Both REACH-OUT and the NYUCI were effective in reducing burden and stress, but not depressive symptoms. Subgroup analyses suggest that the effect on burden was significant only among spouse caregivers.
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