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a University Center for Social and Urban Research, University of Pittsburgh, PA
b Department of Psychiatry, University of Pittsburgh, PA
c Center on Adult Development and Aging, University of Miami, FL
d Texas A&M University, College Station
e Graduate School of Public Health, University of Pittsburgh, PA
f Applied Gerontology Program, University of Alabama at Tuscaloosa
g Community and Homecare Research Division, Thomas Jefferson University, Philadelphia, PA
h Goldman Research Center, Goldman Institute on Aging, San Francisco, CA
i Veterans Affairs Medical Center, Memphis, TN
j Veterans Affairs Medical Center, Department of Psychiatry, Stanford University School of Medicine, Menlo Park, CA
k Division of Gerontology/Geriatric Medicine, School of Medicine, University of Alabama at Birmingham
Correspondence: Richard Schulz, PhD, 121 University Place, University of Pittsburgh, Pittsburgh, PA 15260. E-mail: schulz{at}pitt.edu.
Decision Editor: Laurence G. Branch, PhD
Purpose: We reviewed intervention studies that reported dementia caregiver outcomes published since 1996, including psychosocial interventions for caregivers and environmental and pharmacological interventions for care recipients. Our goal was to focus on issues of clinical significance in caregiver intervention research in order to move the field toward a greater emphasis on achieving reliable and clinically meaningful outcomes. Design and Methods: MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health databases from 1996 through 2001 were searched to identify articles and book chapters mapping to two medical subject headings: caregivers and either dementia or Alzheimer's disease. Articles were evaluated on two dimensions, outcomes in four domains thought to be important to the individual or society and the magnitude of reported effects for these outcomes in order to determine if they were large enough to be clinically meaningful. Results: Although many studies have reported small to moderate statistically significant effects on a broad range of outcomes, only a small proportion of these studies achieved clinically meaningful outcomes. Nevertheless, caregiving intervention studies have increasingly shown promise of affecting important public health outcomes in areas such as service utilization, including delayed institutionalization; psychiatric symptomatology, including the successful treatment of major and minor depression; and providing services that are highly valued by caregivers. Implications: Assessment of clinical significance in addition to statistical significance is needed in this research area. Specific recommendations on design, measurement, and conceptual issues are made to enhance the clinical significance of future research.
Key Words: Alzheimer's disease • Randomized clinical trials • Intervention research
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