Caregiver Interventions Reduce Negative Appraisals by Caregivers dealing with the Problem Behaviors of Family Members with Alzheimer’s Disease

by Barbara Riley-Baker, BA, MA, CMC, C.P.G.


In this study by Mittelman, Roth, Haley and Zarit, (2004) it was found that a caregiver’s negative appraisal of the problem behaviors exhibited by patients with Alzheimer’s Disease could be reduced by interventions such as counseling, social support and education. The decrease in the caregiver’s reaction ratings can not only reduce stress for the caregiver but can delay placement in a nursing home for the patient.

Behavior problems such as agitation, depression, wandering, and incontinence are the leading cause for nursing home placement for patients with Alzheimer’s disease. Caregivers who can longer cope caring for a loved one at home often turn to long term care facilities for relief. Caregiver appraisal of these difficult behaviors and positive interventions to reduce perceived stress were the subject of this study.

In this report, 406 spouses and caregivers were evaluated using the process theory.  The process theory is based on subjective rather than objective reports of events. Caregiver reactions to stressful events vary. Caregiver reactions to negative behaviors result in stress. How the caregiver appraises the situation is relative to their level of stress.

The process theory was used to establish and assess caregiver interventions on caregiver appraisal of negative behaviors and or a decrease in the frequency of such behaviors by increasing social support, education and other resources to the caregiver.

Treatment consisted of individual and family counseling sessions based on the needs of each caregiver. Learning skills for the management of behaviors, education about the disease process, improving communication skills among family members, as well as financial planning assistance were techniques used to reduce caregiver stress.

The study group was required to join weekly support groups during the first 4-month period. The support groups provided emotional support and education in a nonjudgmental environment. Participates could continue in the support groups indefinitely at the end of the initial 4-month period.

The third component for the treatment group was continuous available counseling via telephone. Caregivers and families were able to access this assistance over the course of the disease. Caregivers in the study were trained to triage behaviors, determine which behaviors needed immediate attention such as wandering, a safety risk, to annoying behaviors such as repeating the same question again and again. By altering the caregiver’s subjective appraisal of these negative behaviors through coping strategies, caregiver stress was reduced even when behaviors increased with the progress of the disease.

The distress perceived by the caregivers in the study group continued to be less stressful than the caregivers in the control group even when the troublesome behaviors are replaced with the patient’s inability to perform activities of daily living across time.

The study did not find a reduction in the number of negative behaviors but there was a significant reduction in caregiver reaction scores to these behaviors through caregiver interventions. Depression was found to be a factor in caregiver reaction.

Resources available for patients with Alzheimer’s and their caregivers should include cognitive behavior interventions for caregivers. By reducing the stress caregivers perceive, home care can be extended and nursing home placement delayed.

Upon review of this study it is clear that caregiver interventions can have far reaching benefits for caregivers, their family members with dementia and even society. It has been demonstrated that interventions such as counseling and support can reduce stress and depression for the caregiver. This research demonstrated that when we take care of the caregiver, the caregiver can take care of their loved one at home for a longer period of time thus delaying nursing home placement. Medicaid is the primary payer for dementia patients in long term care facilities. When nursing home placement is delayed we all win, caregiver, loved one and tax payer.


Mittelman, M. S., Roth, D. L., Haley, W. E., Zarit, S. H., (2004).  Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s Disease: Results of a randomized trial. The Journals of Gerontology, 59B,  No. 1, P27-P34.