10| Caregiver Burden: Prevalence, Assessment, and Treatment – with Dr. Geoff Tremont

A tremendous amount of stress and anxiety is experienced by caregivers of older adults with dementia.  Caregivers often endure both psychological and medical illnesses and there are significant barriers (e.g., caregiver responsibilities) preventing them from attending traditional psychotherapy.  In this episode, we talk to Dr. Geoff Tremont, a board-certified neuropsychologist and the developer of a telephone-based intervention that has been shown to enhance the well-being of caregivers.

If you’d like to receive APA-approved CE credit for listening to this episode, click here.

A pdf of the transcript for this episode is available here.

Topics Covered

• The overall prevalence and societal impact of caregiver burden

• Overlap and distinctions between caregiver burden and psychiatric symptoms such as depression, stress, anxiety, and poor quality of life

• Differential challenges in caregiving faced by spouses as compared to children of the care recipient

• Negative physical and mental health outcomes that result from caregiving, and factors that can be protective against these outcomes

• Why caregiving for someone with dementia is more burdensome than caregiving for someone with a physical injury/disability 

• Reasons why caregivers tend not to utilize community resources such as support groups

• Thinking through the decision of when to transition a care recipient to an assisted living facility or skilled nursing facility 

• The issue of caregivers who are themselves cognitively impaired and how to approach this issue from a clinical perspective

• Multicomponent interventions for dementia caregivers – structure, cost, and efficacy

• The Family Intervention: Telephone Tracking-Caregiver (FITT-C) for dementia caregivers – rationale, design, and empirical support

• Comparing telephone interventions such as the FITT-C with multicomponent interventions in terms of practicality and efficacy/effectiveness 

• Ethnic and cultural background as moderators of the response to treatment in dementia caregivers

• As it pertains to a neuropsychological evaluation, the issue of whether, and to what degree, the clinician should try to account for the caregiver’s well-being (given that they are not the patient).

• The issue of physical/emotional abuse of a care recipient by a caregiver

• The issue of older adults with cognitive impairment who don’t have a caregiver and how we might help these people

About Geoff

Geoffrey Tremont, Ph.D., ABPP-CN, completed his graduate training at Nova Southeastern University, internship at the University of Oklahoma Health Sciences Center, and postdoctoral fellowship at Brown Medical School and Rhode Island Hospital.  He is currently Associate Professor of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University and Director of Neuropsychology at the Rhode Island and Miriam Hospitals.  He has used neuropsychological methods to study a variety of clinical populations, including cerebrovascular disease, dementia, epilepsy, and psychiatric disorders.  He has a history of grant funding in psychosocial interventions for patients and caregivers with age-related cognitive disorders.

Selected References

Belle, S. H., Burgio, L., Burns, R., Coon, D., Czaja, S. J., Gallagher-Thompson, D., … & Martindale-Adams, J. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Annals of internal medicine, 145(10), 727-738.

Mittelman, M. S., Haley, W. E., Clay, O. J., & Roth, D. L. (2006). Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67(9), 1592-1599.

Tremont, G., Davis, J. D., Ott, B. R., Galioto, R., Crook, C., Papandonatos, G. D., … & Bishop, D. S. (2017). Randomized trial of the family intervention: telephone tracking—caregiver for dementia caregivers: use of community and healthcare resources. Journal of the American Geriatrics Society, 65(5), 924-930.

Tremont, G., Davis, J., Papandonatos, G. D., Grover, C., Ott, B. R., Fortinsky, R. H., … & Bishop, D. S. (2013). A telephone intervention for dementia caregivers: background, design, and baseline characteristics. Contemporary clinical trials, 36(2), 338-347.

Tremont, G., Davis, J. D., Papandonatos, G. D., Ott, B. R., Fortinsky, R. H., Gozalo, P., … & Bishop, D. S. (2015). Psychosocial telephone intervention for dementia caregivers: a randomized, controlled trial. Alzheimer’s & Dementia, 11(5), 541-548.