Reducing burden and anxiety for caregivers of Veterans with traumatic brain injury and dementia: Randomized controlled trial of the resources for enhancing all caregivers’ health—Hope intervention

Abstract: Purpose/Objective: Caregivers of veterans with comorbid traumatic brain injury (TBI) and dementia face many challenges managing their loved ones’ neurobehavioral functioning and, importantly, their own well-being. This study developed and tested Resources for Enhancing All Caregivers’ Health (REACH) Hope, which provides caregivers with one-on-one telehealth education, support, skills building, and personalized digital information. Method: Caregivers (N = 110) of veterans with both TBI and dementia were randomly assigned to either REACH Hope (n = 56) or a waitlist-control group (n = 54) for 3 months; waitlist participants then received REACH Hope. Data collection occurred by telephone at baseline, 3 months (postintervention/waitlist switch), 6 months, and 9 months (for waitlist-control only). The 12-item short-form Zarit Burden Interview (ZBI-12) at 3 months (posttreatment) was the primary outcome. Secondary outcomes included caregiver depression, anxiety, self-efficacy, and number of veteran safety risks. Results: REACH Hope reduced burden and anxiety for caregivers with moderate to high levels of burden and anxiety compared to the waitlist group. Caregivers with ZBI-12 scores ≥ 21 had increasing treatment benefits with higher burden. Caregivers with Generalized Anxiety Disorder-7 scores ≥ 13 showed the same pattern for higher anxiety levels. There were no significant treatment group effects for depression, self-efficacy, or veteran safety. Conclusion: This is the first clinical trial to evaluate the efficacy of a telehealth intervention for caregivers of veterans with both TBI and dementia. REACH Hope represents the first evidence-based intervention of its kind and one that warrants further study and implementation. This study is the first clinical trial to evaluate the efficacy of a telehealth intervention for caregivers of veterans with both traumatic brain injury and dementia. Resources for Enhancing All Caregivers’ Health—Hope significantly reduced burden for caregivers with moderate-to-high levels of burden, with a similar effect for caregivers with moderate-to-high anxiety compared to the waitlist group. Caregivers with higher baseline burden and anxiety levels increasingly benefited from the intervention, indicating Resources for Enhancing All Caregivers’ Health—Hope’s effectiveness for those most in need.

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