Mohammed T. Abou-Saleh

CAREGIVERS AND THEIR SUPPORT 767Figure 3 Survival curve showing percentage of patients not placed in aninstitution over time in the three programme groups. From Brodaty andGresham 2 , by permission of the BMJ Publishing GroupFigure 5 Kaplan–Meier survival functions for death comparing thecombined training groups with the memory retraining group. FromBrodaty et al. 1 , with permission. Copyright John Wiley & Sons LtdNursing Home Admission and MortalityIn the first 30 months, there was a marked difference between thegroups in the percentage of patients still at home (Lee-Desustatistic=6.19, df=2, p50.05) (Figure 3). At 8 years follow-up,the rates of nursing home admission in the immediate and delayedcarer training groups were similar and were combined, allowingfor a comparison of the effect of caregiver training in general tothe memory retraining group (Figure 4). Using Kaplan–Meiersurvival functions, there was a significant difference between thegroups in survival at home and mortality. The rates of death ofpatients at 30 month and 8 year reviews were lower wherecaregivers had had training (Figure 5).CostsProgram Costs and Institutional CostsFigure 4 Kaplan–Meier survival functions for nursing home admissioncomparing the combined training groups with the memory retraininggroup. From Brodaty et al. 1 , with permission. Copyright John Wiley &Sons LtdPatients’ OutcomesOver the 12 months there was a steady decline in all measuresof patient cognition and function (Figure 2). Thus for the totalsample, the MMSE scores declined from 17.1 (6.5) at baselineto 16.2 (7.3) at 6 months and 15.2 (7.6) at 12 months. Similarly,the Blessed dementia scale score increased from 7.0 (2.9) to 8.2(4.3) and 10.4 (5.4) over the 12 months. Activities of DailyLiving declined from 0.3 (0.6) to 1.1 (1.4) and 1.7 (1.7) over the12 months. There were no differences between the three groupsin the rate of patient decline. Patients were not depressedclinically. Fewer than six at any assessment over the 12 monthshad a Hamilton score of 516. Their mean Hamilton andGeriatric Depression scale scores remained low and stable overtime.As the program was conducted within the psychiatric unit of ageneral teaching hospital, it was more expensive than may havebeen necessary. Even so, we were able to demonstrate that thecosts of training were more than counterbalanced by the delay innursing home admission. By 39 months follow-up, there were only32 patients still alive at home: 17 of 31 (55%) from the immediatecarers’ program, 11 of 29 (38%) from the delayed carers’ programand 4 of 30 (13%) from the memory retraining program. At thetime, the average cost of a nursing home bed was *$92.23/day. Wecalculated the total institutional costs for the three groups as$19 918 for immediate carers’ training patients, $27 375 fordelayed carers’ program patients, and $36 753 for memoryretraining program patients. The cost of the training wasestimated in 1991 as $8868, including the hospital stay and 12months’ follow-up. This represented a saving of $7967 (Australian)($5975 US) per couple in the immediate training program(compared to those in the memory training program) in the first39 months of the program.*Costs quoted in Australian dollars throughout. $1 Australian=$0.75 USat that time.