The effects of counseling spouse caregivers of people with Alzheimer disease taking donepezil and of country of residence on rates of admission to nursing homes and mortality

Am J Geriatr Psychiatry. 2009 Sep;17(9):734-43. doi: 10.1097/jgp.0b013e3181a65187.


Objective: Does psychosocial intervention for caregivers whose spouses with Alzheimer disease (AD) are taking donepezil delay nursing home (NH) placement or death of patients?

Design: Randomized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up (mean: 5.4 years, SD: 2.4).

Setting: Outpatients of research clinics in Australia, the United Kingdom, and the United States.

Participants: One hundred and fifty-five persons with AD and their spouses.

Intervention: Five sessions of individual and family counseling (+ prn ad hoc counseling) or usual care.

Measurements: Time to institutionalization and death using Cox proportional hazards methods.

Results: Over a mean of 5.4 years (SD: 2.4), there were no differences in NH placement or mortality by intervention group, but there were by country, with Australian patients admitted to NHs earlier than U.S. than U.K. patients.

Conclusion: Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care, NH systems, availability, and affordability.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / drug therapy
  • Alzheimer Disease / mortality*
  • Alzheimer Disease / nursing
  • Alzheimer Disease / psychology
  • Australia
  • Caregivers / psychology*
  • Cholinesterase Inhibitors / therapeutic use
  • Counseling / methods*
  • Donepezil
  • Female
  • Homes for the Aged / statistics & numerical data*
  • Humans
  • Indans / therapeutic use
  • Institutionalization / statistics & numerical data*
  • Male
  • Nursing Homes / statistics & numerical data*
  • Piperidines / therapeutic use
  • Social Support
  • Spouses / psychology*
  • Surveys and Questionnaires
  • United Kingdom
  • United States


  • Cholinesterase Inhibitors
  • Indans
  • Piperidines
  • Donepezil