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Janson P, Hung CW, Willeke K, Frisch D, Berghöfer A, Heuschmann P, Zapf A, Wildner M, Stupp C, Keil T. [How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses]. DAS GESUNDHEITSWESEN 2024. [PMID: 39146966 DOI: 10.1055/a-2340-1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany. METHOD We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany. RESULT Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life. CONCLUSION The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.
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Affiliation(s)
- Patrick Janson
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Chu-Wei Hung
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Willeke
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Dieter Frisch
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Anne Berghöfer
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Zentrum für Klinische Studien Würzburg, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Zapf
- Bayerisches Staatsministerium für Umwelt und Verbraucherschutz, München, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Manfred Wildner
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-Universität München, München, Germany
| | - Carolin Stupp
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Thomas Keil
- Landesinstitut Gesundheit I, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen, Germany
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hetzel C, Schaller J, Michel W, Froböse I. [Effects of a One-Week Inpatient Health Programme for Family Caregivers and Persons in Need of Care (SVLFG Care Tandem) - A Quasi-Experimental Study]. DAS GESUNDHEITSWESEN 2024. [PMID: 38604607 DOI: 10.1055/a-2305-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
AIM The aim of this study was to assess the effect of a one-week inpatient health programme for family carers together with the persons in need of care (care tandem) on the well-being of family carers. Acceptance and subjective benefits were also assessed. The intervention was funded by the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). METHODOLOGY Central to the intervention are (1) the home care counselling before the seminar, (2) the one-week seminar in the setting of a rehabilitation clinic at a health resort, in particular with a care course, exercise and relaxation units and the use of local remedies, (3) the substitute care of the person in need of care in close proximity to the seminar location and (4) the low-threshold telephone aftercare by SVLFG specialists. In a controlled prospective panel study (IG n=35, VG n=67, allocation not randomised), well-being (WHO-5, range 0-100) was measured at several points in time (IG: 0, 1, 9, 17, 28 and 43 weeks after the start of the seminar; VG 0, 17, 28 and 43 weeks). Statistical analyses were performed using fixed-effects panel regression, controlling for time-varying covariates (period effects, external stress). RESULTS In the IG (80% women, mean age 66.5 years), 69% of family carers showed evidence of clinically relevant depression at baseline. All care levels were represented among the people in need of care, predominantly 2 and 3, with medically diagnosed dementia in 37% of the cases. The VG was similarly structured. Under the condition of stable external stress, the initial effect was very clear (delta=+19 points). The effect then flattened out, but remained fairly stable at around 10 points above the initial level. Although the last measurement (43 weeks) was no longer statistically significantly higher, it was independent of the development of external stress. Acceptance and subjective benefit were very high. CONCLUSIONS The strength of the intervention is the dyadic approach. The intervention promotes well-being and is highly accepted. The design allows at least cautious causal conclusions. For the remaining limitations, larger case numbers and a randomised controlled trial would be necessary.
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Affiliation(s)
- Christian Hetzel
- Institut für Qualitätssicherung in Prävention und Rehabilitation iqpr GmbH an der Deutschen Sporthochschule Köln, Köln, Germany
| | - Julia Schaller
- Gesundheitsangebote, Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Kassel, Germany
| | - Wolfgang Michel
- Gesundheitsangebote, Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Kassel, Germany
| | - Ingo Froböse
- Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln, Köln, Germany
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Hetzel C, Bühne D, Michel W, Holzer M, Froböse I. [More free time for me? Effects of a group intervention for informal caregivers based on routine data from the SVLFG long-term care insurance]. Z Gerontol Geriatr 2023; 56:477-483. [PMID: 35852589 DOI: 10.1007/s00391-022-02086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND The intervention is a multiday health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) for informal caregivers. AIM OF THE WORK Does the intervention increase the use of outside help to gain free time for self-care? MATERIAL AND METHODS Using a quasi-experimental within-design, we analyze annual benefit data from the SVLFG long-term care insurance for the cluster sample Bavaria from 2017 to 2020 with intervention in 2018/2019. Using fixed effects panel regressions, we determine the effect heterogeneity for care relationship, duration of care and degree of care, adjusting for period effects (intervention and comparison group: 88 and 6045 persons with 207 and 16,091 observations, respectively). RESULT After the intervention, the use of services for outside help tends to be higher than before. The effect is significantly more pronounced with increasing care level, care within the partnership and shorter care duration. With care within the partnership, start of care before 1 year and care level 4/5, more outside help is used afterwards for 1160 € (p < 0.001) than before. DISCUSSION Design and statistical method would allow a causal conclusion; however, in view of the limitations, in particular the small number of cases in the intervention group and the only limited characteristics available to control for time-dynamic heterogeneity, caution is advisable.
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Affiliation(s)
- Christian Hetzel
- Institut für Qualitätssicherung in Prävention und Rehabilitation iqpr GmbH, Deutsche Sporthochschule Köln, Eupener Str. 70, 50933, Köln, Deutschland.
| | - David Bühne
- Institut für Qualitätssicherung in Prävention und Rehabilitation iqpr GmbH, Deutsche Sporthochschule Köln, Eupener Str. 70, 50933, Köln, Deutschland
| | - Wolfgang Michel
- Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Weißensteinstraße 70-72, 34131, Kassel, Deutschland
| | - Michael Holzer
- Sozialversicherung für Landwirtschaft, Forsten und Gartenbau, Weißensteinstraße 70-72, 34131, Kassel, Deutschland
| | - Ingo Froböse
- Institut für Bewegungstherapie und bewegungsorientierte Prävention und Rehabilitation, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland
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