Konzept eines einwöchigen Gesundheitsprogramms für pflegende Angehörige gemeinsam mit ihrer pflegebedürftigen Person – „Pflegetandem“

[How effective are non-pharmacological interventions for family caregivers? A systematic review with meta-analyses]

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.

[Effects of a One-Week Inpatient Health Programme for Family Caregivers and Persons in Need of Care (SVLFG Care Tandem) - A Quasi-Experimental Study]

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.

[More free time for me? Effects of a group intervention for informal caregivers based on routine data from the SVLFG long-term care insurance]

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.