Systematic review of the effect of psychological interventions on family caregivers of people with dementia

Caregiver coping mediates the relationship between caregivers' understanding of dementia as terminal and their distress

We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation. Caregivers who correctly understood dementia as terminal and those unsure (vs incorrect), experienced more distress (correct: β [95% confidence interval (CI)]: 0.80 [0.00 to 1.60]; unsure: 0.95 [0.04 to 1.87]). Caregivers with correct understanding of dementia as terminal (vs incorrect) employed more dysfunctional (2.01 [0.60 to 3.42]) and problem-focused coping strategies (2.56 [0.08 to 5.05]). Although dysfunctional and problem-focused coping (associated with higher distress) mediated the positive association between caregivers' understanding that dementia is terminal and their distress, emotion-focused coping (associated with lower distress) did not offset this relationship. Results suggest that terminal illness disclosure to caregivers should be accompanied by interventions to promote emotion-focused coping strategies. Highlights Caregivers who understood dementia as terminal experienced more distress. Dysfunctional and problem-focused coping mediated the positive relationship between terminal illness understanding and caregiver distress. Emotion-focused coping did not offset this relationship.

Non-pharmacological interventions to improve mental health outcomes among female carers of people living with a neurological condition: a systematic review

PURPOSE

This systematic review aims to examine the effectiveness of non-pharmacological interventions for improving mental health outcomes among female carers of people living with a neurological condition.

MATERIALS AND METHODS

A narrative synthesis of English-language randomized controlled trials was undertaken.

RESULTS

18 unique studies were included. Intervention components that were found to have improved mental health outcomes were: delivered in person, to groups, on an intermittent schedule with ≥10 sessions; had a duration between 3-6 months; and were facilitated by research staff or allied health professionals. As the review had few robust studies, results of mental health outcomes reported in studies assessed as low risk of bias were highlighted in the review. Psychoeducation interventions, cognitive behavioural interventions, and support group interventions were found to improve depression. Psychoeducation interventions were also found to improve burden.

CONCLUSIONS

There is a clear need for adequately powered, high-quality randomised controlled trials to determine the effectiveness of non-pharmacological interventions for female carers of people living with a neurological condition.

E-bibliotherapy for improving the psychological well-being of informal caregivers of people with dementia: a randomized controlled trial protocol

BACKGROUND

Providing informal care for individuals with dementia is frequently a challenging and demanding experience that can have detrimental effects on the psychological well-being of caregivers. Regrettably, community-based caregiver services often prove inadequate, highlighting the necessity for innovative approaches to support caregivers.

AIM

To test the efficacy of e-bibliotherapy in improving the psychological well-being of informal caregivers of people with dementia.

METHOD

The study is divided into two phases. In phase 1, the research team will co-design the e-bibliotherapy app with caregivers. In phase 2, a randomized controlled trial will be conducted among 192 informal caregivers of people with dementia in Hong Kong. Caregivers will be randomly assigned to either the e-bibliotherapy group or the control group using simple randomization. Outcome measures will encompass caregivers' psychological well-being, caregiving appraisal, mental health, saliva cortisol levels as an indicator of stress, and health-related quality of life for caregivers. Data will be collected at baseline, immediately post intervention, and 3 months and 6 months post intervention. General linear mixed model will be employed to analyze intervention effects. Qualitative interviews will be undertaken to explore caregiver experiences within this study and evaluate intervention acceptability using conventional content analysis methods.

DISCUSSION

This study represents a pioneering effort in utilizing e-bibliotherapy to enhance the psychological well-being of informal caregivers of individuals with dementia, addressing the existing gap in caregiver services and facilitating knowledge dissemination within the community.

TRIAL REGISTRATION

The trial has been registered on ClinicalTrial.gov (Ref: NCT05927805).

Exploring usability characteristics in computer-based digital health technologies for family caregivers of people with chronic progressive conditions: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the literature on how usability is considered during the design and/or evaluation of computer-based digital health technologies for family caregivers of persons with chronic progressive conditions.

INTRODUCTION

Computer-based digital health technologies offer convenient alternatives for delivering interventions to caregivers of people with chronic progressive conditions. Usability is a critical component of good practice in developing and implementing health and social care technologies; however, we need to determine whether usability is incorporated in the design and/or evaluation of computer-based digital health technologies for caregivers of people with chronic progressive conditions. Within this context, a broad overview of the existing literature on usability in computer-based digital health technologies is needed.

INCLUSION CRITERIA

We will include studies published from 2012 to the present that describe usability characteristics of computer-based digital health technologies targeting adult (≥18 years old) family caregivers of people with chronic progressive conditions, regardless of study design or setting.

METHODS

We will use the JBI methodology for scoping reviews. We will conduct searches of MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), and Web of Science Core Collection to capture eligible studies. After the results are deduplicated, 2 independent reviewers will assess each study for eligibility and extract data from the included studies. Conflicts will be resolved through discussion or with a third reviewer. Data analysis will use a textual narrative synthesis approach.

REVIEW REGISTRATION

Open Science Framework osf.io/w4vk5.

Uptake and Use of Care Companion, a Web-Based Information Resource for Supporting Informal Carers of Older People: Mixed Methods Study

BACKGROUND

Informal carers play a major role in supporting relatives and friends who are sick, disabled, or frail. Access to information, guidance, and support that are relevant to the lives and circumstances of carers is critical to carers feeling supported in their role. When unmet, this need is known to adversely affect carer resilience and well-being. To address this problem, Care Companion was co-designed with current and former carers and stakeholders as a free-to-use, web-based resource to provide access to a broad range of tailored information, including links to local and national resources.

OBJECTIVE

This study aimed to investigate the real-world uptake and use of Care Companion in 1 region of England (with known carer population of approximately 100,000), with local health, community, and social care teams being asked to actively promote its use.

METHODS

The study had a convergent parallel, mixed methods design and drew on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data included metrics from carers' use of Care Companion, surveys completed by users recruited through general practice, and interviews with carers and health and social care providers regarding their views about Care Companion and their response to it. Quantitative data were analyzed using descriptive statistics. Interview data were analyzed thematically and synthesized to create overarching themes. The qualitative findings were used for in-depth exploration and interpretation of quantitative results.

RESULTS

Despite awareness-raising activities by relevant health, social care, and community organizations, there was limited uptake with only 556 carers (0.87% of the known carer population of 100,000) registering to use Care Companion in total, with median of 2 (mean 7.2; mode 2) visits per registered user. Interviews with carers (n=29) and stakeholders (n=12) identified 7 key themes that influenced registration, use, and perceived value: stakeholders' signposting of carers to Care Companion, expectations about Care Companion, activity levels and conflicting priorities, experience of using Care Companion, relevance to personal circumstances, social isolation and networks, and experience with digital technology. Although many interviewed carers felt that it was potentially useful, few considered it as being of direct relevance to their own circumstances. For some, concerns about social isolation and lack of hands-on support were more pressing issues than the need for information.

CONCLUSIONS

The gap between the enthusiastic views expressed by carers during Care Companion's co-design and the subsequent low level of uptake and user experience observed in this evaluation suggests that the co-design process may have lacked a sufficiently diverse set of viewpoints. Numerous factors were identified as contributing to Care Companion's level of use, some of which might have been anticipated during its co-design. More emphasis on the development and implementation, including continuing co-design support after deployment, may have supported increased use.

Experiences of psychological interventions in neurodegenerative diseases: a systematic review and thematic synthesis

Background: Psychological interventions for managing emotional distress in neurodegenerative diseases are needed, but progressive worsening of symptoms and increasing disability might pose difficulties with engagement. We aimed to synthesise the experiences of engaging with and using psychological interventions in neurodegenerative diseases and identify relevant barriers and facilitators. Methods: Systematic searches were conducted in six electronic databases and results were screened. We included qualitative and mixed methods studies reporting patient or caregivers' views or experiences of psychological interventions. Qualitative data were extracted and thematically synthesised. Results: 34 papers were included, covering a range of diseases and interventions. Engagement was facilitated by flexible intervention formats and tailoring to the specific needs of people with neurodegenerative diseases. Interventions were sometimes inaccessible or burdensome because of physical and cognitive symptoms, and the time and effort required for the intervention. Participants' levels of acceptance and readiness often differed and influenced engagement with the intervention. Across different interventions, participants experienced wide-ranging benefits including changes in insight, perspective, self-efficacy, emotions and relationships. Conclusion: Although people with neurodegenerative diseases and caregivers experience benefits from psychological interventions, burden-reducing adaptations and sensitive tailoring to the specific disease context is required to improve acceptability and engagement.

A qualitative investigation of the psychosocial services utilised by care-givers of patients with Alzheimer's disease and related dementias in southwestern Uganda

Individuals with Alzheimer's disease and related dementias often require substantial support from other people. Much of the care-giving is from family members who eventually experience physical, emotional and financial stress, depression and fatigue. In Uganda, families are a cornerstone in providing care to individuals with dementia. However, little is known about the psychosocial supports available to the care-givers in their care-giving role. We assessed the psychosocial supports available to care-givers of individuals with Alzheimer's disease and related dementias in southwestern Uganda. We conducted 34 in-depth interviews at three referral hospitals at which care-givers identified by the treating clinicians were approached for informed consent. The interviews were conducted until thematic saturation was reached, and the interviews were translated and transcribed. Thematic content analysis was used to analyse the data. Care-giver supports were structured into two major themes: medical supports utilized and supports beyond the medical care system. Medical supports highlighted information provided by medical professionals. Supports beyond the medical care system included emotional and instrumental supports provided by religious leaders, the local communities and family members. Care-givers for individuals with dementia in southwestern Uganda receive educational support from medical practitioners, and unstructured emotional and instrumental supports from the family and community.

Educational care for patients with Alzheimer's disease and their caregivers in France: A mapping proposal

OBJECTIVES

To formalize a proposal for educational approach for patients with Alzheimer's disease and related dementias (ADRD) and caregivers across existing diagnosis/care organizations and structures.

METHODS

Three steps:1/ identifying the existing organizations and structures that could be involved in educational care; 2/ identifying the main educational skills of interest for ADRD patients and caregivers; 3/ conducting a survey among these organizations and structures to achieve a mapping proposal of educational care.

RESULTS

Nine organizations and structures, and 29 educational skills of interest were identified for the step 3 survey. Overall, 423 organizations/structures completed the step 3 survey. Twelve of 29 educational skills were covered by 50% of organizations/structures included. The most covered skills were "Maintaining autonomy in daily living activities", "coping with cognitive disorders", and "coping with behavioral disorders".

CONCLUSIONS

A mapping of educational care that could be provided by the different structures and organizations involved in the ADRD care pathway was proposed regarding their missions and intervention place.

PRACTICE IMPLICATIONS

Policy makers and funding bodies will need to invest in the healthcare professionals' training about educational approach and ADRD in order to extend educational care throughout the patient's care pathway.

A systematic literature review of group-based training interventions for informal carers: impact on the behavioural and psychological symptoms of dementia (BPSD)

OBJECTIVES

Caring for a relative with dementia can be extremely challenging especially when someone presents with behavioural and psychological symptoms of dementia (BPSD). The training provided to informal carers is varied and inconsistent. Group-based training programmes are often prescribed but their impact on care-recipient wellbeing and symptomology is yet to be well established. This review synthesises the literature on consensus, themes and effectiveness of informal-carer, group-based educational training programmes on BPSD symptoms.

METHODS

Ten papers were included of which very few considered BPSD outcomes as their primary aim of investigation.

RESULTS

Methodological and theoretical approaches across the empirical papers varied considerably. Generally, studies of higher quality and with some positive results on BPSD outcomes tended to incorporate teaching on structured problem-solving skills. Studies measuring for longer term changes also tended to conclude more beneficial outcomes. The length and duration of groups and the group-sizes appeared inconsequential to BPSD outcomes.

CONCLUSION

The empirical evidence is weak for carer group interventions in the management of BPSD. Practice reasons for this are discussed. Future studies designed to measure BPSD as a primary outcome would be a welcome addition to the literature.

Mindfulness-Based Intervention for Caregivers of Frail Older Chinese Adults: A Study Protocol

Studies have consistently showed that informal caregivers have worse health, more medical consultations, anxiety and depression, and lower quality of life than those who do not provide such care. Positive outcomes of psychoeducation interventions have been found, but many of them are relatively long in duration, making them less cost-effective in implementation. The proposed study is a multi-site, three-arm randomized controlled trial of a mindfulness-based intervention for Chinese family caregivers. Effects of the intervention will be compared with those of an evidence-based psychoeducation program and treatment-as-usual. Two hundred forty cross-generational caregivers of frail older adults with moderate to severe levels of frailty will be recruited and randomly assigned to mindfulness-based intervention, psychoeducation, and treatment-as-usual experimental conditions. Program effectiveness will be analyzed on measures of caregiver burden, depression, anxiety, positive caregiving experience, spirituality, family conflict, and the biomarker of heart rate variability. Measures on coping styles, experiential avoidance, and self-efficacy will be explored to see if they mediate the changes to participant improvements in outcomes. Six-month follow-up will be included to investigate the maintenance effects. This study will provide evidence on mindfulness-based interventions on caregivers of frail older adults and expand the existing models of intergenerational caregiving in Chinese culture.

Promoting Social Connection in Dementia Caregivers: A Call for Empirical Development of Targeted Interventions

Social connection is an understudied target of intervention for the health of individuals providing care for a family member with Alzheimer's disease and related dementias (ADRD). To guide future research, we discuss considerations for interventions to promote social connection, with a particular focus on reducing loneliness: (a) include caregiver perspectives in designing and delivering interventions; (b) adapt to stages of dementia; (c) consider caregiving demands, including the use of brief interventions; (d) specify and measure mechanisms of action and principles of interventions; (e) consider dissemination and implementation at all stages of research. With support from the National Institute on Aging for a Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging, we are developing a portfolio of mechanism-informed and principle-driven behavioral interventions to promote social connection in ADRD caregivers that can be flexibly applied to meet a diverse set of needs while maximizing resources and reducing demands on caregivers.

The effect of mental health interventions on psychological distress for informal caregivers of people with mental illness: A systematic review and meta-analysis

INTRODUCTION

Informal caregivers of people with a mental illness are at increased risk of developing depression, anxiety, and stress, so preventive interventions are needed.

METHOD

The review was reported in PROSPERO (ID: CRD42018094454). The PsycINFO, PubMed, and Scopus databases were searched in June 2019. The Cochrane Risk of Bias and Jadad scale scores were used to assess study quality. Inclusion criteria were: RCTs of informal caregiver interventions regardless of the care receiver's mental illness and intervention modality. Interventions should be compared to a waitlist, treatment as usual or active control, taught in real-time by a mental health professional, include an outcome measure on psychological distress, and published in a peer-reviewed journal article in English. RCTs were excluded if the intervention was given in dyads (caregiver + care receiver), limited to the provision of respite care where the patient sample included a mix of both physical and psychological illnesses, unpublished, not peer-reviewed, study protocols, or dissertations.

RESULTS

A total of 2,148 studies were identified; of these, 44 RCT studies met the inclusion criteria, and 31 had sufficient data to conduct a meta-analysis including subgroup analysis (N = 1,899). The systematic review showed that thirty-one out of the 44 RCTs had an effect of the intervention on decreasing psychological distress. The results of the meta-analysis, which included informal caregiver interventions, compared to waitlist, treatment as usual, or active control, regardless of care-receiver mental illness or intervention modality showed a small effect of -0.32 (95% CI -0.53 to -0.11). The heterogeneity of the included studies was high (I ² = 78). The subgroup analysis included manualized interventions lasting at least 8 weeks and the subgroup analysis that included an active control showed a small effect and low heterogeneity. Lack of active control and long-term follow-up is a limitation of most of the studies.

CONCLUSION

The evidence supports that several interventions improve the mental health of caregivers. Manualized interventions ≥ 8 weeks with active participation are most effective. Future RCTs should improve methodology, and research should investigate which intervention modality is most effective for what kind of caregiver. Future research should clearly specify what the included intervention components are, use longer follow-up times, and conduct mediational analyses to better understand what mechanisms create the effect of an intervention.

SYSTEMATIC REVIEW REGISTRATION

Identifier: CRD42018094454.

The efficacy of psychological interventions for depressed primary caregivers of patients with Alzheimer's disease: A systematic review and meta-analysis

OBJECTIVES

To systematically evaluate the effectiveness of psychological intervention durations and different psychological interventions on treating depression in primary caregivers of Alzheimer's disease (AD) patients.

METHODS

A computerized search of PubMed, Cochrane Library, Embase, Ebsco, Web of Science, CNKI, CSBD, and CSTJ databases on randomized controlled trials (RCTs) of psychological interventions for depressed primary caregivers of AD patients was performed. Depression scores were derived from the Self-rated Depression Scale (SDS) and the Centre for Epidemiological Studies Depression Scale (CES-D). The results were analyzed using Revman 5.3 utilizing Trial Sequential Analysis (TSA) software for data analysis.

RESULTS

Eight RCTs involving 857 depressed primary caregivers of AD patients were included in the study. Of the four psychological interventions studied, only three (i.e., cognitive-behavioral psychological, integrated psychological, and psychological interview intervention) were shown to significantly reduce depression levels in primary caregivers of AD patients after 2-months, 10-weeks, and 6-months of treatment (p ≤ 0.05). It is uncertain that a supportive psychological intervention or a 3-months psychological intervention reduced the level of depression. Sequential and sensitivity analyses confirmed the reliability of the outcome measures.

CONCLUSION

Cognitive-behavioral psychological, integrated psychological, and psychological interview interventions were able to significantly reduce depression levels in primary caregivers of AD patients. These findings reveal that psychological interventions may be a promising means for depressed primary caregivers of patients with AD.

CLINICAL RELEVANCE

For the primary caregivers of AD patients, effective interventions can help reduce psycho-depressive symptoms and improve the quality of life for the caregivers and the patients. Medical staff may want to use this information to help to provide a more effective guide for primary caregivers in an effort to reduce possible levels of depression.

Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial

Background

Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT).

Objective

This paper reports the protocol of a pilot RCT evaluating the iSupport VA.

Methods

Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed.

Results

This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455).

Conclusions

This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz

International Registered Report Identifier (IRRID)

PRR1-10.2196/33572

Stress, Burden, and Well-Being in Dementia and Nondementia Caregivers: Insights From the Caregiving Transitions Study

BACKGROUND AND OBJECTIVES

Few population-based studies have directly compared caregivers of persons with dementia to caregivers of persons with other disabilities (nondementia caregivers). We enrolled dementia and nondementia caregivers who were providing substantial and sustained care and compared these groups on measures of caregiver stressors, appraisals of burden, and well-being.

RESEARCH DESIGN AND METHODS

Caregivers (N = 251) who provided continuous care for at least 1 year and at least 5 h per week were recruited from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Caregivers reported on dementia caregiving status, stressors, burden, and well-being.

RESULTS

Forty-seven percent (n = 117) reported caring for a person with dementia. Dementia caregivers reported more stressors, providing more care for self-care and behavioral problems than nondementia caregivers. Dementia caregivers also reported higher appraisals of stress and burden, and more depressive symptoms, but did not differ from nondementia caregivers on mental and physical health quality of life. In multivariable-adjusted models, adjustment for the total number of care recipient problems attenuated differences between dementia and nondementia caregivers on burden and depression measures.

DISCUSSION AND IMPLICATIONS

Dementia and nondementia caregivers showed relatively few differences in indicators of overall well-being in this population-based sample, perhaps because both groups of caregivers in this study were providing substantial care. Dementia caregivers may require special assistance with dementia-specific problems such as behavioral problems. Clinical interventions and policy changes targeting highly burdened caregivers are needed to support them in allowing their care recipients to age in place at home.

The Tele-STELLA protocol: Telehealth-based support for families living with later-stage Alzheimer's disease

AIMS

We aim to establish the feasibility and acceptability of the Tele-STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms.

DESIGN

This is a multi-component, quasi-experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia.

METHODS

Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8-week videoconferencing components that address behavioural symptoms-in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021.

DISCUSSION

Tele-STELLA fills a gap in current videoconference-based psychoeducational interventions in that it offers real-time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele-STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial.

IMPACT

Tele-STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele-STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation.

TRIAL REGISTRATION

This trial is registered with ClinicalTrials.gov (#NCT04627662).

Technical Challenges for Smooth Interaction With Seniors With Dementia: Lessons From Humanitude™

Due to cognitive and socio-emotional decline and mental diseases, senior citizens, especially people with dementia (PwD), struggle to interact smoothly with their caregivers. Therefore, various care techniques have been proposed to develop good relationships with seniors. Among them, Humanitude is one promising technique that provides caregivers with useful interaction skills to improve their relationships with PwD, from four perspectives: face-to-face interaction, verbal communication, touch interaction, and helping care receivers stand up (physical interaction). Regardless of advances in elderly care techniques, since current social robots interact with seniors in the same manner as they do with younger adults, they lack several important functions. For example, Humanitude emphasizes the importance of interaction at a relatively intimate distance to facilitate communication with seniors. Unfortunately, few studies have developed an interaction model for clinical care communication. In this paper, we discuss the current challenges to develop a social robot that can smoothly interact with PwDs and overview the interaction skills used in Humanitude as well as the existing technologies.

Caregiver Burden: Caregiving Workshops Have a Positive Impact on Those Caring for Individuals With Dementia in Arkansas

Millions of Americans live with dementia. Caregivers of this population provide countless hours of multifaceted, complex care that frequently cause unrelenting stress which can result in immense burden. However, it is not fully understood what efforts can be made to reduce the stress among caregivers of persons with dementia (PWD). Therefore, the aim of this pretest–posttest designed study was to evaluate changes in caregiver burden after providing an educational intervention to those caring for PWD in Arkansas. Forty-one participants completed the Zarit Caregiver Burden Scale before and after attending a 4-hour dementia-focused caregiving workshop. The analysis of the means, standard deviations, and paired t tests showed that there was an increase in the confidence and competence in caring for PWD 30 to 45 days after attending the workshop. Health care providers need to understand both the vital role caregivers provide in managing a PWD and the importance of the caregiver receiving education about their role as a caregiver. Utilizing caregiver educational programs is a first step.

The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer's disease and dementia with Lewy bodies

OBJECTIVE

The aim of this study was to explore the association between specific aspects of carer distress and time until nursing home admission (NHA) in people with mild dementia.

DESIGN

Prospective cohort study.

SETTING

Participants were recruited from the Dementia Study of Western Norway (DemVest).

PARTICIPANTS

This study included 107 participants admitted to a nursing home who were diagnosed with Alzheimer's disease (AD, n = 64) and dementia with Lewy bodies (DLB, n = 43) and their primary carers.

MEASUREMENTS

The Relative Stress Scale (RSS) was used to assess the level of reported distress in carers. Adjusted partial least square (PLS) prediction analysis of baseline items of the RSS was used to study the associations between individual items of the RSS and time until NHA.

RESULTS

Carer distress is an important contributor to early NHA, explaining 19.3% of the total variance of time until NHA in the model without covariates. In the adjusted PLS model, the most important RSS predictors of time until NHA were feeling frustrated (estimate = -137; CI, -209, -64.5), having limitations on social life (estimate = -118; CI, -172, -64), not being able to get away on vacation (estimate -116; CI, -158.3, -73.7), and feeling unable to cope with the situation (estimate = -63; CI, -122.6, -3.4).

CONCLUSIONS

Preservation of the informal care capacity represents important steps for improving the management of resources in dementia care. This study identifies aspects of carer distress associated with a shorter time until NHA. Looking beyond the sum score of the RSS helps promote the development of flexible and tailored interventions and perhaps delay NHA.

The Integration of Psychosocial Care into National Dementia Strategies across Europe: Evidence from the Skills in DEmentia Care (SiDECar) Project

There is evidence supporting the use of psychosocial interventions in dementia care. Due to the role of policy in clinical practice, the present study investigates whether and how the issue of psychosocial care and interventions has been addressed in the national dementia plans and strategies across Europe. A total of 26 national documents were found. They were analyzed by content analysis to identify the main pillars associated with the topic of psychosocial care and interventions. Specifically, three categories emerged: (1) Treatment, (2) Education, and (3) Research. The first one was further divided into three subcategories: (1) Person-centred conceptual framework, (2) Psychosocial interventions, and (3) Health and social services networks. Overall, the topic of psychosocial care and interventions has been addressed in all the country policies. However, the amount of information provided differs across the documents, with only the category of 'Treatment' covering all of them. Furthermore, on the basis of the existing policies, how the provision of psychosocial care and interventions would be enabled, and how it would be assessed are not fully apparent yet. Findings highlight the importance of policies based on a comprehensive and well-integrated system of care, where the issue of psychosocial care and interventions is fully embedded.

Burden of Care and Perceived Psycho-Social Outcomes among Family Caregivers of Patients Living with Cancer

Objective:

Caring for patients living with cancer requires the support of family caregivers. Literature reports experiences of diverse burdens and health effects among caregivers. This study examined the burden, physical, psycho-social, and financial outcomes of caregiving among caregivers of patients living with cancer.

Methods:

This cross-sectional descriptive study was conducted in the University College Hospital, Ibadan, Nigeria, between January and March 2019. A convenient sample of 201 caregivers who were direct family relatives were selected to complete a validated Zarit Burden Interview (ZBI) Questionnaire (r = 0.994) and perceived outcomes of caregiving questionnaire. The burden scale score ranged from 0 to 20 (no burden) to 61–88 (severe burden). Other outcomes of caregiving were measured on a Likert scale 0–4 (where 2.00 is the threshold score of effect of caregiving experienced), to determine the strength of the effect of caregiving on each variable of interest. The factors that contributed to the health outcomes were also identified. The Statistical Package for the Social Sciences version 22.0 was used for data analysis.

Results:

The mean age was 37.68 ± 14.29 years and majority (60.4%) were female. The mean duration of caregiving was 2.34 ± 1.14. Caregivers (44.5%) reported a mild level of the burden while 4.4% reported severe burden. The mean burden score was 28.30 ± 15.78. Findings also indicate that caregiving affected the physical health (mean = 2.58 ≥ 2.00) and social well-being (mean = 2.42 ≥ 2.00) of the caregivers. The impact on psychological health was less than the threshold value (mean = 1.88 ≤ 2.00), suggesting less impact. Some factors associated with physical effects include poor eating (mean = 2.80) and lack of sleep (mean = 2.92). However, the psychological outcomes were associated with loss of hope (mean = 1.53) and feelings of frustration (mean = 1.65).

Conclusions:

Reported burden of care was mild; although negative health outcomes were noted. Health-care professionals can ameliorate such effects through a regular systemic assessment with standardized instruments, for early identification and intervention.

Remotely delivered information, training and support for informal caregivers of people with dementia

BACKGROUND

Many people with dementia are cared for at home by unpaid informal caregivers, usually family members. Caregivers may experience a range of physical, emotional, financial and social harms, which are often described collectively as caregiver burden. The degree of burden experienced is associated with characteristics of the caregiver, such as gender, and characteristics of the person with dementia, such as dementia stage, and the presence of behavioural problems or neuropsychiatric disturbances. It is a strong predictor of admission to residential care for people with dementia. Psychoeducational interventions might prevent or reduce caregiver burden. Overall, they are intended to improve caregivers' knowledge about the disease and its care; to increase caregivers' sense of competence and their ability to cope with difficult situations; to relieve feelings of isolation and allow caregivers to attend to their own emotional and physical needs. These interventions are heterogeneous, varying in their theoretical framework, components, and delivery formats. Interventions that are delivered remotely, using printed materials, telephone or video technologies, may be particularly suitable for caregivers who have difficulty accessing face-to-face services because of their own health problems, poor access to transport, or absence of substitute care. During the COVID-19 pandemic, containment measures in many countries required people to be isolated in their homes, including people with dementia and their family carers. In such circumstances, there is no alternative to remote delivery of interventions.

OBJECTIVES

To assess the efficacy and acceptability of remotely delivered interventions aiming to reduce burden and improve mood and quality of life of informal caregivers of people with dementia.

SEARCH METHODS

We searched the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE, Embase and four other databases, as well as two international trials registries, on 10 April 2020. We also examined the bibliographies of relevant review papers and published trials.

SELECTION CRITERIA

We included only randomised controlled trials that assessed the remote delivery of structured interventions for informal caregivers who were providing care for people with dementia living at home. Caregivers had to be unpaid adults (relatives or members of the person's community). The interventions could be delivered using printed materials, the telephone, the Internet or a mixture of these, but could not involve any face-to-face contact with professionals. We categorised intervention components as information, training or support. Information interventions included two key elements: (i) they provided standardised information, and (ii) the caregiver played a passive role. Support interventions promoted interaction with other people (professionals or peers). Training interventions trained caregivers in practical skills to manage care. We excluded interventions that were primarily individual psychotherapy. Our primary outcomes were caregiver burden, mood, health-related quality of life and dropout for any reason. Secondary outcomes were caregiver knowledge and skills, use of health and social care resources, admission of the person with dementia to institutional care, and quality of life of the person with dementia.

DATA COLLECTION AND ANALYSIS

Study selection, data extraction and assessment of the risk of bias in included studies were done independently by two review authors. We used the Template for Intervention Description and Replication (TIDieR) to describe the interventions. We conducted meta-analyses using a random-effects model to derive estimates of effect size. We used GRADE methods to describe our degree of certainty about effect estimates.

MAIN RESULTS

We included 26 studies in this review (2367 participants). We compared (1) interventions involving training, support or both, with or without information (experimental interventions) with usual treatment, waiting list or attention control (12 studies, 944 participants); and (2) the same experimental interventions with provision of information alone (14 studies, 1423 participants). We downgraded evidence for study limitations and, for some outcomes, for inconsistency between studies. There was a frequent risk of bias from self-rating of subjective outcomes by participants who were not blind to the intervention. Randomisation methods were not always well-reported and there was potential for attrition bias in some studies. Therefore, all evidence was of moderate or low certainty. In the comparison of experimental interventions with usual treatment, waiting list or attention control, we found that the experimental interventions probably have little or no effect on caregiver burden (nine studies, 597 participants; standardised mean difference (SMD) -0.06, 95% confidence interval (CI) -0.35 to 0.23); depressive symptoms (eight studies, 638 participants; SMD -0.05, 95% CI -0.22 to 0.12); or health-related quality of life (two studies, 311 participants; SMD 0.10, 95% CI -0.13 to 0.32). The experimental interventions probably result in little or no difference in dropout for any reason (eight studies, 661 participants; risk ratio (RR) 1.15, 95% CI 0.87 to 1.53). In the comparison of experimental interventions with a control condition of information alone, we found that experimental interventions may result in a slight reduction in caregiver burden (nine studies, 650 participants; SMD -0.24, 95% CI -0.51 to 0.04); probably result in a slight improvement in depressive symptoms (11 studies, 1100 participants; SMD -0.25, 95% CI -0.43 to -0.06); may result in little or no difference in caregiver health-related quality of life (two studies, 257 participants; SMD -0.03, 95% CI -0.28 to 0.21); and probably result in an increase in dropouts for any reason (12 studies, 1266 participants; RR 1.51, 95% CI 1.04 to 2.20).

AUTHORS' CONCLUSIONS

Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health-related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availability of usual services in the study settings.

A systematic review of the provision and efficacy of patient and carer information and support (PCIS) interventions for patients with dementia and their informal carers

BACKGROUND

The NHS dementia strategy identifies patient and carer information and support (PCIS) as a core component of gold-standard dementia care. This is the first systematic review of PCIS, performed to analyse the literature and evidence for these interventions.

AIMS

To systematically review literature evaluating the effectiveness of the provision of PCIS for people with dementia and their informal carers, in inpatient and outpatient settings.

METHODS

Searches of four online biomedical databases, accessed in September 2018. Studies were selected if they were: relating to people with dementia or their informal carers, based in inpatient or outpatient settings, published in English-language peer-reviewed journals no earlier than the year 2000 and assessed dementia-related information or social support interventions, by measuring qualitative or quantitative carer or patient-reported outcomes. Standardised data extraction and quality appraisal forms were used.

RESULTS

7 of 43 full-text papers analysed were eligible for analysis. 3 papers were different arms of one original study. Trends were present in the quantitative results towards reduced patient and carer depression and anxiety and the themes in the qualitative analysis were in favour of the intervention.

CONCLUSIONS

The studies analysed were too heterogeneous in design, population and outcomes measured to make a conclusive opinion about the efficacy of these interventions. It is surprising that for such a common condition, a gold-standard evidence-based intervention and standardised delivery for provision of PCIS for people living with dementia in the UK does not exist. Further research is therefore vital.

The necessity for sustainable intervention effects: lessons-learned from an experience sampling intervention for spousal carers of people with dementia

OBJECTIVES

Caring for a person with dementia can be challenging over the years. To support family carers throughout their entire caregiving career, interventions with a sustained effectivity are needed. A novel 6-week mobile health (mHealth) intervention using the experience sampling method (ESM) showed positive effects on carers' well-being over a period of 2 months after the intervention. In this study, the effects after 6 months of the selfsame intervention were examined to evaluate the sustainability of positive intervention effects.

METHOD

The 6-week mHealth intervention consisted of an experimental group (ESM self-monitoring and personalized feedback), a pseudo-experimental group (ESM self-monitoring without feedback), and a control group (providing regular care without ESM self-monitoring or feedback). Carers' sense of competence, mastery, and psychological complaints (depression, anxiety and perceived stress) were evaluated pre- and post-intervention as well as at two follow-up time points. The present study focuses on the 6-month follow-up data (n = 50).

RESULTS

Positive intervention effects on sense of competence, perceived stress, and depressive symptoms were not sustained over 6-month follow-up.

CONCLUSION

The benefits of this mHealth intervention for carers of people living with dementia were not sustained over a long time. Similarly, other psychosocial interventions for carers of people with dementia rarely reported long-lasting effects. In order to sustainably contribute to carers' well-being, researchers and clinicians should continuously ensure flexible adjustment of the intervention and consider additional features such as ad-hoc counseling options and booster sessions. In this regard, mHealth interventions can offer ideally suited and unique opportunities.

Antonovsky's sense of coherence and resistance resources reduce perception of burden in family carers of people with Alzheimer's disease

Objectives: Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers.Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD.Results: The path model identified SOC as a major factor related to carer's burden perception (r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' (r = -.235) and 'behavioural disengagement' (r = -.219), and social support perceived (r = .304) were the main carer's personal characteristics directly related with SOC. Caring experience (r = -.281) was the main carer factor related with burden while dependence (r = .156) and BPSD (r = .157) were the dementia factors.Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden.

The Barts Explanatory Model Inventory for Dementia: An item reduction approach based on responses from South Asian communities

BACKGROUND

Cultural differences in how the symptoms, causes, consequences, and treatments of dementia are understood and interpreted by South Asian people are a commonly expressed reason for late- or nonuse of mental health and care services. However, systematic collection of information on South Asian perceptions of dementia is hindered by a lack of appropriate instrumentation.

OBJECTIVES

To produce a shortened version of the Barts Explanatory Model Inventory for Dementia (BEMI-D) schedule.

METHODS

A two stage item reduction approach was employed first using multidimensional scaling categorizing items as core, intermediate, or outlier. Then, item review was undertaken using three criteria: literature importance, clinical face validity, and sub-group prevalence. The analysis followed a nonmetric multidimensional scaling method based on a two-way proximity matrix.

RESULTS

The original BEMI-D had 197 items allocated to four checklists: symptoms, causes, consequences, and treatments. The two stage item reduction approach resulted in the removal of 75 items. These reductions were achieved across all four checklists in relatively equal proportions. There was no evidence of substantive content loss in the revised schedule. The reduced version of the schedule comprises 122 items.

CONCLUSIONS

A condensed version of the BEMI-D is more efficient as an assessment schedule that captures the culturally diverse perceptions of memory problems for South Asians offering a balanced trade-off between feasibility of use and content validity.

"I was Confused About How to Take Care of Mom Because this Disease is Different Everyday": Vietnamese American Caregivers' Understanding of Alzheimer's Disease

Family members provide the majority of caregiving to individuals living with Alzheimer's disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers' understanding of AD: (a) "Now I know:" the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members' cognitive impairments; (c)"Going with the flow:" challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e)"Taking it day by day" in the face of progressively worsening symptoms. Underlining the participants' descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers' outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families' ability to recognize the early symptoms and seek appropriate help.

"I know best:" women caring for kin with dementia

The dementia care literature in the home is vast, particularly in the health sciences where the focus remains on intervention to address carer emotional distress and burden. The sociological literature on dementia care has primarily utilized the illness disruption and (bio)medicalization models to show how meaning and practices are negotiated in the non-expert setting. Instead, I apply a feminist labor process perspective to examine the question of why women dementia kin carers resist relinquishing care responsibilities to others. This qualitative grounded theory study is based on seven waves of interviews (total = 98) conducted over approximately five years with 15 Latina dementia kin carers recruited through clinic and community sites in Northern California. Findings show how Latina kin carers exercise a degree of control and autonomy over the care process because they have developed tacit knowledge and skills to craft quality care of kin. In facing the dilemma of ceding care to others they perceive as unprepared, they reject available help. This study reveals how carers maintain quality care with dignity and comfort for the care recipient and themselves.

Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions

Background and Objectives

Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health.

Research Design and Methods

We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis.

Results

We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented.

Discussion and Implications

Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies.

Acceptability and feasibility of a Japanese version of STrAtegies for RelaTives (START-J): A manualized coping strategy program for family caregivers of relatives living with dementia

The rising older population in Japan is associated with a rise in cases of dementia. Support for the increased number of family caregivers of people living with dementia is crucial, as caring may negatively affect a family caregiver's health. This study seeks to evaluate the feasibility and applicability of a recently developed Japanese version of START (STrAtegies for RelaTives). START is a psychosocial coping intervention program developed in the United Kingdom that has been shown to improve caregivers' mood and quality of life in a randomized controlled trial. We made changes to START (e.g., idioms, linguistic nuance, and providing care insurance information suited for Japan) to make it culturally appropriate. Fourteen Japanese female family caregivers of relatives with mild dementia (n = 10) or mild cognitive impairment (n = 4) were referred to the study, but six were excluded owing to illness and busyness. This single-arm study had a before-after trial evaluating psychological outcomes including depression, anxiety, quality of life, and subjective care burden. The acceptance retention and satisfaction rate suggest the feasibility and acceptability of the START program; 8/14 (>55%) eligible, prospective participants consented and were included in this study, all (8/8) of whom completed all START sessions. The mean program satisfaction score was 30.25 (standard deviation = 2.25) out of a potential 32. The results suggest that it is feasible and acceptable to deliver START in Japanese and based on the results of analysis using a linear mixed model, there is initial indication that the intervention improved family caregivers' quality of life, depressive symptoms, and care burden.

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Background

Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses.

Methods

MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006–2018.

Results

Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulness-based interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings.

Conclusions

This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers’ changing needs in the course of dementia should be a priority for researchers and practitioners.

Cost-Utility Analyses of Interventions for Informal Carers: A Systematic and Critical Review

BACKGROUND

Demographic and epidemiological changes place an increasing reliance on informal carers. Some support programmes exist, but funding is often limited. There is a need for economic evaluation of interventions for carers to assist policymakers in prioritizing carer support.

OBJECTIVE

Our aim was to systematically review and critically appraise cost-utility analyses of interventions for informal carers, in order to assess the methods employed and the quality of the reporting.

METHODS

A systematic review of databases was conducted using MEDLINE, Embase, PsycINFO, and EconLit of items published between 1950 and February 2019. Published studies were selected if they involved a cost-utility analysis of an intervention mainly or jointly targeting informal carers. The reporting quality of economic analyses was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.

RESULTS

An initial set of 1364 potentially relevant studies was identified. The titles and the abstracts were then screened, resulting in the identification of 62 full-text articles that warranted further assessment of their eligibility. Of these, 20 economic evaluations of informal carer interventions met the inclusion criteria. The main geographical area was the UK (n = 11). These studies were conducted in mental and/or behavioural (n = 15), cardiovascular (n = 3) or cancer (n = 2) clinical fields. These cost-utility analyses were based on randomized clinical trials (n = 16) and on observational studies (n = 4), of which only one presented a Markov model-based economic evaluation. Four of the six psychological interventions were deemed to be cost effective versus two of the four education/support interventions, and four of the nine training/support interventions. Two articles achieved a CHEERS score of 100% and nine of the economic evaluations achieved a score of 85% in terms of the CHEERS criteria for high-quality economic studies.

CONCLUSIONS

Our critical review highlights the lack of cost-utility analyses of interventions to support informal carers. However, it also shows the relative prominence of good reporting practices in these analyses that other studies might be able to build on.

Training and support for caregivers of people with dementia: The process of culturally adapting the World Health Organization iSupport programme to Portugal

BACKGROUND

Informal caregivers of people with dementia often struggle with several stressors, and their mental and physical health can be negatively affected by providing care. iSupport is an online self-help programme designed by the World Health Organization to provide education, skills training, and support to those caregivers.

PURPOSE

This paper describes the development of an adapted version of iSupport to the Portuguese culture. We present the adaptation process, methods used and results for the country-specific version.

METHODS

The adaptation of iSupport was operationalised in five steps: needs assessment; content translation by an authorised translator and technical accuracy check by health professionals; cultural adaptation; independent appraisal of contents by an expert panel; and fidelity check by programme authors.

RESULTS

Findings indicated the adjustments needed in the original iSupport contents. Overall, 323 text excerpts were proposed to adaptation, comprising semantic and conceptual equivalence of expressions, and adjustments to cultural habits, customs, traditions, local resources, and practices. The expert panel identified the need to reformulate definitions, designations, recommendations, and case studies to fine-tune the original contents to local knowledge and practices. Most adaptations were considered to be in line with the core concepts of the original programme.

CONCLUSIONS

iSupport is an innovative tool capturing the attention of several organisations around the world interested in translating, adapting, and using the programme. This paper is the first describing the methodological approach for culturally adapting iSupport, constituting an essential resource for those aiming to replicate the process or culturally adapting evidence-based interventions. Tailoring iSupport to the Portuguese context was critical to accommodate the cultural experiences of the target group as well as the knowledge, theoretical approaches, and practices of local professionals. The European-Portuguese version of iSupport introduces the adjustments needed to implement a useful new intervention programme aimed at minimising the psychological distress of Portuguese caregivers.

The relationship between Parkinson's disease symptoms and caregiver quality of life

OBJECTIVE

Caregivers for individuals with Parkinson's disease (PD) can experience high burden, which underlies the importance of examining the needs of caregivers to be able to support them in the caregiving role. The current study aims to assess the relationships among PD symptoms and four measures of caregiver quality of life (QOL; i.e., personal and social activities, anxiety and depression, self-care, and strain).

METHOD

Data from 181 caregiver/care recipient dyads (N = 362) were collected at a multidisciplinary PD clinic in a public, academic medical center in the southeastern United States at the time of the care recipient's first neuropsychological evaluation.

RESULTS

All PD symptoms were positively correlated with each other, as were all forms of caregiver QOL, and all PD symptoms were associated with each measure of caregiver QOL. A series of regressions suggested that demographics and PD symptoms predicted all four types of caregiver QOL, explaining 33% of the variance in caregiver personal and social activities, 24% in anxiety and depression, 28% in self-care, and 36% in strain. Female caregivers and those who provided care to male care recipients generally had worse QOL. Greater PD-related symptoms including difficulties with mobility, decreased emotional well-being, and greater nonmotor functioning impairment were unique predictors of reduced caregiver QOL.

CONCLUSIONS

PD symptoms are robustly related to caregiver QOL, with mobility and nonmotor symptoms as the primary drivers of this relationship. Interventions for PD caregivers should include strategies for managing mobility and nonmotor symptoms, as well as their QOL effects on caregivers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The impact of the implementation of the Dutch combined Meeting Centres Support Programme for family caregivers of people with dementia in Italy, Poland and UK

Objectives: The MEETINGDEM research project aimed to implement the combined Dutch Meeting Centre Support Programme (MCSP) for community-dwelling people with dementia and caregivers within Italy, Poland and UK and to assess whether comparable benefits were found in these countries as in the Netherlands.Method: Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared to usual care (UC) on caregiver outcomes measuring competence (SSCQ), mental health (GHQ-12), emotional distress (NPI-Q) and loneliness (UCLA) analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial. Interviews using standardised measures were completed with caregivers.Results: Pre/post data were collected for 93 caregivers receiving MCSP and 74 receiving UC. No statistically significant differences on the outcome measures were found overall. At a country level MC caregivers in Italy showed significant better general mental health (p = 0.04, d = 0.55) and less caregiver distress (p = 0.02, d = 0.62) at post-test than the UC group. Caregiver satisfaction was rated on a sample at 3 months (n = 81) and 6 months (n = 84). The majority of caregivers reported feeling less burdened and more supported by participating in MCSP.Conclusion: The moderate positive effect on sense of competence and the greater mental health benefit for lonely caregivers using the MCSP compared to UC as found in the original Dutch studies were not replicated. However, subject to study limitations, caregivers in Italy using MCSP benefitted more regarding their mental health and emotional distress than caregivers using UC. Further evaluation of the benefits of MCSP within these countries in larger study samples is recommended.

Staging dementia based on caregiver reported patient symptoms: Implications from a latent class analysis

Background

Tailoring interventions to the needs of caregivers is an important feature of successful caregiver support programs. To improve cost-effectiveness, group tailoring based on the stage of dementia could be a good alternative. However, existing staging strategies mostly depend on trained professionals.

Objective

This study aims to stage dementia based on caregiver reported symptoms of persons with dementia.

Methods

Latent class analysis was used. The classes derived were then mapped with disease duration to define the stages. Logistic regression with receiver operating characteristic curve was used to generate the optimal cut-offs.

Results

Latent class analysis suggested a 4-class solution, these four classes were named as early (25.9%), mild (25.2%), moderate (16.7%) and severe stage (32.3%). The stages based on the cut-offs generated achieved an overall accuracy of 90.8% compared to stages derived from latent class analysis.

Conclusion

The current study confirmed that caregiver reported patient symptoms could be used to classify persons with dementia into different stages. The new staging strategy is a good complement of existing dementia clinical assessment tools in terms of better supporting informal caregivers.

Factors associated with the risk of cardiovascular disease in family caregivers of people with dementia: a systematic review

Objective

This study aimed to systematically review studies that reported factors associated with the risk of cardiovascular disease (CVD) in family caregivers of people with dementia (PWD).

Methods

Literature was searched in PubMed, Medline, CINAHL, and PsycINFO using keywords generated from the terms “dementia”, “caregiver”, and “cardiovascular disease”. We included studies that examined factors associated with CVD risk in family caregivers of PWD, those with longitudinal or cross-sectional study designs, and those published in English.

Results

A total of 34 studies were included in this review. Stress and depressive symptoms, pleasant leisure activity, coping self-efficacy and coping strategy, physical activity, and social support were the main modifiable associated factors of CVD risk in family caregivers of PWD. However, the association between sleep and CVD risk was unclear. Caregiving status, the duration of caregiving, genes, and race, were the main non-modifiable associated factors of CVD risk in family caregivers.

Conclusion

This review showed seven modifiable factors of CVD risk. In particular, leisure activities, physical activity, and social support were significantly negatively associated with the risk of CVD. Researchers and clinical professionals are recommended to consider these risk factors when they develop interventions to reduce CVD risk in family caregivers of PWD.

Clinical effectiveness of the START (STrAtegies for RelaTives) psychological intervention for family carers and the effects on the cost of care for people with dementia: 6-year follow-up of a randomised controlled trial

BACKGROUND

The START (STrAtegies for RelaTives) intervention reduced depressive and anxiety symptoms of family carers of relatives with dementia at home over 2 years and was cost-effective.

AIMS

To assess the clinical effectiveness over 6 years and the impact on costs and care home admission.

METHOD

We conducted a randomised, parallel group, superiority trial recruiting from 4 November 2009 to 8 June 2011 with 6-year follow-up (trial registration: ISCTRN 70017938). A total of 260 self-identified family carers of people with dementia were randomised 2:1 to START, an eight-session manual-based coping intervention delivered by supervised psychology graduates, or to treatment as usual (TAU). The primary outcome was affective symptoms (Hospital Anxiety and Depression Scale, total score (HADS-T)). Secondary outcomes included patient and carer service costs and care home admission.

RESULTS

In total, 222 (85.4%) of 173 carers randomised to START and 87 to TAU were included in the 6-year clinical efficacy analysis. Over 72 months, compared with TAU, the intervention group had improved scores on HADS-T (adjusted mean difference -2.00 points, 95% CI -3.38 to -0.63). Patient-related costs (START versus TAU, respectively: median £5759 v. £16 964 in the final year; P = 0.07) and carer-related costs (median £377 v. £274 in the final year) were not significantly different between groups nor were group differences in time until care home (intensity ratio START:TAU was 0.88, 95% CI 0.58-1.35).

CONCLUSIONS

START is clinically effective and this effect lasts for 6 years without increasing costs. This is the first intervention with such a long-term clinical and possible economic benefit and has potential to make a difference to individual carers.

DECLARATIONS OF INTEREST

G.L., Z.W. and C.C. are supported by the UCLH National Institute for Health Research (NIHR) Biomedical Research Centre. G.L. and P.R. were in part supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart's Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Z.W. reports during the conduct of the study; personal fees from GE Healthcare, grants from GE Healthcare, grants from Lundbeck, other from GE Healthcare, outside the submitted work.

Interventions for reducing levels of burden amongst informal carers of persons with dementia in the community. A systematic review and meta-analysis of randomised controlled trials

Objectives: Caregiver burden can lead to increased stress, depression and health difficulties for caregivers and care-recipients. This systematic review aimed to examine the published evidence, for interventions designed to reduce levels of carer burden, in those caring for a person with dementia. Methods: Three databases were searched (Medline, PsycINFO and CINAHL) for studies reporting on randomised controlled trials of non-pharmacological interventions for dementia-related caregiver burden. Data quality checks were completed for included papers and meta-analysis was performed to estimate the efficacy of individual interventions and different categories of non-pharmacological intervention. Results: Thirty studies were included in the analysis. Seven studies found a significant reduction in carer burden and a pooled effect found that intervening was more effective than treatment as usual (SMD = -0.18, CI = -0.30, -0.05). This result was small, but significant (p = 0.005). Multi-component interventions are more effective than other categories. High heterogeneity means that results should be interpreted with caution. Conclusions: Interventions that significantly reduced levels of burden should be replicated on a larger scale. The relative effectiveness of interventions targeting cognitive appraisals and coping styles suggests that future interventions might be informed by models theorising the role of these processes in carer burden.

The Effectiveness of Psychoeducational and Financial Intervention to Support Caregivers of Individuals With Alzheimer's Disease in Poland

BACKGROUND AND OBJECTIVES

The goal of this study is to create data-driven guidelines and tools for caregivers and health care professionals that will enable caregivers to be prepared for future caregiving-related challenges and decrease their levels of stress.

RESEARCH DESIGN AND METHODS

A total of 60 spousal caregivers of individuals with Alzheimer's disease (AD) living in Poland were recruited for this study. The participants were assigned to two different groups. The intervention group was provided with a five-session training focused on teaching coping strategies for managing difficult behaviors and provided with a stipend for a period of 6 months (a financial aid program recently launched by the local agency). A control group was not provided with any of the interventions but asked to complete the questionnaires. The effectiveness of each intervention was assessed at a baseline and 6 months after baseline evaluation.

RESULTS

Caregivers who received financial and educational training reported significantly decreased levels of depression and caregiver burden in comparison to the control group. The majority of caregivers emphasized that caregiving created financial problems and that their work has been underestimated by the government.

DISCUSSION AND IMPLICATIONS

This project addresses several issues of central importance to the success of building research foundation for the interventions. The results have the potential of generating more efficient and personalized interventions that address the needs of the caregiver as they occur, leading to increased knowledge of AD and decreased levels of depression and caregiver burden.

„Berliner Inventar zur Angehörigenbelastung – Demenz Praxisversion (BIZA-D-PV)“ auch für den nicht demenziellen Bereich?

Zusammenfassung. Pflegende Angehörige sind eine vulnerable Zielgruppe mit zunehmender Bedeutung. Es gibt insbesondere im nicht-demenziellen Bereich wenig Evidenz zu Unterstützungs- und Entlastungsangeboten. Für indikationsübergreifende Evaluationsstudien hat das mehrdimensionale Berliner Inventar zur Angehörigenbelastung – Demenz Praxisversion (BIZA-D-PV) konzeptionelles Potenzial. Es soll die Teststatistik des BIZA-D-PV im nicht-demenziellen und im demenziellen Bereich geprüft werden. Das Instrument hat 33 Items in 7 Skalen. Die Datenbasis waren 161 pflegende Angehörige im nicht-demenziellen Bereich und 133 im demenziellen Bereich. Es wurden explorative Faktorenanalysen und ein Multiple Indicators Multiple Causes (MIMIC) Modell eingesetzt. Die faktorielle Validität und die Reliabilitäten sind in beiden Stichproben vergleichbar und gut. Populationsheterogenität sowie Relationen der Skalen insbesondere mit selbstberichteter Depressivität deuten auf Konstruktvalidität hin. Das BIZA-D-PV ist auch im nicht-demenziellen Bereich ein reliables und faktoriell valides Instrument. Hinweise auf Konstruktvalidität liegen vor, bedürfen aber der weiteren Fundierung.

An acceptance, role transition, and couple dynamics-based program for caregivers: A qualitative study of the experience of spouses of persons with young-onset dementia

Objective

In this study, we assessed a support program based on acceptance, role transition, and couple dynamics for spouses of people with young-onset dementia. The qualitative feedback from the caregivers’ experience is analyzed. The goal was to explore how this home-based support program is perceived and to appraise the impact of the different approaches that were offered.

Design

A thematic analysis was conducted on the answers to the end-of-session questionnaires and the follow-up semistructured interviews.

Results

Five themes emerged from the analyses. They highlighted caregivers’ ability to overcome their emotional struggle as well as the control of their loved one’s behaviors. The results also showed the possibility for caregivers to access new ways to support their loved ones and to maintain the quality of their relationship.

Conclusion

These findings represent preliminary evidence of this program’s efficacy for caregivers.

Depression in carers of people with dementia from a minority ethnic background: Systematic review and meta-analysis of randomised controlled trials of psychosocial interventions

OBJECTIVES

Systematic review and meta-analysis to determine the effectiveness of interventions in reducing depressive symptoms in ethnic minority carers of people with dementia.

METHODS

We systematically searched EMBASE, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Applied Social Sciences Index and Abstracts (ASSIA), The Cochrane Central Register of Controlled Trials (CENTRAL), and Sociological Abstracts and Social Policy and Practices databases from 1990 to 2015, supplemented by a grey literature search, hand searches of bibliographies, and contacting authors. Study quality was assessed independently by two researchers using The Effective Public Health Practice Project Quality Assessment Tool, with an inter-rater reliability of Cohen's kappa of 0.72 (95% CI, 0.42-1.01). Narrative synthesis and meta-analysis were used to assess intervention effectiveness. Meta-regression was used to assess whether factors such as intervention type, peer support, and ethnicity accounted for hetereogeneity.

RESULTS

Thirteen studies were eligible for inclusion, with 1076 participants in control groups and 980 participants in intervention groups; 12 studies provided estimates for meta-analysis. All studies were from the United States. Interventions were associated with an overall mean reduction in depression in caregivers (SMD -0.17 (95% CI, -0.29 to -0.05; P = 0.005). Meta-regression did not indicate any potential sources of heterogeneity, although narrative synthesis suggested that interventions developed with the target ethnic minority group's preferred mode of engagement in mind alongside cultural adaptations may have enhanced effectiveness.

CONCLUSIONS

Psychosocial interventions for depression in ethnic minority carers of people with dementia are effective and could be enhanced through cultural adaptations. High-quality studies targeting minority ethnic groups outside of the United States are needed.

Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention

Background

Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum—from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings.

Objective

This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR).

Methods

A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist.

Results

Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C.

Conclusions

We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR.

Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

BACKGROUND

Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location.

OBJECTIVES

The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population.

SEARCH METHODS

We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another.

DATA COLLECTION AND ANALYSIS

Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively.

MAIN RESULTS

We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison.

AUTHORS' CONCLUSIONS

Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.