Caregiver intervention programs: the moral equivalent of free haircuts?

Kin caregivers of the cognitively impaired elderly: Problems and interventions

Much can be found in the literature concerning the burdens, problems and stressors that caregivers experience. The following is an attempt to identify special needs of kin caregiver subgroups. It is hoped that the problems of the female categories within these subgroups are understood and that health care professionals will begin to develop an awareness that will lead to better ways to provide appropriate interventions.

Caregiving Burden

This article critically examines the burden concept, its lack of clear definition, the inconsistency between its conceptualization and operationalization, its inappropriate use within the stress paradigm, and its marginal policy relevance. A needs-based conceptualization of burden is presented in which burden is defined in terms of frustration of basic needs arising from five characteristics of family care for frail elderly people: awareness of degeneration, unpredictability, time constraints, the caregiver-receiver relationship, and lack of choice. These contributors to burden are called crises of decline to contrast with the experiences normally encountered through child care. The model has received empirical support and represents a reconceptualization that not only accommodates the increasingly popular stress paradigm but also provides a bridge between research that focuses on burden as an individualistic phenomenon and research that links dominant caregiving practices with social injustice.

Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial

Dementia induces morbidity not only in the patients but also in the families taking care of them. Many studies described the impact of care-giving on physical and psychological health. Support groups were designed to alleviate the burden of care-givers. The objective of this study was to measure the efficacy of a support group programme for care-givers of demented patients in the community. Forty-one primary care-givers were randomly assigned to a study (n=23) or a control group (n=18). Subjects of the study group attended a structured programme of eight 2-h sessions. These weekly sessions consisted of information on the disease, role-playing on management of behavior problems, discussion on emotional impact of care-giving, and learning of stress management techniques. Subjects of the control group were referred to informal monthly meetings of the Alzheimer's Society. Subjects of both groups were evaluated at the entry (T1), after 8 weeks (T2) and after 8 months (T3). The outcome variables were the Burden Interview, the Revised Memory and Behavior Problems Checklist, the Brief Symptoms Inventory, the Alzheimer's Disease Knowledge Test and a questionnaire on health care utilization. Compared with the control group, subjects of the study group yielded only a significant increase in knowledge about the disease (p<0.0001) but no significant difference on the other outcome variables. It is concluded that this type of support group programme seems to have only a minimal impact on morbidity and on the burden of care-givers. These results are similar with two other studies examining the same issue.