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de-Moraes-Ribeiro FE, Moreno-Cámara S, da-Silva-Domingues H, Palomino-Moral PÁ, del-Pino-Casado R. Effectiveness of Internet-Based or Mobile App Interventions for Family Caregivers of Older Adults with Dementia: A Systematic Review. Healthcare (Basel) 2024; 12:1494. [PMID: 39120195 PMCID: PMC11311318 DOI: 10.3390/healthcare12151494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Global aging presents socioeconomic and health challenges. Dementia, a growing concern, affects millions of older adults, intensifying the burden on family caregivers. E-health interventions offer hope through technological solutions, although current research is limited. This study evaluated the effectiveness of internet-based or mobile app interventions for family caregivers of older adults with dementia. METHODOLOGY A systematic review with a narrative synthesis was conducted using databases (PubMed, CINAHL, Scopus, LILACS, and PsycInfo) and the bibliographies of retrieved articles, with no restrictions on time or language. RESULTS The search yielded 2092 results, of which 22 studies met the inclusion criteria, encompassing a total of 2761 family caregivers. Twenty-one different outcomes were evaluated and classified into three main types of interventions: psychoeducational, psychotherapeutic, and multicomponent. CONCLUSIONS The study highlights the importance of internet-based and mobile app interventions in supporting family caregivers of older adults with dementia. These interventions positively affect many aspects of caregiver well-being, suggesting their utility in addressing this group's emotional, social, and self-care needs.
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Affiliation(s)
| | - Sara Moreno-Cámara
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Henrique da-Silva-Domingues
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Pedro Ángel Palomino-Moral
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
| | - Rafael del-Pino-Casado
- Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain; (S.M.-C.); (P.Á.P.-M.); (R.d.-P.-C.)
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Cheng JY, Nurul SBMS, Cheng LJ, He HG. Effectiveness of Technology-Delivered Psychosocial Interventions for Family Caregivers of Patients With Dementia: A Systematic Review, Meta-Analysis and Meta-Regression. Int J Ment Health Nurs 2024. [PMID: 39034437 DOI: 10.1111/inm.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/23/2024] [Accepted: 06/29/2024] [Indexed: 07/23/2024]
Abstract
Family caregivers living with patients with dementia (PwD) face psychological challenges due to care burden. Technology-delivered psychosocial interventions (TPIs) have played a promising role in improving health outcomes among family caregivers living with PwD. This review aims to synthesise evidence of the effectiveness of TPIs on primary (burden and depression) and secondary outcomes (self-efficacy, stress and anxiety) for family caregivers living with PwD. Random-effects meta-analyses were performed to determine effect size. Using Cochran's Q and I2 tests, statistical heterogeneity was evaluated. Sensitivity, subgroup analyses and meta-regression were employed to explain statistical heterogeneity. Twenty-eight trials comprising 4160 family caregivers from eight countries were included. Our meta-analysis revealed that TPIs resulted in slight reduction in depression, probably resulted in a slight reduction in burden and anxiety and slight increase in self-efficacy. Subgroup differences were detected in geographical regions (Western Pacific and Southeast Asia) for burden. While there were no significant subgroup differences in other factors, TPIs with preventive function and mobile applications had a more prominent larger effect size. Meta-regression analysis showed that attrition rate was a significant moderator on depression. Results are limited by the high risk of bias of included trials, which may reduce certainty of evidence. This review suggest TPIs are recommended as an adjunct treatment for alleviating burden and depressive outcomes in healthcare institutions. PROSPERO Registration Number: PROSPERO (CRD42023387962).
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Affiliation(s)
- Jing Ying Cheng
- Khoo Teck Put Hospital, Yishun Health, National Healthcare Group, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Saatirah Bte Mohamad S Nurul
- Khoo Teck Put Hospital, Yishun Health, National Healthcare Group, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Ling Jie Cheng
- National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
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Damant J. Unpaid carers of people with dementia and information communication technology: Use, impact and ideas for the future. DEMENTIA 2024; 23:779-799. [PMID: 38664990 PMCID: PMC11163843 DOI: 10.1177/14713012241249793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Several 100,000s of people living with dementia in the UK are cared for at home by a spouse or relative. Few studies have considered the ICT needs and experiences of unpaid carers. This study explores the types of ICT unpaid carers use, the ways they use ICT, the impact of ICT-use, and their ideas for how ICT could be more supportive of their role as a carer. METHODS Six focus groups with 32 unpaid carers of people living with dementia discussed their experiences of - and barriers to - using ICT. Transcripts were analysed thematically according to three types of ICT (mainstream, accessible and formal) and five functions (supporting domestic tasks, care management, monitoring, communication and information and education). RESULTS Participants predominantly used mainstream ICT devices such as laptops and smartphones and internet-enabled applications including videoconferencing and social media platforms to support their daily activities and assist them in their caring role. A few participants discussed using accessible devices such as memory clocks and formal telecare and care-phone services for care management and monitoring functions. Participants' ideas for improvements centred on personalised communication applications that facilitate remote interactions and promote persons living with dementia's independence. Others expressed concerns about the growing need to use ICT to access formal care services and the inadequacy of the ICT infrastructure in some care homes. CONCLUSIONS Unpaid carers mostly turn to readily available mainstream ICT to support their personal and care activities. Further research is required to understand the social impact of the increasing reliance of ICT across health, social and residential care service sectors. Improved cooperation between unpaid carers, technology developers and care services providers could align ICT development to the needs and experiences of families living with dementia and assist unpaid carers with identifying ICTs that optimally support their personal circumstances.
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Affiliation(s)
- Jacqueline Damant
- Care Policy and Evaluation Centre of the London School of Economics and Political Science, London, UK
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Zhu L, Xing Y, Jia H, Xu W, Wang X, Ding Y. Effects of telehealth interventions on the caregiver burden and mental health for caregivers of people with dementia: a systematic review and meta-analysis. Aging Ment Health 2024:1-13. [PMID: 38946249 DOI: 10.1080/13607863.2024.2371480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES To systematically evaluate the effects of telehealth interventions on the caregiver burden and mental health of caregivers for people with dementia (PWD). METHOD Relevant randomized controlled trials (RCTs) of telehealth interventions on caregivers were extracted from nine electronic databases (PubMed, The Cochrane Library, Web of Science, Embase, CINAHL, SinoMed, CNKI, WanFang, and VIP). The retrieval time was from inception to 26 July 2023. RESULTS Twenty-two articles with 2132 subjects were included in the final analysis. The meta-analysis demonstrated that telehealth interventions exerted a significant effect in reducing caregiver burden (SMD: -0.14, 95 % CI: -0.25, -0.02, p = 0.02), depression (SMD = -0.17; 95%CI: -0.27, -0.07, p < 0.001) and stress (SMD = -0.20, 95%CI: -0.37, -0.04, p = 0.01). However, no statistically significant effect was observed on anxiety (SMD = -0.12, 95%CI: -0.27, 0.03, p = 0.12). Moreover, subgroup analysis showed that tailored interventions were associated with more evident reductions in depression (SMD = -0.26; 95%CI: -0.40, -0.13, p < 0.001) than standardized interventions (SMD = -0.08; 95%CI: -0.22, 0.06, p = 0.25). In addition, telehealth was effective in relieving depression in Internet-based (SMD = -0.17, 95%CI: -0.30, -0.03, p = 0.01) and Telephone-based group (SMD = -0.18, 95%CI: -0.34, -0.02, p = 0.03), while there was no significant difference in the Internet and Telephone-based group (SMD = -0.18, 95%CI: -0.54, 0.18, p = 0.32). CONCLUSION Telehealth could effectively reduce the burden and relieve the depression and stress of caregivers of PWD, while its effect on anxiety requires further research. Overall, telehealth has potential benefits in dementia care.
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Affiliation(s)
- Ling Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yurong Xing
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Hongfei Jia
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Wenhui Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiaoxiao Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, Nanjing, China
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Atefi GL, Koh WQ, Kohl G, Seydavi M, Swift JK, Akbari M, de Vugt ME. Adherence to Online Interventions for Family Caregivers of People With Dementia: A Meta-Analysis and Systematic Review. Am J Geriatr Psychiatry 2024:S1064-7481(24)00319-1. [PMID: 38735829 DOI: 10.1016/j.jagp.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE Online interventions hold promise in supporting the well-being of family caregivers and enhancing the quality of care they provide for individuals with long-term or chronic conditions. However, dropout rates from support programs among specific groups of caregivers, such as caregivers of people with dementia, pose a challenge. Focused reviews are needed to provide more accurate insights and estimates in this specific research area. METHODS A meta-analysis of dropout rates from available online interventions for family caregivers of people with dementia was conducted to assess treatment acceptability. A systematic search yielded 18 studies involving 1,215 caregivers. RESULTS The overall pooled dropout rate was 18.4%, with notable heterogeneity indicating varied intervention adherence. Interventions incorporating human contact, interactive features, and personalization strategies for specific types and stages of dementia predicted significantly lower dropout rates. Methodological assessment revealed variability in study quality. CONCLUSION Findings support the effectiveness of social support, personalization strategies, and co-design in enhancing intervention adherence among dementia family caregivers. Further research is needed to explore factors influencing dropout rates and conduct robust trials to refine the implementation of future interventions.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands.
| | - Wei Qi Koh
- School of Health and Rehabilitation Sciences (WQK), The University of Queensland, Brisbane, Australia
| | - Gianna Kohl
- Research Department of Clinical (GK), Educational and Health Psychology, University College London, London, UK
| | - Mohammad Seydavi
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Joshua K Swift
- Department of Psychology (JKS), Idaho State University, 921 S. 8th St, Pocatello, ID
| | - Mehdi Akbari
- Department of Clinical Psychology (MS, MA), Faculty of Psychology and Education, Kharazmi University, Tehran, Iran.
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg (GLA, MEV), Maastricht University, Maastricht, The Netherlands
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Castillo LIR, Tran V, Hadjistavropoulos T. Are mobile apps meeting the needs of caregivers of people living with dementia? An evaluation of existing apps for caregivers. Aging Ment Health 2024; 28:577-586. [PMID: 36775643 DOI: 10.1080/13607863.2023.2177832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/02/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES Informal caregivers of people living with dementia (ICPDs) experience stressors that can lead to adverse outcomes. Although apps for ICPDs are available, evidence to support their effectiveness is limited. This investigation was aimed at providing an evaluation of available apps for ICPDs. METHODS We conducted two studies: 1) search and evaluation of available apps; and 2) controlled trial of two apps identified in the Study 1 (NCT05217004). For Study 2, participants were randomly assigned to one of the two app-using groups or a control group. Outcome measures were administered before, post-intervention, and at a follow-up. Interviews with caregivers were conducted to examine their needs regarding the development of future apps. RESULTS Sixteen apps were examined in Study 1. Results suggest that the number and type of features present in each app may not be sufficient to address the multifaceted needs of ICPDs. In Study 2, contrary to expectation, we did not identify differences between the app-using and control conditions on our outcome measures. Participants noted several content and user-experience needs to consider in developing new apps. CONCLUSION Findings from the investigation can inform future developments of apps to address the needs of ICPDs.
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Affiliation(s)
- Louise I R Castillo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Canada
| | - Vivian Tran
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, Canada
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Suárez-González A, John A, Brotherhood E, Camic PM, McKee-Jackson R, Melville M, Sullivan MP, Tudor-Edwards R, Windle G, Crutch S, Hoare Z, Stott J. "Better Living with Non-memory-led Dementia": protocol for a feasibility randomised controlled trial of a web-based caregiver educational programme. Pilot Feasibility Stud 2023; 9:172. [PMID: 37821924 PMCID: PMC10566043 DOI: 10.1186/s40814-023-01403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Non-memory-led dementias such as posterior cortical atrophy (PCA), primary progressive aphasia (PPA) and behavioural variant frontotemporal dementia (bvFTD) are low prevalent and often affect individuals under the age of 65. Tailored educational and support resources for caregivers of people living with these dementia phenotypes are scarce and unevenly distributed geographically. Web-based educational programmes are emerging as promising alternatives to improve caregiver self-efficacy and well-being. Here, we present the protocol of a study aiming to assess the feasibility of a co-produced online educational programme for caregivers of people living PCA, PPA and bvFTD: the Better Living with Non-memory-led Dementia programme. METHODS A randomised controlled feasibility trial will be conducted on a sample of 30 caregivers of people living with PCA, PPA and bvFTD. Participants will be recruited among members of the support organisation Rare Dementia Support (based at UCL in the UK). The intervention group will be given access to an 8-week co-produced web-based educational programme consisting of 6 modules addressing education about PCA, PPA and bvFTD and support strategies for the person with dementia and for the caregiver. The control group will receive treatment as usual (TAU). Feasibility will be measured through feasibility of recruitment, clinical measurement tools and acceptability. Clinical measures will be used to assess preliminary efficacy and data on completion rates, missing data and variability used to decide on measures to be included in a full-scale trial. Allocation ratio will be 2:1 (intervention:control) stratified by diagnosis. Feasibility of recruitment and acceptability will be assessed. Clinical measures will be administered at baseline and 8-week and 3-month post-randomisation. The control group will be offered access to the intervention at the completion of data collection. Participants will be unblinded, and all measures will be self-reported online. DISCUSSION Online-delivered educational programmes show potential for improving care competency of caregivers and may contribute to overcoming geographical inequalities in local provision of support services. This pilot study will inform a fully powered international trial to determine the effectiveness of Better Living with Non-memory-led Dementia. TRIAL REGISTRATION This trial has been registered prospectively on the Clinical Trials Registry on 1st September 2022, registration number NCT05525377.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK.
| | - Amber John
- Psychology and Language Sciences, University College London, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Roberta McKee-Jackson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Mel Melville
- Psychology and Language Sciences, University College London, London, UK
| | - Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON, Canada
| | | | - Gill Windle
- Dementia Services Development Centre, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, UK
| | - Joshua Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, WC1N 3BG, UK
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Harding E, Rossi-Harries S, Alterkawi S, Waddington C, Grillo A, Wood O, Brotherhood EV, Windle G, Sullivan MP, Camic PM, Stott J, Crutch SJ. 'The oxygen of shared experience': exploring social support processes within peer support groups for carers of people with non-memory-led and inherited dementias. Aging Ment Health 2023; 27:1912-1928. [PMID: 36999880 DOI: 10.1080/13607863.2023.2194848] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES To explore support processes and behaviours taking place during online peer support groups for family carers of people living with rare, non-memory-led and inherited dementias (PLWRD). METHODS Twenty-five family carers of PLWRD participated in a series of ongoing online peer support groups on the theme of 'Independence and Identity'. Transcripts from 16 sessions were analysed using qualitative directed content analysis with a coding framework informed by Cutrona & Suhr's (2004) Social Support Behaviour Code (SSBC). RESULTS Most of the social support behaviours outlined in the SSBC were identified within the sessions, along with two novel social support categories - 'Experiential Support' and 'Community Support' - and novel support behaviours including 'Advocacy and Collective Action' and 'Uses Humour'. The SSBC code 'Relationship' appeared to be of central importance. CONCLUSIONS This study sheds light on the unique challenges of the caring context for those affected by non-memory-led and inherited dementias and the significant contributions carers can offer to, and receive from, peers in similar situations. It highlights the importance of services which recognise the value of the informational and emotional expertise of carers of PLWRD and encourages the continued development and delivery of tailored support for these populations.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Samuel Rossi-Harries
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Shaima Alterkawi
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, Nipissing, Ontario, Canada
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Gill Windle
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, Nipissing, Ontario, Canada
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Joshua Stott
- Department of Clinical, Educational, and Health Psychology, UCL Division of Psychology and Language Sciences, UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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Yu Y, Xiao L, Ullah S, Meyer C, Wang J, Pot AM, He JJ. The effectiveness of internet-based psychoeducation programs for caregivers of people living with dementia: a systematic review and meta-analysis. Aging Ment Health 2023; 27:1895-1911. [PMID: 36951611 DOI: 10.1080/13607863.2023.2190082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The objectives of this systematic review and meta-analysis were to identify the characteristics of internet-based psychoeducational programs for caregivers of people living with dementia and to synthesise program effectiveness. METHOD Five English databases and four Chinese databases were searched in June 2021 with no time limit applied. A narrative summary was performed to describe the characteristics of studies reviewed. Meta-analysis was applied to synthesise the pooled effects where data were available. RESULTS A total of 14352 articles were identified from the database search and 19 were included in the final review. Interventions comprised educational, psychological, and behavioural training relevant to dementia care. Program duration ranged from 3 weeks to 12 months. Meta-analysis of 13 RCTs showed that internet-based psychoeducational programs had a significant effect on reducing caregivers' depressive symptoms (SMD -0.19; 95% CI -0.03 - 0.35) and stress (SMD -0.29; 95% CI -0.03 -0.54). However, these programs did not show an effect on quality of life, anxiety, burden or self-efficacy in caregivers. CONCLUSION Internet-based psychoeducational programs can improve some aspects of caregivers' mental health and emotional wellbeing. The effects of programs on self-efficacy, anxiety, burden and quality of life for caregivers remain inconclusive.
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Affiliation(s)
- Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Jing Wang
- Faculty of Nursing, Xi'an Jiao tong University, Xi'an, China
| | - Ann Margriet Pot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Optentia, North-West University, Vanderbijlpark, South-Africa
| | - Jin Jie He
- Faculty of Nursing, Xi'an Jiao tong University, Xi'an, China
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Scerbe A, O'Connell ME, Astell A, Morgan D, Kosteniuk J, Panyavin I, DesRoches A, Webster C. Digital tools for delivery of dementia education for caregivers of persons with dementia: A systematic review and meta-analysis of impact on caregiver distress and depressive symptoms. PLoS One 2023; 18:e0283600. [PMID: 37196022 DOI: 10.1371/journal.pone.0283600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/13/2023] [Indexed: 05/19/2023] Open
Abstract
Continuing education for dementia has been shown to be beneficial by improving informal caregiver knowledge, dementia care, management, and caregiver physical and mental health. Technology-based dementia education has been noted to have equivalent effects as in-person education, but with the added benefit of asynchronous and/or remote delivery, which increases accessibility. Using Cochrane review methodology, this study systematically reviewed the literature on technology-based dementia education and its impacts on caregivers. Technology-based delivery included dementia education delivered via the Internet, telephone, telehealth, videophone, computer, or digital video device (DVD). In the review, twenty-eight studies were identified with fourteen included in a meta-analysis, and these data revealed a significant small effect of technologically based dementia education on reducing caregiver depression, and a medium effect on reducing caregiver distress in response to caregivers' observations of behavioral problems displayed by persons with dementia. No evidence was found for a significant effect of the educational intervention on caregiver burden or self-efficacy, which are known to be gendered aspects of caregiving. None of the studies included in the meta-analysis reported separate outcomes for male and female care providers, which has implications for gendered caregiving norms and aspects of care. Registration number: PROSPERO 2018 CRD42018092599.
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Affiliation(s)
- Andrea Scerbe
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Arlene Astell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Debra Morgan
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kosteniuk
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ivan Panyavin
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Andrea DesRoches
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Claire Webster
- Certified Alzheimer Care Consultant, Caregiver Crosswalk Inc., Montréal, Quebec, Canada
- McGill University Dementia Education Program, Montréal, Quebec, Canada
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11
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Wen Y, Xing Y, Ding Y, Xu W, Wang X. Challenges of conducting of online educational programs for family caregivers of people with dementia living at home: An integrative review. Int J Nurs Sci 2022; 10:121-128. [PMID: 36860711 PMCID: PMC9969171 DOI: 10.1016/j.ijnss.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives This integrative review aimed to understand the challenges of conducting online educational programs for family caregivers of people with dementia by focusing on the components and design of them. Methods Following Whittemore & Knafl's five-step method, seven databases were systematically searched. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. Results Of the 25,256 articles identified, 49 studies were included. Limitations in components (including useless or repetitive information, incomplete access to dementia-related information, the impact of components related to culture or ethnicity or gender) and in the format of delivered information (including less interaction, time schedule limitations and preference for traditional forms of delivery of information) make it more challenging to conduct online educational programs. Additionally, implementation constraints such as technical problems, poor computer literacy, and fidelity assessment are challenges that cannot be ignored. Conclusions Insight into the challenges of online educational programs for family caregivers of people with dementia can help guide researchers in constructing the optimal online educational program. Incorporating cultural specificity, considering structured construction strategies, optimizing interaction design, and increasing fidelity assessment may contribute to the conduct of online educational programs.
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Affiliation(s)
- Yuting Wen
- The School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- The School of Nursing, Pingxiang Health Vocational College, Pingxiang, Jiangxi, China
| | - Yurong Xing
- The School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaping Ding
- The School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- Corresponding author.
| | - Wenhui Xu
- The School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoxiao Wang
- The School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
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12
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Boyt N, Ho AK, Morris-Bankole H, Sin J. Internet-facilitated interventions for informal caregivers of patients with neurodegenerative disorders: Systematic review and meta-analysis. Digit Health 2022; 8:20552076221129069. [PMID: 36276187 PMCID: PMC9585576 DOI: 10.1177/20552076221129069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/11/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This systematic review explored the effectiveness of internet-delivered interventions in improving psychological outcomes of informal caregivers for neurodegenerative-disorder (ND) patients. Methods We searched seven databases for English-language papers published from 1999 to May 2021. Study-eligibility required that interventions used a minimum 50% internet-facilitation, targeting unpaid, adult informal caregivers of community-based ND-patients. We included randomised controlled trials (RCTs) and pre-post evaluative studies reporting outcomes for at least one-time point post-intervention. Independent quality checks on abstract and full-text screening were completed. Data extraction encompassed interventions' features, approaches, theoretical bases and delivery-modes. The Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) framework assessed risk of bias. Alongside narrative synthesis, we calculated meta-analyses on post-intervention using outcome measures from at least two RCTs to assess effectiveness. Results Searches yielded 51 eligible studies with 3180 participants. In 48 studies, caregivers supported a dementia-diagnosed individual. Intervention-durations encompassed four weeks to 12 months, with usage-frequency either prescribed or participant-determined. The most frequently-used approach was education, followed by social support. We calculated meta-analyses using data from 16 RCTs. Internet-delivered interventions were superior in improving mastery (g = 1.17 [95% CI; 0.1 to 2.24], p = 0.03) and reducing anxiety (g = -1.29 [95% CI; -1.56 to -1.01], p < 0.01), compared to all controls. Findings were equivocal for caregivers' quality of life, burden and other outcomes. High heterogeneity reflected the multifarious combinations of approaches and delivery-modes, precluding assessment of the most efficacious intervention features. Analyses using burden and self-efficacy outcomes' follow-up data were also non-significant compared to all comparator-types. Although 32 studies met the ICROMS threshold scores, we rated most studies' evidence quality as 'very-low'. Conclusions This review demonstrated some evidence for the efficacy of internet-delivered interventions targeting informal ND-caregivers. However, more rigorous studies, with longer follow-ups across outcomes and involving NDs other than dementia, are imperative to enhance the knowledge-base.
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Affiliation(s)
- Neil Boyt
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England,Neil Boyt, School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England, UK.
| | - Aileen K Ho
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England
| | - Hannah Morris-Bankole
- School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, RG6 6AL, England
| | - Jacqueline Sin
- School of Health Sciences, University of London, Myddelton Street Building, Myddelton Street, London, EC1R 1UW, England
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13
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Wu KC, Su Y, Chu F, Chen AT, Zaslavsky O. Behavioral Change Factors and Retention in Web-Based Interventions for Informal Caregivers of People Living With Dementia: Scoping Review. J Med Internet Res 2022; 24:e38595. [PMID: 35797100 PMCID: PMC9305400 DOI: 10.2196/38595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Web-based interventions aimed at supporting informal caregivers of people living with dementia have the potential to improve caregivers' well-being and psychological health. However, few interventions are widely implemented for this population, and none of the prior reviews have systematically examined the use of behavior change techniques (BCTs), theories, and agents in web-based interventions for informal caregivers of people living with dementia. To better understand this implementation gap, we reviewed the literature to map behavioral factors (BCTs, theories, and agents) deployed in the studies. Furthermore, because there is an emerging consensus that retention could be shaped by participant characteristics and behavioral factors, we explored relationships between these features and retention rates across studies. OBJECTIVE We pursued 3 objectives: to map behavioral factors involved in the web-based interventions for informal caregivers of people living with dementia; to examine the relationship between behavioral change elements and retention in the studies; and to examine the relationship between participant characteristics (gender, age, and spouse or adult children caregiver proportion) and study retention. METHODS We conducted a literature review using the following keywords and their corresponding Medical Subject Headings terms: dementia, caregivers, and web-based intervention. The time limits were January 1998 to March 2022. Using the BCTv1 taxonomy, which specifies active behavioral components in interventions, 2 coders collected, summarized, and analyzed the frequency distributions of BCTs. Similarly, they abstracted and analyzed participant characteristics, behavior change theories, behavior change agents, and retention rates in the studies. RESULTS The average age was 61.5 (SD 7.4) years, and the average proportion of spousal informal caregivers, adult children informal caregivers, and retention rates were 51.2% (SD 24.8%), 44.8% (SD 22%), and 70.4% (SD 17%), respectively. Only 53% (17/32) of the studies used behavior change theories, but 81% (26/32) included behavior change agents. The most common BCTv1 clusters were shaping knowledge and social support. The median number of BCTv1 clusters was 5 (IQR 3). We observed a negative correlation between the proportion of spousal informal caregivers and the retention rate (r=-0.45; P=.02) and between the number of BCTv1 clusters and retention rates (r=-0.47; P=.01). We also found that the proportion of adult children informal caregivers in the study was significantly and positively correlated with the retention rate (r=0.5; P=.03). No other participant characteristics or behavioral factors were associated with retention rates. CONCLUSIONS We found that almost half of the studies were not informed by behavior change theories. In addition, spousal involvement and a higher number of BCTs were each associated with lower retention rates, while the involvement of adult children caregivers in the study was associated with higher retention. In planning future studies, researchers should consider matching participant characteristics with their intended intervention as the alignment might improve their retention rates.
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Affiliation(s)
- Kuan-Ching Wu
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Yan Su
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Frances Chu
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, United States
| | - Oleg Zaslavsky
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, United States
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14
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Guessi Margarido M, Shah A, Seto E. Smartphone applications for informal caregivers of chronically ill patients: a scoping review. NPJ Digit Med 2022; 5:33. [PMID: 35314766 PMCID: PMC8938465 DOI: 10.1038/s41746-022-00567-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractMobile-health applications can be used to deliver timely and personalized health information to family and friends of chronically ill adults living in the community. This scoping review aims to investigate the nature and extent of native smartphone applications for informal caregivers. Six databases were searched for articles on applications across ten chronic conditions, namely heart disease, stroke, cancer, chronic obstructive respiratory disease, asthma, diabetes, Alzheimer’s disease or other dementia, rheumatoid arthritis, hypertension, and mood or anxiety disorders. In total, 36 articles were included, encompassing 26 applications. Of these, smartphone applications were designed for use only by caregivers (n = 15), with a few applications also intended to be used with patients (n = 5), healthcare providers (n = 4), or all three roles (n = 2). Most applications targeted a single chronic condition (n = 25), with Alzheimer’s and other dementia being the most common (n = 18). Only one application was designed for management of multiple chronic conditions. Long-term evaluation methods are needed to continually assess the impact of applications on a range of process and health outcomes, such as usability, caregiver burden, and quality of life. Additional directions to advance native smartphone applications for caregivers are discussed, including personalization and expansion of eligibility criteria.
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15
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Sun Y, Ji M, Leng M, Li X, Zhang X, Wang Z. Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis. Int J Nurs Stud 2022; 129:104204. [DOI: 10.1016/j.ijnurstu.2022.104204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/21/2022]
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16
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Biliunaite I, Kazlauskas E, Sanderman R, Andersson G. Process Evaluation of Internet-Based Cognitive Behavioral Therapy Intervention for Informal Caregivers. Front Med (Lausanne) 2021; 8:725510. [PMID: 34869422 PMCID: PMC8632733 DOI: 10.3389/fmed.2021.725510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Informal caregivers are individuals who provide care for ill, frail, or otherwise dependent family members, siblings, or friends. Due to the caregiving demands, informal caregivers are known to experience negative mental health symptoms, such as stress or anxiety. Interventions based on Internet-based Cognitive Behavioral Therapy (ICBT) principles have been previously found to be effective for different populations and could also be considered as a plausible support option for informal caregivers. However, findings regarding effectiveness alone might not be sufficient for informing about the overall feasibility of the intervention. Objective: The aim of this process evaluation study was to evaluate the feasibility of a previously developed ICBT intervention for informal caregivers in Lithuania. More specifically, we evaluated the suitability of the intervention in relation to its content and delivery mode. Methods: Two studies were conducted. Study 1 consisted of participant evaluations of an 8-week, 8-module long therapist supported ICBT intervention. Evaluations for the Study 1 were retrieved from previously unused data, obtained from pilot testing of the intervention in which 63 informal caregivers took part. The evaluations contained of qualitative data (participant comments), as well as quantitative data (evaluations of each of the sessions). The Study 2 was an online stakeholder focus-group discussion conducted via Zoom. Eight stakeholders took part in the discussion, among whom there were social workers, medical professionals as well as individuals with caregiving experience themselves. Data were analyzed using descriptive statistics, thematic analysis, and data coding. Results: Results of the Study 1 showed that most of the pilot randomized controlled trial participants evaluated content and format of the intervention positively. These results were complemented by the findings in the Study 2, in which stakeholders evaluated the intervention as suitable and promising. In addition, stakeholders made certain suggestions for improving the intervention's usability for the informal caregivers. This included improving the instructions, providing with more guidance, and considering personalization options. Conclusion: The process evaluation helped to evaluate the feasibility of the ICBT intervention for informal caregivers in Lithuania from the two perspectives: users and stakeholders. Our findings suggest that the intervention is suitable for the target population.
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Affiliation(s)
- Ieva Biliunaite
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health & Technology, University of Twente, Enschede, Netherlands
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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17
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Sztramko R, Levinson AJ, Wurster AE, Jezrawi R, Sivapathasundaram B, Papaioannou A, Cowan D, St Onge J, Marr S, Patterson C, Woo T, Mosca L, Lokker C. Online Educational Tools for Caregivers of People with Dementia: A Scoping Literature Review. Can Geriatr J 2021; 24:351-366. [PMID: 34912490 PMCID: PMC8629496 DOI: 10.5770/cgj.24.506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Informal caregivers of people with dementia provide the majority of health-based care to people with dementia. Providing this care requires knowledge and access to resources, which caregivers often do not receive. We set out to evaluate the effect of online educational tools on informal caregiver self-efficacy, quality of life, burden/stress, depression, and anxiety, and to identify effective processes for online educational tool development. METHODS We conducted a scoping review of articles on online educational interventions for informal caregivers of people with dementia searching CINAHL, MEDLINE, EMBASE, and PubMed from 1990 to March 2018, with an updated search conducted in 2020. The identified articles were screened and the data were charted. RESULTS 33 articles that reported on 24 interventions were included. There is some evidence that online interventions improve caregiver-related outcomes such as self-efficacy, depression, dementia knowledge, and quality of life; and decrease caregiver burden. Common findings across the studies included the need for tailored, stage-specific information applicable to the caregiver's situation and the use of psychosocial techniques to develop the knowledge components of the interventions. CONCLUSION We demonstrate the importance of having caregivers and health-care professionals involved at all stages of tool conceptualization and development. Online tools should be evaluated with robust trials that focus on how increased knowledge and development approaches affect caregiver-related outcomes.
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Affiliation(s)
- Richard Sztramko
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Anthony J. Levinson
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Andrea E. Wurster
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Rita Jezrawi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | | | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - David Cowan
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Joye St Onge
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Sharon Marr
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Tricia Woo
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Lori Mosca
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
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18
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Non-pharmacological Interventions for Caregivers with Depression and Caregivers of Care Recipients with Co-morbid Depression: Systematic Review and Meta-analysis. J Gen Intern Med 2021; 36:3159-3178. [PMID: 34159546 PMCID: PMC8481392 DOI: 10.1007/s11606-021-06891-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Caregivers experiencing depression or caring for people experiencing depression are at risk of high burden. This systematic review examined the effect of non-pharmacological interventions for caregivers that (a) target improving caregivers' depressive symptoms, (b) help caregivers manage the depressive symptoms of the person for whom they provide care, or (c) both (a) and (b). METHODS Eligible trials published between January 1, 1985, and May 30, 2019 were retrieved from five electronic databases. The studies' methodological quality was assessed against 15 criteria. Pooled effect sizes (ESs) were calculated, and heterogeneity assessed using the Higgin's I2 statistic. Meta-regressions were also conducted to identify significant moderators (participant sub-group analyses) and mediators (identify how the interventions worked). RESULTS Sixteen studies evaluating 18 interventions were included for review. These studies included a total of 2178 participants (mean = 94, SD = 129.18, range 25-518). The most common condition (n = 10/16) of the care recipient was dementia. The average methodological score was in the moderate range (8.76/15). Interventions had a moderate effect on caregivers' depression in the short term (ES = - 0.62, 95% CI - 0.81, - 0.44), but the effect dissipated over time (ES = - 0.19; 95% CI - 0.29, - 0.09). A similar pattern was noted for anxiety. The moderator analysis was not significant, and of the mediators examined, significant ones were self-management skills of taking action, problem solving, and decision-making. DISCUSSION Non-pharmacological interventions are associated with improvement of depression and anxiety in caregivers, particularly in the short term. The main recommendation for future interventions is to include the self-management skills taking action, problem-solving, and decision-making. Enhancing the effect of these interventions will need to be the focus of future studies, particularly examining the impact of booster sessions. More research is needed on non-dementia caregiving and dyadic approaches.
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19
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Dequanter S, Gagnon MP, Ndiaye MA, Gorus E, Fobelets M, Giguère A, Bourbonnais A, Buyl R. The Effectiveness of e-Health Solutions for Aging With Cognitive Impairment: A Systematic Review. THE GERONTOLOGIST 2021; 61:e373-e394. [PMID: 32525977 PMCID: PMC8437510 DOI: 10.1093/geront/gnaa065] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives e-Health solutions are an innovative approach to support aging with cognitive impairment. Because technology is developing at a fast pace, the aim of this review was to present an overview of the research regarding the effectiveness of these solutions. Moreover, the availability of these solutions was examined. Research Design and Methods Systematic searches were conducted in 7 databases. Full texts of potentially relevant references were assessed by 2 reviewers, and discrepancies were solved through discussion. Data on study characteristics, technology type, application domain, availability, outcomes, and effects were extracted. A categorization exercise and narrative synthesis were conducted. Results In total, 72 studies describing 70 e-Health solutions were identified. The majority of solutions comprised cognitive training for older adults, followed by educational and supportive web platforms for caregivers. Outcomes included mainly measures of cognition, psychosocial functioning, caregiving processes, caregiver–care receiver relationship, and activities of daily living. Positive effects of cognitive training technologies were observed on cognitive functioning of older adults, as well as those of supportive web platforms on behavioral and psychological symptoms of dementia and caregiver self-efficacy. The effects of these solutions on depression in both target groups were inconclusive. The methodological quality of the studies was moderate to good. However, some important limitations were observed. Discussion and Implications The review identified cognitive training solutions and supportive web platforms as the most effective on a limited number of outcomes. Although other solutions seem promising, further research has to overcome methodological issues. Furthermore, solutions for leisure and reminiscence and outcomes specifically related to independent living deserve more attention.
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Affiliation(s)
- Samantha Dequanter
- Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel, Belgium
| | - Marie-Pierre Gagnon
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care of Laval University (CERSSPL-UL), Québec, Canada.,Faculty of Nursing Sciences, Université Laval, Québec, Canada
| | - Mame-Awa Ndiaye
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care of Laval University (CERSSPL-UL), Québec, Canada
| | - Ellen Gorus
- Department of Gerontology, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Belgium
| | - Maaike Fobelets
- Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel, Belgium
| | - Anik Giguère
- Institute of Health and Social Services in Primary Care, Research Center on Healthcare and Services in Primary Care of Laval University (CERSSPL-UL), Québec, Canada.,Faculty of Nursing Sciences, Université Laval, Québec, Canada
| | | | - Ronald Buyl
- Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel, Belgium
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20
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Kim E, Baskys A, Law AV, Roosan MR, Li Y, Roosan D. Scoping review: the empowerment of Alzheimer's Disease caregivers with mHealth applications. NPJ Digit Med 2021; 4:131. [PMID: 34493819 PMCID: PMC8423781 DOI: 10.1038/s41746-021-00506-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/03/2021] [Indexed: 11/09/2022] Open
Abstract
Alzheimer's Disease (AD) is one of the most prevalent neurodegenerative chronic diseases. As it progresses, patients become increasingly dependent, and their caregivers are burdened with the increasing demand for managing their care. Mobile health (mHealth) technology, such as smartphone applications, can support the need of these caregivers. This paper examines the published academic literature of mHealth applications that support the caregivers of AD patients. Following the PRISMA for scoping reviews, we searched published literature in five electronic databases between January 2014 and January 2021. Twelve articles were included in the final review. Six themes emerged based on the functionalities provided by the reviewed applications for caregivers. They are tracking, task management, monitoring, caregiver mental support, education, and caregiver communication platform. The review revealed that mHealth applications for AD patients' caregivers are inadequate. There is an opportunity for industry, government, and academia to fill the unmet need of these caregiver.
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Affiliation(s)
- Eunhee Kim
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA
| | - Andrius Baskys
- Western University of Health Sciences, College of Graduate Biomedical Sciences, Pomona, CA, USA
| | - Anandi V Law
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA
| | - Moom R Roosan
- Chapman University, School of Pharmacy, Department of Pharmacy Practice, Pomona, CA, USA
| | - Yan Li
- Claremont Graduate University, School of Information Systems & Technology, Pomona, CA, USA
| | - Don Roosan
- Western University of Health Sciences, College of Pharmacy, Department of Pharmacy Practice and Administration, Pomona, CA, USA.
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21
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Effects of e-Health Training and Social Support Interventions for Informal Caregivers of People with Dementia-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157728. [PMID: 34360020 PMCID: PMC8345641 DOI: 10.3390/ijerph18157728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/11/2023]
Abstract
Along with the burden commonly experienced by informal caregivers (ICs) of people with dementia (PwD), associated with the progressive decline that accompanies dementia, the lockdown due to the public health crisis has had a great negative impact on the emotional wellbeing, physical health, and social relationships of ICs. Support interventions through telemedicine represent an opportunity for ICs to learn the skills required for the care and maintenance of social networks. In this work, a narrative review of the effects of e-health training and social support interventions was carried out. A literature search was conducted using the ProQuest, Ovid, and Scopus databases. Information regarding social support (SS), psychological interventions, and training for the management of medications and behavioral changes was extracted. One hundred and nine studies were included in this review. Forums and training platforms were the main tools for ICs. The most effective platforms to improve SS include the participation of both ICs and health professionals. However, no significant improvements in objective caring skills were identified. Platforms developed specifically for ICs should be based in tools that ICs are familiar with, because many ICs have not yet incorporated Information and Communication Technologies in many activities of their daily lives. Education in the digitalization to ICs of PwD should be one of the priority objectives in telehealth interventions.
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22
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Etxeberria I, Salaberria K, Gorostiaga A. Online support for family caregivers of people with dementia: a systematic review and meta-analysis of RCTs and quasi-experimental studies. Aging Ment Health 2021; 25:1165-1180. [PMID: 32363901 DOI: 10.1080/13607863.2020.1758900] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Online interventions focused on mitigating the negative impact of care on family caregivers of people with dementia have become increasingly popular recently. The aim of this systematic review and meta-analysis was to analyze the effectiveness of these online support programs and to assess whether they do indeed enhance participants' wellbeing. A systematic literature search of 5 scientific databases was performed: PubMed, PsycInfo, CINAHL, Web of Science and Cochrane Library. Online interventions published between January 2014 and July 2018 targeted at informal family caregivers of people with dementia living at home were systemically reviewed. A total of 10 randomized controlled trials (RCTs) or studies with quasi-experimental designs were found. The characteristics of the interventions varied widely, as did their duration and results. In general, the effect size found was medium-small, despite the high methodological quality of the studies. The results reveal that online support interventions are a valid resource for improving caregivers' psychological wellbeing, including depression, anxiety, burden and caregiving competence. The best results were found for multi-component interventions: psychoeducation, training in psychological strategies and skills, professional support and online forums or support groups with other caregivers. The meta-analysis indicated that family caregivers' depression levels were reduced in the intervention group (Hedges' g = -0.21, 95% confidence interval of -0.410 to -0.025; z = -2.216: p = 0.027), although no significant differences were observed between the mean changes found in the intervention and control groups in relation to anxiety, burden or competence.Online interventions targeted at family caregivers can help improve their psychological wellbeing. Nevertheless, more randomized controlled trials are required, with rigorous methodological criteria, in order to provide further evidence of the utility of these interventions which seem to be effective.
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Affiliation(s)
- Igone Etxeberria
- Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
| | - Karmele Salaberria
- Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
| | - Arantxa Gorostiaga
- Department of Social Psychology and Behavioral Sciences Methods, Faculty of Psychology, University of the Basque Country UPV/EHU, San Sebastián, Guipúzcoa, Spain
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23
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Do caregivers who connect online have better outcomes? A systematic review of online peer-support interventions for caregivers of people with stroke, dementia, traumatic brain injury, Parkinson’s disease and multiple sclerosis. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractBackground and Objectives:This systematic review aimed to identify and appraise the evidence for online peer-support interventions for caregivers of stroke survivors (with and without aphasia), and people with dementia, traumatic brain injury (TBI), Parkinson’s disease and multiple sclerosis.Research Design and Methods:Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases were systematically searched up until September 2020: EMBASE, PubMed, CINAHL, Scopus and Web of Science. Two reviewers independently screened titles, abstracts and full-text articles. The methodological quality of included studies was assessed using Physiotherapy Evidence Database (PEDro) and Mixed-Methods Appraisal Tool (MMAT) scales. Interventions were described using the Template for Intervention Description and Replication (TIDieR) checklist.Results:A total of 3026 records were identified from database searches. Following screening, 18 studies reporting 17 interventions were included in this review. Most studies (n = 13) reported interventions for caregivers of people with dementia. All studies incorporated an element of peer support as part of the intervention, however, most interventions (n = 15) comprised both psychosocial and educational elements. Statistically significant changes were reported for 11 interventions in one or more of the following domains: caregiver knowledge, mental health, stress, depression, distress, burden, self-efficacy, mastery, helplessness and perceived support. Qualitative outcomes included perceived reductions in stress and increased emotional and informational support.Discussion and Implications:Positive changes in caregiver outcomes were identified in response to multi-component online interventions (i.e., peer support in addition to education). Peer support was often poorly described, limiting the conclusions that could be drawn about the intervention components which result in better outcomes. Online interventions may provide an accessible and effective means of supporting caregivers.
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Faieta J, Sheehan J, DiGiovine C. Mhealth interventions to improve health and quality of life related outcomes for informal dementia caregivers: A scoping review. Assist Technol 2021; 34:362-374. [PMID: 33006526 DOI: 10.1080/10400435.2020.1829174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The devastating effects of dementia extend to the health and well-being of informal dementia caregivers. The physical and mental requirements of serving as a dementia caregiver are evidenced in the negative health effects that this population experiences. There is a present need for effective interventions to improve health and quality of life in informal dementia caregivers. OBJECTIVE To investigate the health and well-being related outcomes following mHealth use in dementia caregiver and care recipient populations. METHODS A scoping review was undertaken to investigate mHealth use in dementia caregivers. Searches spanning four databases yielded 172 articles. Following screening procedures, 12 articles were included for data extraction.. RESULTS Articles were organized into three major themes: social and indirect support, health education, and technology-supported monitoring. Social and indirect support apps may be valuable for caregiver stress relief, confidence, and fatigue. Health education apps were found to 1) assist with the organization of user's health information, and 2) impact depressive symptoms. Monitoring apps provided caregivers with methods of observing both physical and emotional well-being.. CONCLUSION Currently, the limited evidence on the usability and usefulness of mHealth within dementia caregiver populations indicates that mHealth holds promise as an intervention platform and warrants continued investigation.Abbreviations: AD: Alzheimer's Disease; CANE: Camberwell Assessment of Need for the Elderly; CCS: Caregiver Competence Scale, CDN: COGKNOW Day Navigator; CES-D: Center for Epidemiologic Studies Depression Scale; CG: Caregivers; CQoL-AD: Carer's Overall Quality of Life in Alzheimer's Disease; Dx: Diagnosis; ESM: experience sampling methodology; FB: Facebook; PA: Positive Affect; Pss-14: Perceived Stress Scale; QOL: Quality of Life; RCSS: Revised Caregiving Satisfaction Scale; SSCQ: Short Sense of Competence Questionnaire.
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Affiliation(s)
- Julie Faieta
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Jamie Sheehan
- Battelle Biomedical Research Center, West Jefferson, North Carolina, USA.,Assistive Technology Center, The Ohio State University Wexner Medical Center, Ohio, Columbus, USA
| | - Carmen DiGiovine
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Occupational Therapy Division, The Ohio State University, Columbus, Ohio, USA.,Biomedical Engineering Department, The Ohio State University, Columbus, Ohio, USA
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González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J. Remotely delivered information, training and support for informal caregivers of people with dementia. Cochrane Database Syst Rev 2021; 1:CD006440. [PMID: 33417236 PMCID: PMC8094510 DOI: 10.1002/14651858.cd006440.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
| | - Javier Ballesteros
- Department of Neuroscience, University of the Basque Country, CIBER Salud Mental (CIBERSAM), Leioa, Spain
| | - José-Ramón Rueda
- Department of Preventive Medicine and Public Health, University of the Basque Country, Leioa, Spain
| | - Borja Santos-Zorrozúa
- Scientific coordination Unit, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Miguel Cruz A, Daum C, Comeau A, Salamanca JDG, McLennan L, Neubauer N, Liu L. Acceptance, adoption, and usability of information and communication technologies for people living with dementia and their care partners: a systematic review. Disabil Rehabil Assist Technol 2020; 18:443-457. [PMID: 33378627 DOI: 10.1080/17483107.2020.1864671] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This review aims to examine the instruments, approaches, scales, or assessment tools used to evaluate technology acceptance, technology adoption, and usability of information and communication technologies (ICTs) for people living with dementia and their care partners. METHODS A systematic literature review was conducted. Studies that explored the use of instruments, approaches, scales, or assessment tools to evaluate the technology acceptance and usability of ICTs for people living with dementia and their care partners were identified through five databases: Medline, EMBASE, CINAHL, Web of Science, and Scopus. RESULTS We included 74 out of 2182 papers. The most common scales used included the System Usability Scale (SUS) (11%), the ISONORM 9241/10 Questionnaire (4%), and the Post-Study System Usability Questionnaire (PSSUQ) (4%). Most (59%) of the included approaches, however, were bespoke (i.e., created by the authors for a particular study) and were not named. The approaches or tools used to assess technology acceptance, technology adoption, and usability of ICTs that applied to people living with dementia had an average of 15 items and used an average of 5.23 scale points. CONCLUSION There is no clear, standardised approach for assessing the technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners. The findings of this review may be used by academics to design and implement improved and more consistent assessment tools to assess technology acceptance, technology adoption, and usability of ICTs for people living with dementia and their care partners.IMPLICATIONS FOR REHABILITATIONThe number of ICTs for people with dementia and their care partners that can be used for rehabilitation is increasingThe most commonly recognized assessment tools used in this study were the SUS, ISONORM 9241/10, and PSSUQ questionnaires.For the custom assessment tools, the average number of items included in this study was 15 with five-point bidirectional labelling.There is no clear, standardized approach for assessing the technology acceptance, technology adoption, or usability of ICTs for people with dementia and their care partners.
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Affiliation(s)
- Antonio Miguel Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Glenrose Rehabilitation Research, Innovation & Technology (GRRIT) Hub, Glenrose Rehabilitation Hospital, Edmonton, Canada.,Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Christine Daum
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Aidan Comeau
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Juan David Guevara Salamanca
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Sociology, Faculty of Arts, University of Alberta, Edmonton, Canada
| | | | - Noelannah Neubauer
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, Canada
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Lorca-Cabrera J, Martí-Arques R, Albacar-Riobóo N, Raigal-Aran L, Roldan-Merino J, Ferré-Grau C. Mobile Applications for Caregivers of Individuals with Chronic Conditions and/or Diseases: Quantitative Content Analysis. Int J Med Inform 2020; 145:104310. [PMID: 33161319 DOI: 10.1016/j.ijmedinf.2020.104310] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Mobile health applications can help empowering caregivers and promote their wellbeing and their quality of life. OBJECTIVE To analyze the technical and functional characteristics of mobile health applications designed for caregivers of individuals with chronic conditions and/or diseases. MATERIALS AND METHODS Systematic search of mobile health applications for smartphones (apps) based on the PRISMA standard for systematic reviews on the App Store and Google Play store during May and June 2018. A second search was carried out on the Pubmed and Google Scholar database to determine whether the applications had been tested or evaluated with results published in scientific journals and then a third search was performed on the Spanish health apps catalogs to evaluate the quality and security of the selected apps. RESULTS 746 available health apps were identified and 43 were included in this paper. 67% (n = 29) of the apps were aimed exclusively at informal caregivers, 51% (n = 22) were designed to support caregivers and only 21% (n = 9) of them provided any sort of social or emotional support. The screening in Pubmed and Google Scholar determined that the apps analyzed lacked published papers and most of the apps (84%; n = 36) lacked approval from official agencies supporting their usage. DISCUSSION The apps available on the market that meet the actual needs of caregivers are limited. Most of the apps were aimed at improving the care of the individual with a chronic illness. CONCLUSION Despite the remarkable benefits of mHealth regarding the care of chronic diseases, a relatively poor contribution has been made to support caregivers. Customized apps, interventions assessing their effectiveness and adequate evidence are needed to understand the impact of this digital tool on caregivers' health.
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Affiliation(s)
- Jael Lorca-Cabrera
- Emergency Department, Hospital de Tortosa Verge de la Cinta, Esplanetes Street, 44-58, 43500 Tortosa, Spain.
| | - Rut Martí-Arques
- Nursing Department, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Remolins avenue, 13-15, 43500 Tortosa, Spain.
| | - Núria Albacar-Riobóo
- Nursing Department, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Remolins avenue, 13-15, 43500 Tortosa, Spain.
| | - Laia Raigal-Aran
- Nursing Department, Campus Catalunya, Universitat Rovira i Virgili, Catalunya avenue, 35, 43002 Tarragona, Spain.
| | - Juan Roldan-Merino
- Mental Health Institution, Campus Docent Sant Joan de Déu, Esade-3 Building, Miret i Sans Street, 10-16, 08034, Barcelona, Spain.
| | - Carmen Ferré-Grau
- Nursing Department, Campus Catalunya, Universitat Rovira i Virgili, Catalunya avenue, 35, 43002 Tarragona, Spain.
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Leng M, Zhao Y, Xiao H, Li C, Wang Z. Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e19468. [PMID: 32902388 PMCID: PMC7511858 DOI: 10.2196/19468] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/25/2020] [Accepted: 07/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Caring for people with dementia is perceived as one of the most stressful and difficult forms of caring. Family caregivers always experience high levels of psychological burden and physical strain, so effective and practical support is essential. Internet-based supportive interventions can provide convenient and efficient support and education to potentially reduce the physical and psychological burden associated with providing care. Objective This review aimed to (1) assess the efficacy of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and (2) evaluate the potential effects of internet-based supportive intervention access by caregivers on their care recipients. Methods An electronic literature search of the PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO databases was conducted up to January 2020. Two reviewers (ML and YZ) worked independently to identify randomized controlled trials (RCTs) that met the inclusion criteria and independently extracted data. The quality of the included RCTs was evaluated using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMDs) with 95% CIs were applied to calculate the pooled effect sizes. Results In total, 17 RCTs met the eligibility criteria and were included in this systematic review. The meta-analysis showed that internet-based supportive interventions significantly ameliorated depressive symptoms (SMD=–0.21; 95% CI –0.31 to –0.10; P<.001), perceived stress (SMD=–0.40; 95% CI –0.55 to –0.24; P<.001), anxiety (SMD=–0.33; 95% CI –0.51 to –0.16; P<.001), and self-efficacy (SMD=0.19; 95% CI 0.05-0.33; P=.007) in dementia caregivers. No significant improvements were found in caregiver burden, coping competence, caregiver reactions to behavioral symptoms, or quality of life. Six studies assessed the unintended effects of internet-based supportive intervention access by caregivers on their care recipients. The results showed that internet-based supportive interventions had potential benefits on the quality of life and neuropsychiatric symptoms in care recipients. Conclusions Internet-based supportive interventions are generally effective at ameliorating depressive symptoms, perceived stress, anxiety, and self-efficacy in dementia caregivers and have potential benefits on care recipients. Future studies are encouraged to adopt personalized internet-based supportive interventions to improve the health of family caregivers and their care recipients. Trial Registration PROSPERO CRD42020162434; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162434
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Affiliation(s)
- Minmin Leng
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Yajie Zhao
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Hongmei Xiao
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ce Li
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing: A Joanna Briggs Institute Affiliated Group, Beijing, China
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Holt Clemmensen T, Hein Lauridsen H, Andersen-Ranberg K, Kaae Kristensen H. Informal carers' support needs when caring for a person with dementia - A scoping literature review. Scand J Caring Sci 2020; 35:685-700. [PMID: 32781496 DOI: 10.1111/scs.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hassan AYI. Challenges and Recommendations for the Deployment of Information and Communication Technology Solutions for Informal Caregivers: Scoping Review. JMIR Aging 2020; 3:e20310. [PMID: 32723720 PMCID: PMC7424480 DOI: 10.2196/20310] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
Background Information and communication technology (ICT)–based solutions have the potential to support informal caregivers in home care delivery. However, there are many challenges to the deployment of these solutions. Objective The aim of this study was to review literature to explore the challenges of the deployment of ICT-based support solutions for informal caregivers and provide relevant recommendations on how to overcome these challenges. Methods A scoping review methodology was used following the Arksey and O’Malley methodological framework to map the relevant literature. A search was conducted using PubMed, IEEE library, and Scopus. Publication screening and scrutiny were conducted following inclusion criteria based on inductive thematic analysis to gain insight into patterns of challenges rising from deploying ICT-based support solutions for informal caregivers. The analysis took place through an iterative process of combining, categorizing, summarizing, and comparing information across studies. Through this iterative process, relevant information was identified and coded under emergent broader themes as they pertain to each of the research questions. Results The analysis identified 18 common challenges using a coding scheme grouping them under four thematic categories: technology-related, organizational, socioeconomic, and ethical challenges. These range from specific challenges related to the technological component of the ICT-based service such as design and usability of technology, to organizational challenges such as fragmentation of support solutions to socioeconomic challenges such as funding of technology and sustainability of solutions to ethical challenges around autonomy and privacy of data. For each identified challenge, recommendations were created on how to overcome it. The recommendations from this study can provide guidance for the deployment of ICT-based support solutions for informal caregivers. Conclusions Despite a growing interest in the potential offered by ICT solutions for informal caregiving, diverse and overlapping challenges to their deployment still remain. Designers for ICTs for informal caregivers should follow participatory design and involve older informal caregivers in the design process as much as possible. A collaboration between designers and academic researchers is also needed to ensure ICT solutions are designed with the current empirical evidence in mind. Taking actions to build the digital skills of informal caregivers early in the caregiving process is crucial for optimal use of available ICT solutions. Moreover, the lack of awareness of the potential added-value and trust toward ICT-based support solutions requires strategies to raise awareness among all stakeholders—including policy makers, health care professionals, informal caregivers, and care recipients—about support opportunities offered by ICT. On the macro-level, policies to fund ICT solutions that have been shown to be effective at supporting and improving informal caregiver health outcomes via subsidies or other incentives should be considered.
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Affiliation(s)
- Alhassan Yosri Ibrahim Hassan
- Centre for Socio-Economic Research on Ageing, Italian National Institute of Health & Science on Ageing, Ancona, Italy.,Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Università Politecnica delle Marche, Ancona, Italy
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Carter G, Monaghan C, Santin O. What is known from the existing literature about peer support interventions for carers of individuals living with dementia: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1134-1151. [PMID: 31919974 DOI: 10.1111/hsc.12944] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
This scoping review comprehensively describes evidence of using peer support to assist informal carers of individuals with dementia (any type). A systematic search of 11 databases (CINAHL, Cochrane Library, Medline, Embase, PsychInfo, Web of Science, Scopus, Science Direct, ProQuest, TRIP and PubMed) was conducted for research published between 2007-2017 focussing on informal dementia carers, and research designs with interventions incorporating or consisting exclusively of peer support. Authors worked independently to screen retrieved articles, review applicability and extract data. Thirty-six research papers (representing 28 original studies) were identified, from these, two modes of delivery were demonstrated: 12 studies provided the intervention online, and the remainder face-to-face. The review indicated that peer support is of potential benefit to carers if it is delivered via either mode. It is not clear what components may or may not be effective as results provided a mixed landscape of differing intervention effectiveness due to the wide variation in outcome measurements. Trial design using a multi-component intervention was the predominant choice, with the most common components being Information Sharing and Non-Healthcare Professional Support for both delivery modes. The burden/anxiety/depression compendium and health and well-being were the most frequently measured outcomes; perceived level of support was one of the least. The peer support interventions identified included various components, demonstrating no true best practice model. Nonetheless, they can be offered successfully online or face-to-face. This provides a unique opportunity to develop and supply tailored peer support interventions for informal dementia carers to ensure their specific needs are met. Further work is required to construct and evaluate the effectiveness of targeted peer-led support whether online or face-to-face to meet the individual needs of dementia carers.
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Affiliation(s)
- Gillian Carter
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University, Belfast, UK
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Petrovic M, Gaggioli A. Digital Mental Health Tools for Caregivers of Older Adults-A Scoping Review. Front Public Health 2020; 8:128. [PMID: 32411643 PMCID: PMC7198719 DOI: 10.3389/fpubh.2020.00128] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/30/2020] [Indexed: 01/25/2023] Open
Abstract
Aim: Informal caregivers have an important role in bridging the gap between the assistance care recipients need and what can be provided by the health care systems across Europe. The burden of the caregiving role places a significant threat to caregiver health, and the vast majority of caregiver's report stress and emotional strain, depression, and increased rates of chronic diseases. In line with this, strengthening the caregiver's mental health is one of the main goals for optimal caregiving. Caregivers already struggle with the demand of their role while coping with health problems, social, family, and work obligations. The solution for the caregiver's mental health needs to be accessible, low cost, and time-effective. This scoping review investigates digital mental health tools available as a mean of supporting the mental health of caregivers. Method: Databases searched include Summon search box, the Cochrane Library, and PubMed. Three groups of keywords were combined: relating to digital mental health interventions for caregivers, digital mental health interventions and stress in elderly care, and digital mental health interventions and burden in elderly care. Results: Caregivers reported that digital mental health tools have an overall positive role in their health. Coping skills, emotion regulation, skill building, and education are found to be important aspects of digital mental health tools. There was a noted lack of digital mental health apps available specifically for the caregiver of older adults. Furthermore, the digital mental health tools, divided into three categories in this review, focused either on building skills or educating caregivers and assisting with the duties rather than the mental health of the caregiver itself. As repeatedly suggested in the reviewed studies, digital mental health interventions overall contribute to reducing the caregiver burden with a limitation of addressing one aspect of caregiver needs –i.e., specific coping skills or education regarding illnesses such as Alzheimer's disease and Dementia. The lack of all-encompassing, data and theory-driven digital mental health tools for addressing and supporting the caregiver's mental health is evident.
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Affiliation(s)
- Milica Petrovic
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - Andrea Gaggioli
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano (IRCCS), Milan, Italy
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Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:764-785. [PMID: 32096857 DOI: 10.1001/jama.2019.22258] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. STUDY SELECTION Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. MAIN OUTCOMES AND MEASURES Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. RESULTS The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. CONCLUSIONS AND RELEVANCE Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Lorca-Cabrera J, Grau C, Martí-Arques R, Raigal-Aran L, Falcó-Pegueroles A, Albacar-Riobóo N. Effectiveness of health web-based and mobile app-based interventions designed to improve informal caregiver's well-being and quality of life: A systematic review. Int J Med Inform 2019; 134:104003. [PMID: 31790857 DOI: 10.1016/j.ijmedinf.2019.104003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internet-based interventions can help empower caregivers of people with chronic diseases and can develop solutions to decrease the physical and psychological consequences resulting from caregiving. OBJECTIVE Analysing the effectiveness of health web-based and/or mobile app-based interventions with regard to the level of well-being and quality of life of informal caregivers in charge of people with chronic diseases. MATERIALS AND METHODS Systematic review of the following databases: Pubmed, Apa PsycINFO, ProQuest Health & Medical Complete and Scopus. Quality standards established by PRISMA and Joanna Briggs Institute Systematic Review Approach have been followed. The two phases of the selection process were carried out independently and a cross-case comparative analysis by three reviewers. RESULTS A total of 17 studies met inclusion criteria. The analysis shows that almost all studies involved web-based interventions with the exception of one which concerned a mobile app-based intervention. Most of them prove their effectiveness in the overall well-being of the caregiver and more specifically in the mental dimension, highlighting a decrease in caregivers' anxiety and/or distress, depression symptoms and sense of competence. CONCLUSIONS The findings support that web-based interventions have an impact mainly on caregivers' well-being. Nevertheless, other dimensions that are necessary for caregiving, such as physical, mental and social dimension, have been scarcely explored. More studies on mobile app-based interventions are needed to know their effectiveness.
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Affiliation(s)
- Jael Lorca-Cabrera
- Nursing Department, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Av/ Remolins, 13-15, 43500 Tortosa, Spain.
| | - Carme Grau
- Nursing Department, Campus Catalunya, Universitat Rovira i Virgili, Av/ Catalunya, 35, 43002 Tarragona, Spain.
| | - Rut Martí-Arques
- Nursing Department, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Av/ Remolins, 13-15, 43500 Tortosa, Spain.
| | - Laia Raigal-Aran
- Nursing Department, Campus Catalunya, Universitat Rovira i Virgili, Av/ Catalunya, 35, 43002 Tarragona, Spain.
| | - Anna Falcó-Pegueroles
- Nursing Department, Escola Universitaria d'Infermeria, Universitat de Barcelona, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona.
| | - Núria Albacar-Riobóo
- Nursing Department, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Av/ Remolins, 13-15, 43500 Tortosa, Spain.
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Klimova B, Valis M, Kuca K, Masopust J. E-learning as valuable caregivers' support for people with dementia - A systematic review. BMC Health Serv Res 2019; 19:781. [PMID: 31676005 PMCID: PMC6824008 DOI: 10.1186/s12913-019-4641-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 10/15/2019] [Indexed: 01/22/2023] Open
Abstract
Background Present demographic trends show a considerable rise in elderly populations with aging disorders, such as dementia. The current article focused on the exploitation of e-learning as an informal support for caregivers of people with dementia and considered its benefits and limitations to provide proper and relevant care for this target group of people as well as maintain the quality of life of their caregivers. Methods The methodology of this study is based on a literature review of accessible peer-review articles from three recognized databases: Web of Science, Scopus, and PubMed. The findings of the selected studies were compared and evaluated. Results The findings showed that e-learning educational programs/courses helped caregivers feel more confident about dementia care, reduced their perceived stress and enhanced their feelings of empathy, understanding and concern. Conclusions The findings of this study reveal that the exploitation of e-learning as a support tool, especially for informal caregivers, in the management of dementia may be a promising method, but its implementation requires professional training of informal caregivers in the use of this technology. More evidence-based studies are needed on this topic.
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Affiliation(s)
- Blanka Klimova
- Department of Applied Linguistics, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, Hradec Kralove, Czech Republic
| | - Martin Valis
- Department of Neurology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Biomedical Research Centre, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic. .,Malaysia Japan International Institute of Technology (MJIIT), Universiti Teknologi Malaysia Kuala Lumpur, Jalan Sultan Yahya Petra, Kuala Lumpur, 54100, Malaysia.
| | - Jiri Masopust
- Department of Neurology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic.,Department of Psychiatry, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic
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Aksoydan E, Aytar A, Blazeviciene A, van Bruchem - Visser RL, Vaskelyte A, Mattace-Raso F, Acar S, Altintas A, Akgun-Citak E, Attepe-Ozden S, Baskici C, Kav S, Kiziltan G. Is training for informal caregivers and their older persons helpful? A systematic review. Arch Gerontol Geriatr 2019; 83:66-74. [DOI: 10.1016/j.archger.2019.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
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Deeken F, Rezo A, Hinz M, Discher R, Rapp MA. Evaluation of Technology-Based Interventions for Informal Caregivers of Patients With Dementia-A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 2019; 27:426-445. [PMID: 30642650 DOI: 10.1016/j.jagp.2018.12.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). METHODS PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. RESULTS Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. CONCLUSION Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.
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Affiliation(s)
- Friederike Deeken
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Anna Rezo
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Matthias Hinz
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Robert Discher
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany
| | - Michael A Rapp
- Social and Preventive Medicine (FD, AR, MH, RD, MAR), University of Potsdam, Potsdam, Germany.
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Sikder AT, Yang FC, Schafer R, Dowling GA, Traeger L, Jain FA. Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing. JMIR Aging 2019; 2:e12850. [PMID: 31518275 PMCID: PMC6715046 DOI: 10.2196/12850] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023] Open
Abstract
Background Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants’ perceived feasibility and benefits. Results A total of 17 of the 21 (80%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain “centered” despite caregiving challenges and positive reframing of the caregiver experience. Conclusions App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials.
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Affiliation(s)
| | | | - Rhiana Schafer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Lara Traeger
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Felipe Ananda Jain
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Cheng ST, Au A, Losada A, Thompson LW, Gallagher-Thompson D. Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned. Curr Psychiatry Rep 2019; 21:59. [PMID: 31172302 PMCID: PMC6554248 DOI: 10.1007/s11920-019-1045-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Andrés Losada
- Psychology Department, Universidad Rey Juan Carlos, Madrid, Spain
| | - Larry W. Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA ,Betty Irene Moore School of Nursing/Family Caregiving Institute, University of California, Davis, CA 95616 USA
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Ploeg J, Ali MU, Markle-Reid M, Valaitis R, Bartholomew A, Fitzpatrick-Lewis D, McAiney C, Sherifali D. Caregiver-Focused, Web-Based Interventions: Systematic Review and Meta-Analysis (Part 2). J Med Internet Res 2018; 20:e11247. [PMID: 30368439 PMCID: PMC6229518 DOI: 10.2196/11247] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 01/27/2023] Open
Abstract
Background Approaches to support the health and well-being of family caregivers of adults with chronic conditions are increasingly important given the key roles caregivers play in helping family members to live in the community. Web-based interventions to support caregivers have the potential to lessen the negative health impacts associated with caregiving and result in improved health outcomes. Objective The primary objective of this systematic review and meta-analysis was to examine the effect of caregiver-focused, Web-based interventions, compared with no or minimal Web-based interventions, on caregiver outcomes. The secondary objective was to assess the effect of different types of Web-based interventions (eg, education, peer and professional psychosocial support, and electronic monitoring of the care recipient), compared with no or minimal Web-based interventions, on caregiver outcomes. Methods MEDLINE, EMBASE, CIHAHL, PsychInfo, Cochrane, and AgeLine were searched from January 1995 to April 2017 for relevant randomized controlled trials (RCTs) or controlled clinical trials (CCTs) that compared caregiver-focused, Web-based intervention programs with no or minimal Web-based interventions for caregivers of adults with at least one chronic condition. Studies were included if they involved: adult family or friend caregivers (aged ≥18 years) of adults living in the community with a chronic condition; a caregiver-focused, Web-based intervention of education or psychosocial support or electronic monitoring of the care recipient; and general caregiver outcomes (ie, burden, life satisfaction, self-efficacy or mastery, reaction to problem behavior, self-esteem, strain, and social support). Title and abstract as well as full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for these caregiver outcomes were meta-analyzed. Results The search yielded 7927 unique citations, of which 294 studies were screened at full text. Of those, 14 studies met the inclusion criteria; 12 were RCTs and 1 study was a CCT. One study used an RCT design in 1 country and a CCT design in 2 other countries. The beneficial effects of any Web-based intervention program, compared with no or minimal Web-based intervention, resulted in a mean increase of 0.85 points (95% CI 0.12 to 1.57) for caregiver self-esteem, a mean increase of 0.36 points (95% CI 0.11 to 0.62) for caregiver self-efficacy or mastery, and a mean decrease of 0.32 points (95% CI −0.54 to −0.09) for caregiver strain. However, the results are based on poor-quality studies. Conclusions The review found evidence for the positive effects of Web-based intervention programs on self-efficacy, self-esteem, and strain of caregivers of adults living with a chronic condition. Further high-quality research is needed to inform the effectiveness of specific types of Web-based interventions on caregiver outcomes. Trial Registration PROSPERO CRD42018091715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=91715 (Archived by WebCite at http://www.webcitation.org/738zAa5F5)
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Affiliation(s)
- Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada.,World Health Organization Collaborating Centre for Primary Care and Health Human Resources, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Donna Fitzpatrick-Lewis
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- Program for Interpersonal Practice, Education and Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada.,McMaster Evidence Review and Synthesis Team, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, ON, Canada
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Jütten LH, Mark RE, Wicherts JM, Sitskoorn MM. The Effectiveness of Psychosocial and Behavioral Interventions for Informal Dementia Caregivers: Meta-Analyses and Meta-Regressions. J Alzheimers Dis 2018; 66:149-172. [DOI: 10.3233/jad-180508] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Linda Helena Jütten
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
| | - Ruth Elaine Mark
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
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Christie HL, Bartels SL, Boots LM, Tange HJ, Verhey FR, de Vugt ME. A systematic review on the implementation of eHealth interventions for informal caregivers of people with dementia. Internet Interv 2018; 13:51-59. [PMID: 30206519 PMCID: PMC6112102 DOI: 10.1016/j.invent.2018.07.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The objectives were to (1) systematically review the literature on the implementation of eHealth interventions for informal caregivers of people with dementia, and (2) identify determinants of successful implementation. METHODS Online databases were searched for articles about eHealth interventions for informal caregivers of people with dementia, providing information on their implementation. Articles were independently screened and inductively analyzed using qualitative analysis. The analysis was mapped onto the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). FINDINGS 46 articles containing 204 statements on implementation were included. The statements on implementation were grouped into four categories: Determinants associated with the eHealth application, informal caregiver, implementing organization, or wider context. Mapping of the determinants on the CFIR revealed that studies have focused mostly on characteristics of the intervention and informal caregiver. Limited attention has been paid to organizational determinants and the wider context. CONCLUSIONS Despite prolific effectiveness and efficacy research on eHealth interventions for caregivers of people with dementia, there is a critical dearth of implementation research. Furthermore, there is a mismatch between eHealth intervention research and implementation frameworks, especially concerning organizational factors and wider context. This review underscores the importance of future implementation research in bridging the gap between research and practice.
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Affiliation(s)
- Hannah L. Christie
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
- Corresponding author.
| | - Sara L. Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Lizzy M.M. Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Huibert J. Tange
- Department of Family Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
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Sherifali D, Ali MU, Ploeg J, Markle-Reid M, Valaitis R, Bartholomew A, Fitzpatrick-Lewis D, McAiney C. Impact of Internet-Based Interventions on Caregiver Mental Health: Systematic Review and Meta-Analysis. J Med Internet Res 2018; 20:e10668. [PMID: 29970358 PMCID: PMC6053616 DOI: 10.2196/10668] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The health of informal caregivers of adults with chronic conditions is increasingly vital since caregivers comprise a large proportion of supportive care to family members living in the community. Due to efficiency and reach, internet-based interventions for informal caregivers have the potential to mitigate the negative mental health outcomes associated with caregiving. OBJECTIVE The objective of this systematic review and meta-analysis was to examine the impact of internet-based interventions on caregiver mental health outcomes and the impact of different types of internet-based intervention programs. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, and AgeLine databases were searched for randomized controlled trials or controlled clinical trials published from January 1995 to April 2017 that compared internet-based intervention programs with no or minimal internet-based interventions for caregivers of adults with at least 1 chronic condition. The inclusion criteria were studies that included (1) adult informal caregivers (aged 18 years or older) of adults living in the community with a chronic condition; (2) an internet-based intervention program to deliver education, support, or monitoring to informal caregivers; and (3) outcomes of mental health. Title and abstract and full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for mental health outcomes were meta-analyzed. RESULTS The search yielded 7923 unique citations of which 290 studies were screened at full-text. Of those, 13 studies met the inclusion criteria; 11 were randomized controlled trials, 1 study was a controlled clinical trial, and 1 study comprised both study designs. Beneficial effects of any internet-based intervention program resulted in a mean decrease of 0.48 points (95% CI -0.75 to -0.22) for stress and distress and a mean decrease of 0.40 points (95% CI -0.58 to -0.22) for anxiety among caregivers. For studies that examined internet-based information and education plus professional psychosocial support, the meta-analysis results showed small to medium beneficial effect sizes of the intervention for the mental health outcomes of depression (-0.34; 95% CI -0.63 to -0.05) and anxiety (-0.36; 95% CI -0.66 to -0.07). Some suggestion of a beneficial effect on overall health for the use of information and education plus combined peer and professional support was also shown (1.25; 95% CI 0.24 to 2.25). Overall, many studies were of poor quality and were rated at high risk of bias. CONCLUSIONS The review found evidence for the benefit of internet-based intervention programs on mental health for caregivers of adults living with a chronic condition, particularly for the outcomes of caregiver depression, stress and distress, and anxiety. The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, with combined peer and psychological support. Further high-quality research is needed to inform the effectiveness of interactive, dynamic, and multicomponent internet-based interventions. TRIAL REGISTRATION PROSPERO CRD42017075436; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=75436 (Archived by WebCite at http://www.webcitation.org/709M3tDvn).
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Affiliation(s)
- Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Evidence Review and Synthesis Team, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Muhammad Usman Ali
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Health, Aging and Society, Faculty of Social Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Person-Centred Interventions for Older Adults with Multimorbidity and their Caregivers, Hamilton, ON, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,World Health Organization Collaborating Centre for Primary Care and Health Human Resources, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amy Bartholomew
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Donna Fitzpatrick-Lewis
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carrie McAiney
- Program for Interprofessional Practice, Education and Research, Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Hopwood J, Walker N, McDonagh L, Rait G, Walters K, Iliffe S, Ross J, Davies N. Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review. J Med Internet Res 2018; 20:e216. [PMID: 29895512 PMCID: PMC6019848 DOI: 10.2196/jmir.9548] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/02/2018] [Accepted: 05/08/2018] [Indexed: 01/27/2023] Open
Abstract
Background Caring for someone with dementia is one of the most challenging caring roles. The need for support for family caregivers has been recognized for some time but is often still lacking. With an aging population, demand on health and social care services is growing, and the population is increasingly looking to the internet for information and support. Objective In this review, we aimed to (1) identify the key components of existing internet-based interventions designed to support family caregivers of people with dementia, (2) develop an understanding of which components are most valued by caregivers, and (3) consider the evidence of effectiveness of internet-based interventions designed to support family caregivers of people with dementia. Methods We conducted a systematic search of online databases in April 2018. We searched reference lists and tracked citations. All study designs were included. We adopted a narrative synthesis approach with thematic analysis and tabulation as tools. Results We identified 2325 studies, of which we included 40. The interventions varied in the number and types of components, duration and dose, and outcomes used to measure effectiveness. The interventions focused on (1) contact with health or social care providers, (2) peer interaction, (3) provision of information, (4) decision support, and (5) psychological support. The overall quality of the studies was low, making interpretation and generalizability of the effectiveness findings difficult. However, most studies suggested that interventions may be beneficial to family caregiver well-being, including positive impacts on depression, anxiety, and burden. Particular benefit came from psychological support provided online, where several small randomized controlled trials suggested improvements in caregiver mental health. Provision of information online was most beneficial when tailored specifically for the individual and used as part of a multicomponent intervention. Peer support provided in online groups was appreciated by most participants and showed positive effects on stress. Finally, online contact with a professional was appreciated by caregivers, who valued easy access to personalized practical advice and emotional support, leading to a reduction in burden and strain. Conclusions Although mixed, the results indicate a positive response for the use of internet-based interventions by caregivers. More high-quality studies are required to identify the effectiveness of internet interventions aimed at supporting family caregivers, with particular focus on meeting the needs of caregivers during the different stages of dementia.
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Affiliation(s)
- Jenny Hopwood
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Nina Walker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Lorraine McDonagh
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Stephen Iliffe
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom.,Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
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Burden, resilience and coping in caregivers of patients with interstitial lung disease. Heart Lung 2018; 47:264-268. [PMID: 29627072 DOI: 10.1016/j.hrtlng.2018.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/11/2018] [Indexed: 02/01/2023]
Abstract
RATIONALE Prior work has described the experience of caregiving in idiopathic pulmonary fibrosis, but the effect on caregivers in interstitial lung disease (ILD) has not been explored. OBJECTIVES Describe the burden, resilience, and health related quality of life (HRQoL) of caregivers of people with ILD. METHODS In a mixed methods study, ILD caregivers completed questionnaires and participated in focus groups. A qualitative thematic analysis of the focus group transcripts was conducted. RESULTS Thirty seven caregivers completed the survey, and 15 participated in the focus groups. 65% were female; the average age was 66 (SD = 13). The mean Short Form-36 role emotional and mental health scores were 18 (SD = 4) and 46 (SD = 7). The focus groups identified 4 major themes: emotional burden, changes in relationship, coping strategies, and unmet needs of caregivers. CONCLUSIONS Caregiving for patients with ILD significantly impairs HRQoL, particularly, emotional health. Increasing resources could improve the caregiving experience in ILD.
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Sin J, Henderson C, Spain D, Cornelius V, Chen T, Gillard S. eHealth interventions for family carers of people with long term illness: A promising approach? Clin Psychol Rev 2018; 60:109-125. [PMID: 29429856 DOI: 10.1016/j.cpr.2018.01.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 11/29/2017] [Accepted: 01/31/2018] [Indexed: 12/22/2022]
Abstract
Family carers of people who have long term illness often experience physical and mental health morbidities, and burden. While there is good evidence to suggest that carers benefit from psychosocial interventions, these have primarily been delivered via face-to-face individual or group-formats. eHealth interventions offer a novel, accessible and self-paced approach to care delivery. Whether these are effective for carers' wellbeing has been little explored. This paper reports the first comprehensive systematic review in this area. A total of 78 studies, describing 62 discrete interventions, were identified. Interventions commonly aimed to promote carers' knowledge, self-efficacy, caregiving appraisal, and reduce global health morbidities. Interventions were offered to carers of people with a wide range of long term illness; dementia has been the most researched area, as reported in 40% of studies. Clinical and methodological heterogeneity in interventions precluded meta-analyses, and so data were analysed narratively. The most popular approach has comprised psychoeducational interventions delivered via an enriched online environment with supplementary modes of communication, such as network support with professionals and peers. Overall, carers appreciate the flexibility and self-paced nature of eHealth interventions, with high rates of satisfaction and acceptability. More studies using robust designs are needed to extend the evidence base.
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Affiliation(s)
- Jacqueline Sin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK; School of Psychology & Clinical Language Sciences, University of Reading, Earley Gate, Reading RG6 6AL, England, UK.
| | - Claire Henderson
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Debbie Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, England, UK.
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, England, UK.
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, England, UK.
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, England, UK.
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Maresova P, Tomsone S, Lameski P, Madureira J, Mendes A, Zdravevski E, Chorbev I, Trajkovik V, Ellen M, Rodil K. Technological Solutions for Older People with Alzheimer's Disease: Review. Curr Alzheimer Res 2018; 15:975-983. [PMID: 29701154 PMCID: PMC6128069 DOI: 10.2174/1567205015666180427124547] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/15/2018] [Accepted: 04/25/2018] [Indexed: 01/17/2023]
Abstract
In the nineties, numerous studies began to highlight the problem of the increasing number of people with Alzheimer's disease in developed countries, especially in the context of demographic progress. At the same time, the 21st century is typical of the development of advanced technologies that penetrate all areas of human life. Digital devices, sensors, and intelligent applications are tools that can help seniors and allow better communication and control of their caregivers. The aim of the paper is to provide an up-to-date summary of the use of technological solutions for improving health and safety for people with Alzheimer's disease. Firstly, the problems and needs of senior citizens with Alzheimer's disease (AD) and their caregivers are specified. Secondly, a scoping review is performed regarding the technological solutions suggested to assist this specific group of patients. Works obtained from the following libraries are used in this scoping review: Web of Science, PubMed, Springer, ACM and IEEE Xplore. Four independent reviewers screened the identified records and selected relevant articles which were published in the period from 2007 to 2018. A total of 6,705 publications were selected. In all, 128 full papers were screened. Results obtained from the relevant studies were furthermore divided into the following categories according to the type and use of technologies: devices, processing, and activity recognition. The leading technological solution in the category of devices are wearables and ambient noninvasive sensors. The introduction and utilization of these technologies, however, bring about challenges in acceptability, durability, ease of use, communication, and power requirements. Furthermore, it needs to be pointed out that these technological solutions should be based on open standards.
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Affiliation(s)
- Petra Maresova
- Address correspondence to this author at the Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanskeho 62, 50003, Hradec Kralove, Czech Republic; Tel: + 420 737 928 745; E-mail:
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Waller A, Dilworth S, Mansfield E, Sanson-Fisher R. Computer and telephone delivered interventions to support caregivers of people with dementia: a systematic review of research output and quality. BMC Geriatr 2017; 17:265. [PMID: 29145806 PMCID: PMC5691399 DOI: 10.1186/s12877-017-0654-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022] Open
Abstract
Background To assess the scope, volume and quality of research on the acceptability, utilisation and effectiveness of telephone- and computer-delivered interventions for caregivers of people living with dementia. Methods Medline, EMBASE, CINAHL and Cochrane databases were searched (Jan 1990 – Dec 2016). Eligible papers were classified as data-based descriptive, measurement or intervention studies. Intervention studies were first categorised according to mode of delivery (e.g. telephone, computer); then assessed against the Effective Practice and Organisation of Care (EPOC) methodological criteria for research design. Impact on health-related outcomes; and the acceptability, feasibility and utilisation of interventions were also assessed. Results The number of publications increased by 13% each year (p < 0.001). Half were descriptive studies (n = 92, 50%) describing caregiver views on acceptability, access or utilization of technology. The remainder (n = 89, 48%) reported on interventions designed to improve caregiver outcomes. Only 34 met EPOC design criteria. Interventions were delivered via computer (n = 10), multiple modalities (n = 9) or telephone (n = 15). Interventions that incorporated various elements of psycho-education, peer support, skills training and health assessments led to improvements in caregiver wellbeing. While largely acceptable, utilisation of computer-based interventions was variable, with use often decreasing over time. Conclusion Interventions delivered via telephone and computer have the potential to augment existing dementia care. High-quality trials are required to make clear recommendations about the types of interventions that are most effective. Those that provide caregivers with: access to practical strategies to manage care of the person with dementia and their own wellbeing, advice and support from peers and/or clinicians; and that target the dyad should be explored. Electronic supplementary material The online version of this article (10.1186/s12877-017-0654-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Sophie Dilworth
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
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