1
|
Spiers G, Tan MMC, Astbury JL, Hall A, Ahmed N, Lanyi K, Williams O, Beyer F, Craig D, Hanratty B. What works to support carers of older people and older carers? an international evidence map of interventions and outcomes. BMC Geriatr 2024; 24:301. [PMID: 38553679 PMCID: PMC10979610 DOI: 10.1186/s12877-024-04897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence. METHODS Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years). FINDINGS 205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers' mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers' physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes. CONCLUSION Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers' physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.
Collapse
Affiliation(s)
- Gemma Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michelle M C Tan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jayne L Astbury
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Nisar Ahmed
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kate Lanyi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oleta Williams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Töpfer NF, Wrede N, Theurer C, Wilz G. Face-to-face versus telephone-based cognitive-behavioral therapy for family caregivers of people with dementia. J Clin Psychol 2023; 79:2270-2287. [PMID: 37222452 DOI: 10.1002/jclp.23538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/04/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective was to directly compare the effects and acceptability of telephone-based (TEL-CBT) with face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD). METHOD Caregivers for whom F2F participation was possible were allocated to F2F-CBT (n = 49). The other participants were randomized to TEL-CBT (n = 139) or CG (n = 134). CBT consisted of 12 sessions over 6 months. RESULTS TEL-CBT yielded significantly better physical health (d = 0.27) and coping with daily hassles (d = 0.38) at posttest compared to F2F-CBT. Therapist competence, acceptability, and outcomes at follow-up did not differ between TEL-CBT and F2F-CBT. CONCLUSIONS TEL-CBT is a valuable alternative to F2F-CBT for family caregivers of PwD as TEL-CBT has the advantage of higher accessibility while it does not significantly differ from F2F-CBT in effectiveness and caregivers' evaluation of the setting, their experience with the therapist, and their satisfaction.
Collapse
Affiliation(s)
- Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nicolas Wrede
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| |
Collapse
|
3
|
Wrede N, Töpfer NF, Wilz G. Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers. J Clin Psychol 2023; 79:2207-2224. [PMID: 37192433 DOI: 10.1002/jclp.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers. METHODS In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-six therapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models. RESULTS Caregiver burden was significantly predicted by caregiver-rated emotional bond (β = -0.18) as well as therapist-rated resource activation (β = -0.26), problem actuation (β = -0.22), clarification of meaning (β = -0.18), and mastery (β = -0.18). None of the GCMs predicted depression from any perspective. CONCLUSION The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.
Collapse
Affiliation(s)
- Nicolas Wrede
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| |
Collapse
|
4
|
Nguyen AL, Hussain MA, Pasipanodya E, Rubtsova AA, Moore RC, Jeste DV, Moore DJ. The impact of life stress, psychological resources, and proactive behaviors on quality of life among people living with HIV. Aging Ment Health 2023; 27:948-956. [PMID: 35486380 PMCID: PMC9943531 DOI: 10.1080/13607863.2022.2068126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Quality of life (QoL) is an important consideration for people living with HIV (PWH). We investigated the relationship between stress, psychological resources, and proactive behaviors, on QoL (conceptualized as life satisfaction, successful aging, and depressive symptoms) by testing the hypotheses: (1) greater life stress (stress and functional impairment) is associated with poorer QoL; (2) resources (mastery, resilience, and social support) are associated with better QoL, beyond the influence of stress; and (3) proactive behaviors (medication management and leisure activities) mediate the relationship between resources and QoL. METHODS Secondary analyses were performed (N = 128 PWH). Participants' mean age was 52.3, 83.6% were male, and 53.9 identified as white. Multivariate regressions were performed within the context of path analyses. RESULTS In series 1, greater stress was associated with poorer life satisfaction (p < 0.001), lower self-rated successful aging (p < 0.001), and greater depression (p < 0.001). Functional impairment was associated with lower successful aging (p = 0.017) and greater depression (p = 0.001). In series 2, which accounted for mastery, resilience, social support, as well as demographic covariates, mastery was associated with greater life satisfaction (p = 0.038). In series 3, stress, functional impairment, leisure activities, and ART management were added to the model and social support was associated with engagement in leisure activities (p < 0.001), which was associated with better successful aging (p = 0.006). Fit indices suggested adequate relative fit. In bootstrapped analyses of indirect effects, social support was indirectly associated with successful aging through leisure activities (p = 0.020). CONCLUSIONS QoL, as captured by self-rated successful aging, is threatened by stress but positively influenced by social support and engaging in leisure activities. Findings support a model of proactive successful aging for PWH.
Collapse
Affiliation(s)
- Annie L. Nguyen
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariam A. Hussain
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego, CA, USA
| | | | - Anna A. Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
5
|
Hähnel FS, Töpfer NF, Wilz G. Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study. Aging Ment Health 2023; 27:101-109. [PMID: 34983260 DOI: 10.1080/13607863.2021.2022598] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories. METHODS Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline - T0, 6 months - T1, and 12 months - T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92). RESULTS NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC. CONCLUSIONS The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .
Collapse
Affiliation(s)
- Flora S Hähnel
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| |
Collapse
|
6
|
Töpfer NF, Wrede N, Wilz G. Pragmatic Effectiveness of Face-to-Face Cognitive-Behavioral Therapy for Family Caregivers of People with Dementia. Clin Gerontol 2022:1-12. [PMID: 36495078 DOI: 10.1080/07317115.2022.2156828] [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] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objective was to investigate the pragmatic effectiveness of face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD) implemented in a routine care setting relative to usual care in a quasi-experimental study. METHODS Participants indicating that attendance of F2F-CBT was possible were assigned to F2F-CBT (n = 49). F2F-CBT consisted of 12 sessions over 6 months. Effects were evaluated at posttest and 6-month follow-up on a variety of outcomes relative to usual care (CG; n = 134). RESULTS At posttest, F2F-CBT yielded significantly fewer symptoms of depression (d = 0.37), better emotional well-being (d = 0.64), and better coping with the care situation (d = 0.52) than CG. At 6-month follow-up, the effect on emotional well-being was retained (d = 0.44) and social relationships were rated significantly better in F2F-CBT than CG (d = 0.34). CONCLUSIONS F2F-CBT proved to be effective in supporting family caregivers of PwD. However, only relatively few caregivers were able to regularly attend face-to-face sessions. CLINICAL IMPLICATIONS CBT seems particularly suitable for supporting family caregivers of PwD in coping with the complex psychological burden. Delivery via telephone or internet could be a necessary alternative to F2F-CBT for reducing barriers to participation.
Collapse
Affiliation(s)
- Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nicolas Wrede
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| |
Collapse
|
7
|
Saragih ID, Tonapa SI, Porta CM, Lee BO. Effects of telehealth intervention for people with dementia and their carers: A systematic review and meta-analysis of randomized controlled studies. J Nurs Scholarsh 2022; 54:704-719. [PMID: 35769007 DOI: 10.1111/jnu.12797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Interventions delivered using telehealth modalities are becoming standard practice with patient populations around the world, partly because of innovation necessitated by the COVID-19 pandemic and partly due to improved infrastructure and comfort of providers, patients, and families, through technology. Though increasingly utilized, the effectiveness of telehealth interventions with families with dementia remains unclear. This gives rise to the need for investigation to develop telehealth interventions that are evidence based and not merely convenient tools. This current study is designed to systematically examine the impact and effectiveness of telehealth-delivered psychoeducational and behavioral interventions among persons with dementia and their caregivers. DESIGN The design combines systematic review and meta-analysis. METHODS A total of eight databases were electronically accessed and searched as of November 16, 2021. Experimental studies identifying the results of telehealth interventions for persons with dementia and associated caregivers published in English have been reviewed in this study. Standardized mean differences (SMD) offering 95% confidence intervals (CI) were developed to pool the effect size using a random effects model (in this case, Stata 16.0). The Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB-2) was used to analyze the study's methodological soundness. FINDINGS Nineteen cases met the eligibility criteria (including 1379 persons with dementia and 1339 caregivers). Overall, telehealth interventions demonstrated effects in the expected directions on depression (SMD -0.63; 95% degree of confidence intervals (CI) -0.88 to -0.38, p < 0.001); and caregivers' perceived competency (SMD 0.27; 95% CI -0.05 to 0.50, p = 0.02). There were, however, no statistically significant effects observed on cognitive function or multiple aspects of quality of life for subjects. CONCLUSIONS Telehealth interventions appear to effect a reduction in depression among persons diagnosed with dementia while improving the perceived competency of caregivers. CLINICAL RELEVANCE The study's results could be used as evidence of the effectiveness of using telehealth for persons with dementia and their caregivers, including contextualizing where they are used (i.e., long-term care facilities, private homes, etc.), understanding the mechanisms in play (including intervention delivery and systems), and isolating and identifying mediating influences.
Collapse
Affiliation(s)
| | - Santo Imanuel Tonapa
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Nursing, Sam Ratulangi University, Manado, Indonesia
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
8
|
Toly VB, Zauszniewski JA, Yu J, Sattar A, Rusincovitch B, Musil CM. Resourcefulness Intervention Efficacy for Parent Caregivers of Technology-Dependent Children: A Randomized Trial. West J Nurs Res 2022; 44:296-306. [PMID: 34965784 PMCID: PMC9166934 DOI: 10.1177/01939459211062950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parent caregivers of children who require lifesaving technology (e.g., mechanical ventilation, feeding tubes) must maintain a high level of vigilance 24/7. A two-arm randomized controlled trial tested the efficacy of a resourcefulness intervention on parents' mental/physical health and family functioning at four time points over six months. Participants (n = 93) cared for their technology-dependent children <18 years at home. The intervention arm received teaching on social (help-seeking), personal (self-help) resourcefulness skills; access to the intervention video and skill application video-vignettes; four weeks of skills reinforcement using daily logs; four weekly phone contacts; and booster sessions at two- and four-month postenrollment. The attention control arm received phone contact at identical time points plus the current standard of care. Statistically significant improvement was noted; fewer depressive cognitions and improved physical health for the intervention participants than attention control participants over time after controlling for covariates. The findings support the resourcefulness intervention efficacy.
Collapse
Affiliation(s)
| | | | - Jiao Yu
- Institute for Social Research and Data Innovation, University of Minnesota
| | - Abdus Sattar
- Department of Population and Quantitative Health Science, School of Medicine, Case Western Reserve University
| | | | - Carol M. Musil
- Frances Payne Bolton School of Nursing, Case Western Reserve University
| |
Collapse
|
9
|
Sarabia-Cobo C, Pérez V, de Lorena P, Sáenz-Jalón M, Alconero-Camarero AR. Effectiveness of a telephone intervention based on motivational health coaching for improving the mental health of caregivers of people with dementia: A randomised controlled trial. Int J Older People Nurs 2021; 16:e12398. [PMID: 34337869 DOI: 10.1111/opn.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/17/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Caring for a family member with dementia is considered one of the activities with the greatest negative impact on a person's mental health. Developing long-lasting and effective strategies is a challenge for caregivers. This study sought to evaluate the impact of an intervention based on a programme of motivational coaching delivered by telephone in a group of caregivers of patients with dementia compared to a control group. METHODS A randomised controlled trial with a control group and an intervention group. (CONSORT guidelines were used). Telephone calls were made during six weeks, involving a process of coaching and motivational interviews. The following variables were measured in caregivers: self-efficacy of caring, depression, perceived stress, frequency of problematic behaviours and dysfunctional thoughts. Assessments were conducted at three time points: baseline, post-intervention and three months' post-intervention. RESULTS In total, 106 caregivers participated (53 subjects in the control group and 53 in the intervention group). Statistically significant differences (ANCOVA) were found between both groups for the self-efficacy and stress variables, with improved results in the intervention group (p < .01). Furthermore, statistically significant differences were found in the intervention group between the baseline and post-intervention assessments, with improvements in self-efficacy, decreased stress and decreased dysfunctional thoughts (p < .05). The results were maintained over time for both groups. CONCLUSIONS An intervention based on telephone calls using a health coaching approach with motivational interviewing appears to be effective for the improvement of self-efficacy and mental health of caregivers of people with moderate dementia. Furthermore, these effects appear to be maintained over time.
Collapse
Affiliation(s)
- Carmen Sarabia-Cobo
- Nursing Research Group IDIVAL, Faculty of Nursing, University of Cantabria, Santander, Spain
| | | | | | - María Sáenz-Jalón
- Hospital 12 de Octubre, Nursing Research Group IDIVAL, Madrid, Spain
| | | |
Collapse
|
10
|
Töpfer NF, Wilz G. Increases in utilization of psychosocial resources mediate effects of cognitive-behavioural intervention on dementia caregivers’ quality of life. THE JOURNAL OF POSITIVE PSYCHOLOGY 2021. [DOI: 10.1080/17439760.2020.1716047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nils F. Töpfer
- Department of Counselling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counselling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| |
Collapse
|
11
|
Panerai S, Raggi A, Tasca D, Musso S, Gelardi D, Prestianni G, Catania V, Muratore S, Ferri R. Telephone-Based Reality Orientation Therapy for Patients With Dementia: A Pilot Study During the COVID-19 Outbreak. Am J Occup Ther 2021; 75:7502205130p1-7502205130p9. [PMID: 33657355 DOI: 10.5014/ajot.2021.046672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. OBJECTIVE To determine whether telephone-based reality orientation therapy (T-ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T-ROT can relieve the burden of distress among their caregivers. DESIGN Nonrandomized interventional comparison study. SETTING Individual telephone calls between practitioners and patients and their caregivers. PARTICIPANTS Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. INTERVENTION Ten T-ROT sessions and a pretest-posttest neuropsychological evaluation over 4 wk. OUTCOMES AND MEASURES Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. RESULTS T-ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. CONCLUSIONS AND RELEVANCE T-ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. WHAT THIS ARTICLE ADDS Occupational therapy practitioners can use T-ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.
Collapse
Affiliation(s)
- Simonetta Panerai
- Simonetta Panerai, PsyD, is Head, Unit of Psychology of Brain Aging (I.C.), Oasi Research Institute-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Troina, Italy;
| | - Alberto Raggi
- Alberto Raggi, MD, is Neurologist, Unit of Neurology, G. B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Domenica Tasca
- Domenica Tasca, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Sabrina Musso
- Sabrina Musso, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Donatella Gelardi
- Donatella Gelardi, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Giuseppina Prestianni
- Giuseppina Prestianni, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Valentina Catania
- Valentina Catania, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Stefano Muratore
- Stefano Muratore, PsyD, is Psychologist, Unit of Psychology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Raffaele Ferri
- Raffaele Ferri, MD, is Scientific Director, Oasi Research Institute-IRCCS, Troina, Italy
| |
Collapse
|
12
|
Pfeiffer K, Theurer C, Büchele G, Babac A, Dick H, Wilz G. Relieving distressed caregivers (ReDiCare study): study protocol of a randomized pragmatic trial. BMC Geriatr 2021; 21:4. [PMID: 33407195 PMCID: PMC7787127 DOI: 10.1186/s12877-020-01941-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Providing care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists. METHODS/ DESIGN A pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective. DISCUSSION While comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps. TRIAL REGISTRATION Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 ( www.drks.de, registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593 ( https://apps.who.int/trialsearch/ ).
Collapse
Affiliation(s)
- Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Helene Dick
- Institute of Health Care and Public Management, University of Hohenheim, Stuttgart, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
| |
Collapse
|
13
|
Effectiveness of counselling and psychotherapeutic interventions for people with dementia and their families: a systematic review. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x2000135x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
As there is currently no cure for dementia, providing psycho-social support is imperative. Counselling and psychotherapeutic interventions offer a way to provide individualised support for people with dementia and their families. However, to date, there has not been a systematic review examining the research evidence for these interventions. This review aimed to examine the following research questions: (1) Are counselling/psychotherapeutic interventions effective for people with dementia?, (2) Are counselling/psychotherapeutic interventions effective for care-givers of people with dementia? and (3) Which modes of delivery are most effective for people with dementia and care-givers of people with dementia? A systematic literature search was conducted in MEDLINE (via PubMed), PsycINFO and CINAHL in March 2019. Keyword searches were employed with the terms ‘dement*’, ‘counsel*’, ‘psychotherapy’, ‘therap*’, ‘care’ and ‘outcome’, for the years 2000–2019. Thirty-one papers were included in the review, from seven countries. Twenty studies were randomised controlled trials (RCTs) or adopted a quasi-experimental design. The remaining studies were qualitative or single-group repeated-measures design. The review identified variation in the counselling/psychotherapeutic approaches and mode of delivery. Most interventions adopted either a problem-solving or cognitive behavioural therapy approach. Mixed effectiveness was found on various outcomes. The importance of customised modifications for people with dementia was highlighted consistently. Understanding the dyadic relationships between people with dementia and their care-givers is essential to offering effective interventions and guidance for practitioners is needed. Information about the cognitive impairment experienced by participants with dementia was poorly reported and is essential in the development of this research area. Future studies should consider the impact of cognitive impairment in developing guidance for counselling/psychotherapeutic intervention delivery for people with dementia.
Collapse
|