Effects of a Multimodal Psychoeducational Program on Burden, Depression, and Problem Coping Behaviors in Family Caregivers of Patients with Dementia

Predictors of Sleep Quality in Spouse Caregivers of Community-Dwelling People With Dementia Using Propensity Score Matching Analysis

BACKGROUND

Many family caregivers of people with dementia (PwDs) have sleep problems and poor sleep quality. Sleep may be negatively affected by caring for a family member with dementia, especially a spouse.

PURPOSE

This study was designed to assess sleep quality in spouse caregivers of PwDs and determine the impact of care provision on their sleep quality.

METHODS

A secondary analysis of 58,050 participants in the 2018 Korea Community Health Survey was conducted. To prevent selection bias, a propensity score matching analysis was performed. Multiple logistic regression analysis was conducted to investigate the predictors of sleep quality.

RESULTS

After obtaining a propensity score matching threshold of 3:1, the percentage of poor sleepers was 24.2% in the control group and 33.3% in the spouse-caregiver group, which indicates a significant difference (χ 2 = 11.79, p = .001). After adjusting for depressive symptoms in the multiple logistic analyses, no intergroup difference was found in terms of risk of poor sleep quality (odds ratio = 1.12, 95% CI [0.90, 1.61]).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings of this study support that spouse caregivers of PwDs have poorer sleep quality than their nonspouse peers and that management of depressive symptoms is important to improving the sleep quality of spouses providing care to PwDs. Nursing interventions such as light therapy and exposure to sunlight during daytime hours to both improve sleep quality and reduce depressive symptoms can improve sleep quality in this vulnerable caregiver group.

Evaluating the Efficacy of Therapeutic Programs on Improving Cognitive Function and Depression among Older Adults Living with Dementia in Korea

The purpose of this study was to evaluate the effect size of programs for enhancing cognition and alleviating depression in older adults with dementia. This study selected 45 cognition and 37 depression programs, which conducted pre- and post-tests and had a treatment group and a control group comprising older adults living in Korea. This study conducted a meta-regression analysis to examine the moderating effect of the program location, number of sessions, intervals, group activities, and curriculum on cognition and depression. Most programs improved cognitive function and lowered depression symptoms. The heterogeneity of the effect size was large. The effect size of the number of sessions on a cognitive function significantly increased with an increasing number of sessions. The effect size of the group activity program on cognitive function was higher. The effect of healthcare institutions on depression was lower compared to other locations. To make more effective interventions for cognition and depression, long-term and group activity programs following a comprehensive curriculum will be required. The programs of healthcare institutions are encouraged to accept the advantages of other institutions and apply them to improve the effects of the programs on depression. Future studies shall focus on establishing concrete measures to enable healthcare institutions to connect older adults with dementia with various other institutions that offer long-term group programs.

Useful lessons for the provision of services in long-term care facilities in South Korea: operators' experiences illuminate the phenomenon of working with the elderly in the field

Purpose: The aim of this study was to gain a deeper understanding of elderly long-term care facilities by focusing on insights provided by the operators of these facilities.

Methods: In this phenomenological study, 10 participants who operated nursing home businesses were interviewed. Of the 10 participants, seven had graduated from a nursing programme and three had studied social welfare.

Results: The experiences of facility operators could be organized into four themes: “Starting as a facility operator”, “Dream of an ideal long-term care facility”, “Struggling desperately in practice”, and “Obtaining hope by providing care”. These four themes were divided into 18 subthemes, constituting 96 meaningful statements.

Conclusion: Despite the obvious gap between reality and ideals with regard to caring for residents, operators used a person-centred care strategy for the elderly at their facilities. Our findings indicate that, despite diverse barriers and hardships, participants were encouraged when they offered person-centred healthcare services for the elderly under their care, based on a philosophy of a holistic understanding of humans and respect for human life and dignity. Facility operators who are leaders in the practical field should be involved in the decision/policy-making process, to support health and well-being in the elderly in institutionalized settings.

A Multicenter, Randomized Clinical Trial to Assess the Efficacy of a Therapeutic Intervention Program for Caregivers of People with Dementia

BACKGROUND AND PURPOSE

Caregivers experience tremendous social, financial, physical, and psychological burdens in caring for people with dementia. This study aimed to determine the efficacy of a multicomponent therapeutic intervention program for the caregivers of people with dementia (CGPWD) through a multicenter clinical trial: the intervention program-caregivers of people with dementia study.

METHODS

The 38 caregivers of dementia patients at 8 sites were randomized into 2 groups: treatment (n=19) and control (n=19). The treatment group received the intervention program for 8-10 weeks, including one group session for dementia education and three individual sessions (on cognitive behavioral therapy, coping with stress, and stress management) and single targeted training for daily activities. The Korean version of the Zarit Burden Interview (ZBI-K) and the Geriatric Depression Scale (GDS) were evaluated at pre- and postintervention as primary efficacy measures.

RESULTS

The treatment group displayed significant improvements in scores on the ZBI-K and GDS. The ZBI-K score at postintervention was significantly reduced in the treatment group compared to that in the control group [6.2-point decrease vs. 3.7-point increase, t(37)=-2.9, p<0.01]. There was a significant difference in the GDS score between the treatment and control groups [2.2-point decrease vs. 1.3-point increase, t(18)=2.5, p<0.05].

CONCLUSIONS

The findings of this study imply that a multicomponent therapeutic intervention program is effective in reducing the burden experienced by and depression among CGPWD. Further research is warranted to investigate the long-term effects of the intervention program for CGPWD.

Realist Review: Understanding Effectiveness of Intervention Programs for Dementia Caregivers

PURPOSE

Caring for patients with dementia is a challenging issue entailing heavy responsibility. Many interventions for caregivers have been developed, but their effectiveness is not clear. This study aimed to examine how, why, and under what circumstances interventions for dementia caregivers affected their burden of caring.

METHODS

Authors used a realist review approach to explore the evidence for how different interventions reduce the burden of dementia caregivers. We completed the literature review about the burden of dementia caregivers and extracted the theoretical concepts to explain context-mechanism-outcome configuration why an intervention may be effective in some situations and not others. Six databases were searched for experimental or quasi-experimental studies conducted from 2008 to 2017. Of 1,225 screened studies, 10 studies were eligible for inclusion.

RESULTS

None of the studies included all the derived contexts while explaining in detail the mechanism of the intervention effectiveness. Among contexts, the variable of other family members requiring care was not included in all studies. Among the analyzed studies, no studies have applied repeated intervention. Most studies included only some variables of context and mechanism, and these variables did not directly explain the effectiveness of intervention. The effect of outcome variables was significant for each study, and the effects of research intervention and national services could not be separately described.

CONCLUSION

Authors conclude that Korean culture's emphasis on relationships with others increases the burden of care. In context, Confucian norms and traditional femininity of Korea were reflected in the core. It is necessary to check the homogeneity of participants and the design of intervention to verify the effectiveness of the outcome variable of psychological burden.

[A Prediction Model for Unmet Needs of Elders with Dementia and Caregiving Experiences of Family Caregivers]

PURPOSE

The purposes of this study were to develop and test a prediction model for caregiving experiences including caregiving satisfaction and burden in dementia family caregivers.

METHODS

The stress process model and a two factor model were used as the conceptual frameworks. Secondary data analysis was done with 320 family caregivers who were selected from the Seoul Dementia Management Survey (2014) data set. In the hypothesis model, the exogenous variable was patient symptomatology which included cognitive impairment, behavioral problems, dependency in activity of daily living and in instrumental activity of daily living. Endogenous variables were caregiver's perception of dementia patient's unmet needs, caregiving satisfaction and caregiving burden. Data were analysed using SPSS/WINdows and AMOS program.

RESULTS

Caregiving burden was explained by patient symptomatology and caregiving satisfaction indicating significant direct effects and significant indirect effect from unmet needs. The proposed model explained 37.8% of the variance. Caregiving satisfaction was explained by patient symptomatology and unmet needs. Mediating effect of unmet needs was significant in the relationship between patient symptomatology and caregiving satisfaction.

CONCLUSION

Results indicate that interventions focusing on relieving caregiving burden and enhancing caregiver satisfaction should be provided to caregivers with high levels of dementia patients' unmet needs and low level of caregiving satisfaction.

Recent Updates of Therapeutic Intervention Programs for Caregivers of Patient with Dementia: Proposal of Hospital-Based Individual Therapy

Caring for people with dementia is associated with multiple devastating social, financial, physical, and psychological challenges. There is strong evidence that multicomponent tailored caregiver intervention is effective in improving caregiver well-being and delaying institutionalization. In US, the government is actively funding for developing caregiver program and to prove its efficacy through randomized controlled trials (RCTs) to translate into practice. Even with the introduction of Korean Long-term Care Plan, still, the most of the patients with dementia are being cared by the family members. The distress of caregiving is enormous, but structured therapeutic intervention program which efficacy is proven through RCT is very insufficient in Korea. The purpose of this article is to review the caregiver intervention programs of ongoing clinical trials comparing US and Korea, and to propose a tailored, therapeutic intervention program (I-CARE; A multicenter, randomized trial to assess efficacy of therapeutic intervention programs for decreasing caregiver burden in dementia caregiver) for hospital-care in Korea.