The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis

Pilot quasi-experimental single-arm study of a virtual intervention for caregivers of persons with Lewy body dementia

OBJECTIVES

This pilot study evaluated a web-based intervention, guided by problem-solving therapy, to address challenges faced by caregivers of individuals with Lewy body dementia (LBD).

METHOD

A quasi-experimental single-arm study was conducted with 39 family caregivers (mean age: 67.62 years; 69% women; 95% White). The 8-week program, Virtual Online Communities for Aging Life Experiences Lewy Body Dementia (VOCALE LBD), included a discussion platform, peer support, training, and problem-solving practice. Measurements were taken at baseline, post-intervention, and one month later. Effect sizes and confidence intervals (CIs) were analyzed using bootstrapping, and demographic impacts were assessed through linear mixed-effects models (LMMs).

RESULTS

Of the 39 participants, 29 completed the study. There were no significant differences in demographics between completers and withdrawals. Participants' engagement was high, defined as posting substantive comments at least twice weekly. Significant reductions were observed in depressive (d = -0.54), burden (d = -0.31), and stress scores (d = -0.45), while social support (d = 0.46), positive attitudes (d = 0.32), and negative attitudes towards problem-solving (d = -0.63) improved.

CONCLUSION

This intervention shows promise in reducing caregiver burden and improving emotional well-being, offering a flexible, effective solution for LBD caregivers.

Positive dementia caregiving in 30 days (PDC30): Study protocol of a randomized controlled trial of a self-guided automated online training program

The Benefit-Finding Intervention, a face-to-face psychoeducation program with a focus on the positive meanings of caregiving, has been found to reduce depressive symptoms and burden in dementia caregivers. The program was revamped into a computer-delivered web-based program to enable 24/7 access without location restriction. This study evaluates the efficacy of this new online program called Positive Dementia Caregiving in 30 Days (PDC30). A 2-arm (PDC30 vs. waitlist control) parallel-group randomized controlled trial will be conducted. Target sample is 200 mildly depressed dementia family caregivers with internet access and fluency in English, who will be recruited globally through a YouTube video promoted on social media and through service agencies. The primary outcome is depressive symptoms whereas secondary outcomes are anxiety symptoms, burden, and positive gains, all collected at baseline and 1, 2, and 3 months. The treatment x time (both linear and quadratic) interaction effects will be examined using mixed-effect regression. Additionally, possible therapeutic mechanisms via strengthened self-efficacy in controlling upsetting thoughts and positive reappraisal coping will be examined in a mediation path model. If positive treatment effects are found, the potential public health benefits, given the ease of access, universal availability, and flexible approach, of this online intervention are considerable.

The PDC30 Chatbot-Development of a Psychoeducational Resource on Dementia Caregiving Among Family Caregivers: Mixed Methods Acceptability Study

BACKGROUND

Providing ongoing support to the increasing number of caregivers as their needs change in the long-term course of dementia is a severe challenge to any health care system. Conversational artificial intelligence (AI) operating 24/7 may help to tackle this problem.

OBJECTIVE

This study describes the development of a generative AI chatbot-the PDC30 Chatbot-and evaluates its acceptability in a mixed methods study.

METHODS

The PDC30 Chatbot was developed using the GPT-4o large language model, with a personality agent to constrain its behavior to provide advice on dementia caregiving based on the Positive Dementia Caregiving in 30 Days Guidebook-a laypeople's resource based on a validated training manual for dementia caregivers. The PDC30 Chatbot's responses to 21 common questions were compared with those of ChatGPT and another chatbot (called Chatbot-B) as standards of reference. Chatbot-B was constructed using PDC30 Chatbot's architecture but replaced the latter's knowledge base with a collection of authoritative sources, including the World Health Organization's iSupport, By Us For Us Guides, and 185 web pages or manuals by Alzheimer's Association, National Institute on Aging, and UK Alzheimer's Society. In the next phase, to assess the acceptability of the PDC30 Chatbot, 21 family caregivers used the PDC30 Chatbot for two weeks and provided ratings and comments on its acceptability.

RESULTS

Among the three chatbots, ChatGPT's responses tended to be repetitive and not specific enough. PDC30 Chatbot and Chatbot-B, by virtue of their design, produced highly context-sensitive advice, with the former performing slightly better when the questions conveyed significant psychological distress on the part of the caregiver. In the acceptability study, caregivers found the PDC30 Chatbot highly user-friendly, and its responses quite helpful and easy to understand. They were rather satisfied with it and would strongly recommend it to other caregivers. During the 2-week trial period, the majority used the chatbot more than once per day. Thematic analysis of their written feedback revealed three major themes: helpfulness, accessibility, and improved attitude toward AI.

CONCLUSIONS

The PDC30 Chatbot provides quality responses to caregiver questions, which are well-received by caregivers. Conversational AI is a viable approach to improve the support of caregivers.

Virtual Reality-Based Psychoeducation for Dementia Caregivers: The Link between Caregivers' Characteristics and Their Sense of Presence

In neuropsychology and clinical psychology, the efficacy of virtual reality (VR) experiences for knowledge acquisition and the potential for modifying conduct are well documented. Consequently, the scope of VR experiences for educational purposes has expanded in the health field in recent years. In this study, we sought to assess the effectiveness of ViveDe in a psychoeducational caregiver program. ViveDe is a VR application that presents users with possible daily life situations from the perspective of individuals with dementia. These situations can be experienced in immersive mode through 360° video. This research aimed to ascertain the associations between the sense of presence that can be achieved in VR and some users' psychological characteristics, such as distress and empathetic disposition. The study involved 36 informal caregivers of individuals with Alzheimer's disease. These participants were assessed using scales of anxiety and depression, perceived stress, empathy, and emotional regulation. They were asked to participate in a six-session psychoeducation program conducted online on dementia topics, in addition to experiencing the ViveDe application. The immersive VR sessions enabled the caregivers to directly experience the symptoms of dementia (e.g., spatial disorientation, agnosia, difficulty in problem-solving, and anomia) in everyday and social settings. The results indicated that although the experience in ViveDe (evaluated using the XRPS scale and five questions about emotional attunement) showed efficacy in producing a sense of first-person participation in the symptoms of dementia, further research is needed to confirm this. The structural equation model provided evidence that the characteristics of individuals who enjoy the VR experience play a determining role in the perceived sense of presence, which in turn affects the efficacy of the VR experience as a psychoeducational tool. Further research will be conducted to ascertain the potential role of these elements in conveying change in the caregivers of people with dementia. This will help us study the long-term effectiveness of a large-scale psychoeducation program in VR.

Psychosocial interventions for people with amyotrophic lateral sclerosis and motor neuron disease and their caregivers: a scoping review

BACKGROUND

As amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) is a fatal progressive neurodegenerative disorder, patients experience severe impairments, with patients and family caregivers facing emotional distress and exhaustion. Several psychosocial interventions are aimed at providing tailored support for ALS/MND patients and caregivers. The aim of this study was to conduct a scoping review and present a comprehensive overview of psychosocial interventions designed for individuals and families affected by ALS/MND, while also pinpointing research gaps.

METHODS

This scoping review utilized Arksey and O'Malley's methodological framework to investigate psychosocial interventions designed for individuals with ALS/MND and their families. The study adhered to the PRISMA-ScR checklist for reporting.

RESULTS

A total of 27 articles describing 25 interventions met the inclusion criteria. The predominant interventions observed in the research encompassed education-related strategies, closely followed by behavior therapy, counseling, social support interventions, and psychotherapy interventions. Across the majority of the studies, findings indicated promising feasibility and acceptability of these interventions. Notably, a significant proportion of quantitative investigations yielded one or more statistically significant effects, while qualitative studies consistently reported favorable outcomes, including enhancements in well-being and heightened awareness of individual circumstances.

CONCLUSIONS

Given the progressive and debilitating nature of this condition, coupled with the absence of a cure, the adoption of a psychosocial approach can prove beneficial for both ALS/MND patients and their families. However, high-quality RCTs with a large sample size are recommended to examine and confirm the effectiveness.

Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis

BACKGROUND

Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed.

METHODS

This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions.

RESULTS

In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions.

CONCLUSIONS

The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.