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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; 33:1796-1816. [PMID: 39034437 DOI: 10.1111/inm.13390] [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: 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 Puat 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 Puat 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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Maximiano-Barreto MA, Ottaviani AC, Luchesi BM, Chagas MHN. Empathy Training for Caregivers of Older People: A Systematic Review. Clin Gerontol 2024; 47:704-715. [PMID: 36148523 DOI: 10.1080/07317115.2022.2127390] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To identify empathy training models and the effects on psychological concerns in paid and unpaid caregivers of older people. METHODS A systematic review was conducted. Searches for relevant articles were performed in the Embase, LILACS, PsycInfo, Pubmed, Scopus and Web of Science databases using the following search strategy: "Empathy AND (Education OR Training OR Intervention) AND Caregiver." No restrictions were imposed regarding language or year of publication. RESULTS Empathy training for caregivers of older people were performed in six studies, three of which identified a significant increase in empathy levels and consequent reduction in psychological concerns. Empathy training focused on aspects of empathy and/or the caregiver had significant effects on the outcome variables. Moreover, training conducted online, by telephone and/or in person can generate satisfactory results. The other three studies that conducted training with a focus on aspects of dementia and/or old age did not present any effect on the outcome variables. CONCLUSIONS Empathy training for caregivers of older people can increase levels of this ability, especially in the cognitive domain, as well as diminish psychological concerns caused by the negative impact of providing care. CLINICAL IMPLICATIONS Empathy training directed at empathic abilities and/or aspects of providing care can be effective at increasing levels of this ability. Moreover, training in different care contexts can minimize the negative impacts of providing care.
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Affiliation(s)
| | | | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Campus de Três Lagoas, Federal University of Mato Grosso Do Sul, Três Lagoas, Brazil
| | - Marcos Hortes Nisihara Chagas
- Research Group on Mental Health, Cognition and Aging, Federal University of São Carlos, São Carlos, Brazil
- Bairral Institute of Psychiatry, Itapira, Brazil
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Maximiano-Barreto MA, Luchesi BM, Matias M, Chagas MHN. Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up. Geriatr Nurs 2024; 57:1-10. [PMID: 38452492 DOI: 10.1016/j.gerinurse.2024.02.024] [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: 01/02/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people. METHODS A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups. RESULTS Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention. CONCLUSIONS Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care. CLINICA LTRIAL REGISTRATION RBR-8kjtfx3.
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Affiliation(s)
- Madson Alan Maximiano-Barreto
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil.
| | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil; Três Lagoas Campus, Federal University of Mato Grosso do Sul, Três Lagoas, MS, Brazil
| | - Marisa Matias
- Center for Psychology at University of Porto, Porto, Portugal
| | - Marcos Hortes Nisihara Chagas
- Research Group on Mental Health, Cognition and Aging, Department of Psychology Center for Education and Human Sciences. Rodovia Washington Luís, Federal University of São Carlos - UFSCar, km 235, São Carlos, SP CEP: 13565-905, Brazil; Neurociences and Behavioral Sciences Department, University of São Paulo, Ribeirão Preto, SP, Brazil
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Losada-Baltar A, Mausbach BT, Romero-Moreno R, Jiménez-Gonzalo L, Huertas-Domingo C, Fernandes-Pires JA, Barrera-Caballero S, Gallego-Alberto L, Martín-María N, Olazarán J, Márquez-González M. Longitudinal effects of ambivalent and guilt feelings on dementia family caregivers' depressive symptoms. J Am Geriatr Soc 2024; 72:1431-1441. [PMID: 38485230 PMCID: PMC11090735 DOI: 10.1111/jgs.18871] [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] [Received: 09/18/2023] [Revised: 12/22/2023] [Accepted: 02/18/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown. METHODS Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models. RESULTS Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings. CONCLUSIONS Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.
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Affiliation(s)
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | | | | | | | | | | | - Laura Gallego-Alberto
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Natalia Martín-María
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Departamento de Neurología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María Márquez-González
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
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Thai GH, Rivette S, Sharman J, Epps F, Masoud S. Dementia Caregiver Experiences: Insights From a Telephone-Based Support Program. J Appl Gerontol 2024:7334648241234745. [PMID: 38459827 DOI: 10.1177/07334648241234745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Dementia caregivers face daunting challenges as both the oldest subpopulation of those providing unpaid care and the most at risk of adverse health outcomes as a result of their role, including depression, anxiety, and increased mortality. To better understand the experiences and needs of dementia caregivers, a qualitative content analysis was conducted of secondary data extracted from call logs (N = 569) recorded by a provider-initiated, telephone-based support program. Experiences identified from the call logs were coded, categorized, and ranked to determine the most prevalent dementia caregiving-related experiences. Features of the program, particularly the semi-structured call format and directionality of calls, helped to uniquely capture common experiences of family caregivers and their day-to-day concerns. Findings from this analysis reflect the high prevalence of caregiver mental and emotional health-related concerns. This analysis supports the development of interventions that align with the experiences of dementia caregivers.
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Affiliation(s)
- Glory H Thai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Pohl JS, Fleury J. Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention. Geriatr Nurs 2024; 56:285-290. [PMID: 38412635 DOI: 10.1016/j.gerinurse.2024.02.016] [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: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024]
Abstract
Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.
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Affiliation(s)
- Janet S Pohl
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States.
| | - Julie Fleury
- Arizona State University, Edson College of Nursing and Health Innovation, 500 N 3rd Street, Phoenix, AZ 85004, United States
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Chan HM, Ho KHM, Pang RCK, Chan HYL. Strategies and factors to enhance active participation of family caregivers of people with dementia in psychoeducation: A scoping review. DEMENTIA 2024; 23:272-291. [PMID: 38091474 DOI: 10.1177/14713012231220231] [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] [Indexed: 12/21/2023]
Abstract
Psychoeducation with an active participation component is effective in facilitating family caregivers of people living with dementia to learn about the disease and gain relevant caregiving skills. However, research into the best strategies to promote active participation has received little attention, and the factors hindering active participation are also unknown. Therefore, the nine-stage framework of the Joanna Briggs Institute methodology for scoping reviews was adopted to map and identify information about the active participation of family caregivers of people living with dementia in psychoeducation. The search criteria focused on identifying primary research studies and grey literature relevant to psychoeducation with active participation that had the family caregivers of community dwelling people living with dementia as the target population. Two reviewers independently screened and selected items from the literature. Content analysis was conducted to thematically synthesise strategies mentioned in 29 articles published from 2011 and 2021. Content analysis revealed six strategies that promoted active participation: (1) the involvement of interventionist and qualifications; (2) the teaching and learning methods used to conduct psychoeducation with active participation; (3) tailoring the contents and formats to the experiences, preferences, and resources of the caregivers; (4) collaborating with caregivers; (5) facilitating sharing and support between peers; and (6) providing experiential learning opportunities. Two factors hindering active caregiver participation were negative caregiver emotions and cultural taboos. This review offers ideas for evidence-based practices that can be used by health and social care providers when planning psychoeducation with active participation for the family caregivers of people living with dementia.
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Affiliation(s)
- Hoi Man Chan
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
| | - Ken Hok Man Ho
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
| | | | - Helen Yue Lai Chan
- The Nethersole School of NursingThe Chinese University of Hong Kong, Hong Kong, China
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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.
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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
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Gómez-Morales A, Coon D, Joseph RP, Pipe T. Behind the Scenes of a Technologically Enhanced Intervention for Caregivers of People With Dementia: Protocol for a Feasibility and Acceptability Study. JMIR Res Protoc 2023; 12:e42655. [PMID: 37000480 PMCID: PMC10131762 DOI: 10.2196/42655] [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: 09/12/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Alzheimer's disease affects 55 million people worldwide. As the disease progresses, these individuals require a devoted caregiver, often a family member, who provides evolving complex care. Caregivers can experience a variety of ongoing stressors, resulting in reductions in caregiver emotional well-being (and other quality-of-life indicators). Information and communication technologies provide an excellent opportunity to train caregivers remotely and help them to manage these stressors and related distress. OBJECTIVE This protocol describes the theoretical rationale, study design, and methods of a new, technologically enhanced psychoeducational skill-building intervention for caregivers of people with dementia that includes a virtual reality component. METHODS Through Alzheimer's Eyes is a 4-week, single-arm, pre-post test pilot study consisting of 4 sessions of 90 minutes each that are delivered by videoconferencing. These sessions include a weekly virtual reality experience characterizing the journey of an older Latina with Alzheimer's disease from her perspective to help caregivers see through the eyes of a person with dementia. The 4 sessions cover the skill-training topics of communication, managing challenging behaviors and unhelpful thoughts, the importance of self-care, and mindfulness-all of which are key components designed to reduce stress and distress in family caregivers. Individual interviews conducted before and after the intervention gather participant insights into the intervention, evaluate its feasibility and acceptability, and assess its impact on key outcomes. RESULTS Data collection for the study started in January 2022, and the results are expected to be submitted for publication in the second half of 2023. Twenty caregivers from the United States have completed the workshop to date. Preliminary data gathered from these participants support the intervention's feasibility and acceptability. CONCLUSIONS Through Alzheimer's Eyes leverages existing technology combined with psychoeducational skill building to help caregivers manage their stress, regardless of their location. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42655.
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Affiliation(s)
- Abigail Gómez-Morales
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - David Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Rodney P Joseph
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Teri Pipe
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
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Mårtensson E, Coumoundouros C, Sörensdotter R, von Essen L, Woodford J. Psychological interventions for symptoms of depression among informal caregivers of older adult populations: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 320:474-498. [PMID: 36174787 DOI: 10.1016/j.jad.2022.09.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Symptoms of depression are commonly experienced by informal caregivers of older adults, however there is uncertainty concerning effectiveness of psychological interventions targeting symptoms of depression in this population. Further, there is uncertainty concerning important clinical moderators, including intervention type and care recipient health condition. This review examined the effectiveness of psychological interventions targeting symptoms of depression in informal caregivers of older adults. METHODS PubMed, CINAHL, Embase, PsycINFO, Cochrane Library and Web of Science were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Fifteen studies were identified and twelve (1270 participants) provided data for the meta-analysis. Interventions included cognitive behavioral therapy (4 studies), problem-solving therapy (4 studies); non-directive supportive therapy (4 studies) and behavioral activation (3 studies). A small effect size favouring the intervention was found for symptoms of depression (g = -0.49, CI = -0.79, -0.19, I2 = 83.42 %) and interventions were effective in reducing incidence of major depression (OR = 0.177, CI = 0.08, 0.38), caregiver burden (g = -0.35, CI = -0.55, -0.15) and psychological distress (g = -0.49, CI = -0.70, -0.28). Given high heterogeneity, findings should be interpreted with caution. Overall risk of bias was high. LIMITATIONS Studies were limited to those in English or Swedish. CONCLUSION Psychological interventions may be effective in reducing symptoms of depression among informal caregivers of older adults. However, evidence is inconclusive due to heterogeneity, high risk of bias, and indirectness of evidence.
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Affiliation(s)
- Erika Mårtensson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden; Centre for Gender Research, Uppsala University, 752 36 Uppsala, Sweden.
| | - Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | | | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
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Shrestha S, Richey S, Lipovac-Dew M, Kunik ME, Stanley MA, Ramsey D, Amspoker AB. An Examination of Positive and Negative Dementia Caregiving Experiences. Clin Gerontol 2022; 45:1263-1272. [PMID: 33357171 PMCID: PMC8236064 DOI: 10.1080/07317115.2020.1868033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We examined associations among three measures of caregiver experiences (i.e., positive aspects of caring [PAC], caregiver burden, and mutuality) in 228 dyads involving persons with dementia (PWD) and their informal caregivers. The associations between predisposing, enabling, and need factors and each of these three measures of caregiver experiences were also examined. METHODS We used baseline data from a randomized controlled trial of a psychosocial intervention aimed at preventing aggression in PWD. Associations among PAC, caregiver burden, and mutuality were examined. The Behavioral Model of Health Services Utilization guided the selection of predisposing, enabling, and need components. RESULTS Enabling characteristics (e.g., race/ethnicity, caregiver education and employment and PWD education) and most predisposing characteristics (e.g., caregiver age, PWD age, relationship type) were not associated with any caregiving experience measures. Need characteristics (e.g., levels of memory and functional impairment, behavioral problems, depression, pleasant events) were associated with the caregiving experience. CONCLUSIONS Bivariate correlations between PAC, caregiver burden, and mutuality were between -0.20 and -0.58. Predisposing, enabling, and need factors were differentially associated with outcomes, with need characteristics being most frequently associated with various aspects of caregiving. CLINICAL IMPLICATIONS Assessment of both positive and negative aspects of caregiving is important. Particular attention to depression and interventions that improve depressive symptoms may increase PAC and mutuality and reduce caregiver burden.
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Affiliation(s)
- Srijana Shrestha
- Wheaton College, Norton, MA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Sheila Richey
- Department of Medicine, Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center
| | - Martha Lipovac-Dew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Mark E. Kunik
- Department of Medicine, Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center)
| | - Melinda A. Stanley
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - David Ramsey
- Department of Medicine, Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center)
| | - Amber B. Amspoker
- Department of Medicine, Baylor College of Medicine, Houston, TX; Michael E. DeBakey VA Medical Center
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center)
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Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial. Behav Ther 2022; 53:887-899. [PMID: 35987546 DOI: 10.1016/j.beth.2022.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022]
Abstract
Sleep disturbances are common among family caregivers of people with dementia (PWD). Although behavioral activation (BA) shows the potential to improve sleep quality, to date, evidence for this treatment's feasibility and efficacy for family caregivers of PWD is limited. Therefore, this study pilot tested an evidence-based BA protocol for improving sleep quality in Chinese family caregivers of PWD. The BA intervention involved eight weekly individual telephone-based sessions designed to teach caregivers specific BA techniques. Sleep quality and depression were measured using the Chinese versions of the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression (CES-D) Scale, respectively. This study also measured leisure activity, positive aspect of caregiving, caregiving burden, health status, and relationship satisfaction. All participants were asked to complete the assessments on paper at baseline and immediately after the intervention. After completing the pilot randomized controlled trial, semistructured interviews were conducted to explore participants' experiences participating in the BA intervention. A total of 71 family caregivers of PWD (35 in the intervention group and 36 in the control group) were recruited. The majority of participants were female (n = 53, 74.65%), and their mean age was 54.07 years (SD = 10.95). Compared with controls, caregivers in the intervention group displayed significantly greater improvement in sleep quality, as well as perceptions of positive aspects of caregiving and reduction of depression. Most participants were very satisfied with the intervention. These findings suggest that individual telephone-based BA interventions are feasible, acceptable, and effective in improving sleep quality and psychological health in family caregivers of PWD. These results contribute to the literature by providing evidence for developing effective, accessible, and sustainable BA interventions for family caregivers of PWD.
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He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6973. [PMID: 35742220 PMCID: PMC9222573 DOI: 10.3390/ijerph19126973] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
The present review aims to examine whether multi-component interventions for informal caregivers of people with dementia are effective on positive and negative aspects of caregiver well-being. Eleven databases were searched from inception to 8 March 2021. Only randomized controlled trials reporting the effectiveness of multi-component intervention on positive and negative aspects of caregiver well-being were eligible. Endnote X7 (Thomson ResearchSoft, Stanford, CA, USA) was used for study selection and version 5.1.0 of Cochrane Collaboration's tool (Cochrane, London, UK) was applied for quality assessment. Review Manager (Revman) Version 5.3 (Cochrane, London, UK) was used for the meta-analysis, and if statistical synthesis was inappropriate, only narrative analysis was performed. A total of 31 RCTs with 3939 participants were included. Meta-analyses showed small to moderate effects on subjective well-being, depression, and burden of caregivers, and a moderate to high effect on caregiver anxiety. Due to insufficient data and vast heterogeneity, meta-analysis was not performed for other outcomes, such as resilience, competence, and empathy. This review suggests that individualized multi-component interventions for caregivers may be one of the ways to promote their well-being. Further research is needed to explore the impact of rigorously designed and personalized multi-component interventions on informal caregivers, especially on more positive indicators, as well as its long-term effects and sustainability.
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Affiliation(s)
- Jinjie He
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Jing Wang
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
| | - Hongmei Zhong
- Department of Nursing, School of Medicine, Shihezi University, Shihezi 832002, China;
| | - Chengguo Guan
- Faculty of Nursing, Health Science Center, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, China; (J.H.); (C.G.)
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Huang SS. Depression among caregivers of patients with dementia: Associative factors and management approaches. World J Psychiatry 2022; 12:59-76. [PMID: 35111579 PMCID: PMC8783169 DOI: 10.5498/wjp.v12.i1.59] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.
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Affiliation(s)
- Si-Sheng Huang
- Division of Geriatric Psychiatry, Department of Psychiatry, Changhua Christian Hospital, Changhua 500, Taiwan
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Self-reported burden of caregiver of adults with depression: a cross-sectional study in five Western European countries. BMC Psychiatry 2021; 21:312. [PMID: 34154555 PMCID: PMC8215758 DOI: 10.1186/s12888-021-03255-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/03/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Caregiving in depression imposes a complex health and economic burden. Moreover, there is a paucity of studies examining the impact of caregiving for adult relatives with unipolar depression (CG-UD). This study assessed the burden among CG-UD in five western European (EUR5) countries (France, Germany, Italy, Spain and the United Kingdom) compared with caregivers of adults with other chronic comorbidities (CG-OD) and general non-caregiving (non-CG) population. METHODS A retrospective observational study was conducted using the 2016 National Health and Wellness Survey (NHWS) in EUR5. Differences in humanistic burden (health status and health-related quality of life [HRQoL]) and economic burden (work productivity and activity impairments, health care resource utilization [HRU]) were assessed between CG-UD and CG-OD respondents. Caregiver-specific burden (caregiving responsibilities and caregiver reaction assessment [CRA]) was assessed between caregiver groups. Generalized linear models were used to compare between the groups on the outcomes after adjusting for potential confounders. RESULTS Of the 77,418 survey respondents examined, 1380 identified as CG-UD, 6470 as CG-OD and 69,334 as non-CG. Compared to CG-OD and non-CG, CG-UD, reported significantly lower health status (e.g., EuroQoL-5 Dimensions-5 Levels [EQ-5D-5L]: CG-UD = 0.63, CG-OD = 0.67, and non-CG = 0.73, p < 0.001) and HRQoL (e.g., mental component score: CG-UD = 35.0, CG-OD = 37.8, and non-CG = 40.7, p < 0.001). Although effect sizes were small (d < 0.2), minimal clinically important differences (MCID) were apparent for HRQoL and health status. Increased economic-related burden was observed for work and activity impairment (e.g., absenteeism: CG-UD = 32.6%, CG-OD = 26.5%, and non-CG = 14.8%, p < 0.001) and HRU (e.g., healthcare provider [HCP; mean, past 6 months]: CG-UD = 10.5, CG-OD = 8.6, and non-CG = 6.8, p < 0.001). Caregiving-specific burden was associated with experiencing a greater lack of family support (CG-UD: 2.9 vs CG-OD: 2.8, p < 0.01), impact on finances (CG-UD: 3.0 vs CG-OD: 2.9, p = 0.036), and on the caregiver's schedule (CG-UD: 3.1 vs CG-OD: 3.0, p = 0.048). CONCLUSION Caregivers of persons with chronic disease experience an excess humanistic and economic burden compared to the general population, with a greater burden confronting caregiver for adults with depression. These findings illustrate the far-reaching burden of depression on both the patient and the relatives who care for them.
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Graven LJ, Glueckauf RL, Regal RA, Merbitz NK, Lustria MLA, James BA. Telehealth Interventions for Family Caregivers of Persons with Chronic Health Conditions: A Systematic Review of Randomized Controlled Trials. Int J Telemed Appl 2021; 2021:3518050. [PMID: 34093704 PMCID: PMC8164532 DOI: 10.1155/2021/3518050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to provide an in-depth analysis of the components and outcomes of telehealth interventions for family caregivers of individuals with chronic health conditions. METHODS A systematic review of 17 databases was conducted for randomized controlled trials published between January 2002 and January 2017. Interventions were analyzed based on type of telecommunication modality, caregiver and care recipient characteristics, intervention components, and caregiver outcomes. RESULTS A total of 57 articles met criteria for inclusion. Telephone was the most frequently used mode of telehealth delivery and focused primarily on caregivers of older adults with dementia and stroke. Skills training was the most prevalent treatment strategy across telephone, web, and combined telephone and web modalities. Improved psychological functioning was reported most frequently across telehealth modalities. CONCLUSION Telehealth is an effective tool in delivering caregiver interventions and leads to significant improvement in caregiver outcomes. Telephone was used most often to deliver cognitive-behavioral and psychoeducational strategies as compared to web and combined telephone and web modalities. Further research is needed to examine the effects of telehealth interventions on caregiving skills and self-efficacy, as well as health outcomes.
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Affiliation(s)
| | | | | | - Nancy K. Merbitz
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA
| | - Mia L. A. Lustria
- Florida State University College of Communication and Information, Tallahassee, FL, 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: 4.5] [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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Frias CE, Risco E, Zabalegui A. Psychoeducational intervention on burden and emotional well-being addressed to informal caregivers of people with dementia. Psychogeriatrics 2020; 20:900-909. [PMID: 33015927 DOI: 10.1111/psyg.12616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In dementia it is necessary that a family member become an informal caregiver. This labour has social, physical and emotional repercussions on the caregiver's health. The objective was to assesses the impact of the INFOSA-DEM intervention on burden and emotional well-being among caregivers of people with dementia, evaluating the effects at 3 and 6 months. METHOD We adopted an experimental, non-randomised design with an intervention group and a control group. The intervention group received the intervention and the control group received usual care. The study was carried out in the catchment areas of three centres specialising in the care of people with cognitive impairment in the province of Barcelona. RESULTS At 3 months, there was an improvement with respect to burden in the intervention group with a significant worsening (P < 0.012) in the control group. Similarly, a positive effect on emotional well-being was observed in the intervention group compared with a small negative effect among controls. CONCLUSIONS Programs addressed to informal caregivers based on psychoeducational and cognitive-behavioural therapies are effective in improving quality of life and emotional well-being, and in reducing burden, with a positive effect on the quality of care provided at home.
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Affiliation(s)
- Cindy E Frias
- Department of Nursing, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ester Risco
- Hospital Pere I Virgili of Barcelona, Barcelona, Spain
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Ma KPK, Saw A. An international systematic review of dementia caregiving interventions for Chinese families. Int J Geriatr Psychiatry 2020; 35:1263-1284. [PMID: 32964577 DOI: 10.1002/gps.5400] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/26/2020] [Accepted: 08/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. METHODS Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). RESULTS Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy. CONCLUSIONS To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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20
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Lai FHY, Yan EWH, Tsui WS, Yu KKY. A randomized control trial of activity scheduling for caring for older adults with dementia and its impact on their spouse care-givers. Arch Gerontol Geriatr 2020; 90:104167. [DOI: 10.1016/j.archger.2020.104167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/14/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023]
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Zabihi S, Lemmel FK, Orgeta V. Behavioural Activation for Depression in Informal Caregivers: A Systematic Review and Meta-Analysis of Randomised Controlled Clinical Trials. J Affect Disord 2020; 274:1173-1183. [PMID: 32663948 DOI: 10.1016/j.jad.2020.03.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/06/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Carers experience significant physical and psychological burden and are at increased risk of experiencing clinical depression. Although several psychological treatments have been shown to be effective for preventing and treating depression in carers, most are complex, costly, and not easily accessible to family carers. In this paper, we review evidence of effectiveness of Behavioural Activation (BA) for depressive symptoms in informal caregivers and report on its quality. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Online trial registers for randomised controlled clinical trials of BA for carers. RESULTS Twelve trials met inclusion criteria and eleven were included in the meta-analyses. BA reduced depressive symptoms for carers (standardised mean difference (SMD) -0.68; confidence interval (CI) -1.14 to -0.22) at post intervention (4-14 weeks) and in the long term (l year; SMD -0.99; CI -1.26 to -0.71). BA decreased risk of a diagnosis of major depression (Odds Ratio 0.35; CI 0.19 to 0.67), and reduced negative affect (SMD -0.53; 95% CI -0.83 to -0.23), and caregiver burden (SMD -0.32; CI -0.55 to -0.09) at post-treatment. Quality of evidence was moderate and there was no evidence of publication bias. LIMITATIONS There was high heterogeneity in the studies included. CONCLUSION BA is effective in reducing depressive symptoms post-treatment and long-term (1 year) and decreases odds of a diagnosis of major depression in informal caregivers. Our review provides further evidence that BA is an effective psychological intervention, which is potentially highly scalable across many settings, populations and cultures (Registration: PROSPERO-CRD42019138860).
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Affiliation(s)
- Sedigheh Zabihi
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London
| | - Frederike K Lemmel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London
| | - Vasiliki Orgeta
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF London.
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Bilbrey AC, Laidlaw K, Cassidy-Eagle E, Thompson LW, Gallagher-Thompson D. Cognitive Behavioral Therapy for Late-Life Depression: Evidence, Issues, and Recommendations. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Xu XY, Kwan RYC, Leung AYM. Behavioural activation for family dementia caregivers: A systematic review and meta-analysis. Geriatr Nurs 2020; 41:544-552. [PMID: 32143964 DOI: 10.1016/j.gerinurse.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022]
Abstract
The current study aims to investigate the effectiveness of behavioral activation (BA) for family dementia caregivers. A systematic literature search was conducted through PubMed, Medline, CINAHL, Cochrane, Embase and PsycINFO for studies published from March 1988 to September 2019. Standardized mean differences (SMDs) were combined to synthesize pooled effect measures using random effects. The review was based on ten randomized controlled trials. Depression was significantly reduced after participants received BA (n = 9; 786 participants; SMD = -0.69; 95% CI: -1.12 to -0.25; p = 0.002). BA also has a positive impact on other areas of psychological health (e.g., self-efficacy, anxiety, and distress) and physical health (e.g., interleukin-6) in family dementia caregivers. In conclusion, BA not only has a moderate effect on reducing depression but also has the potential to improve other areas of psychological and cardiovascular health in family caregivers. However, more interventional studies of BA for family dementia caregivers are needed.
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Affiliation(s)
- Xin Yi Xu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
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Au A, Lai DWL, Yip HM, Chan S, Lai S, Chaudhury H, Scharlach A, Leeson G. Sense of Community Mediating Between Age-Friendly Characteristics and Life Satisfaction of Community-Dwelling Older Adults. Front Psychol 2020; 11:86. [PMID: 32194465 PMCID: PMC7064721 DOI: 10.3389/fpsyg.2020.00086] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/13/2020] [Indexed: 01/07/2023] Open
Abstract
The growth of age-friendly community initiatives underscores a paradigmatic shift from the individual to the community, addressing dynamic transactions between people and the environment they are living in. The purpose of the present study is to address the gap in existing research by examining the psycho-social effects of the sense of community in mediating between WHO domains of age-friendliness and the life satisfaction of older adults. Data were obtained from 898 participants in Hong Kong. Path analysis was conducted. Two AFC domains, Social Participation as well as Community Support and Health Services, were found to be associated with life satisfaction. Sense of community was found to mediate between these two domains and life satisfaction. The implications of these findings are discussed with reference to developing opportunities in social participation of older adults and enhancing community/health support services in the context of developing sustainability in the community.
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Affiliation(s)
- Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Daniel W. L. Lai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ho-ming Yip
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Stephen Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Simon Lai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew Scharlach
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - George Leeson
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
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Hinton L, Tran D, Nguyen TN, Ho J, Gitlin L. Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review. BMJ Glob Health 2019; 4:e001830. [PMID: 31798992 PMCID: PMC6861057 DOI: 10.1136/bmjgh-2019-001830] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite increasing numbers of persons living with Alzheimer's disease and Alzheimer's-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia. METHODS The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English. RESULTS Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR-China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations. CONCLUSION This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Duyen Tran
- University of California Davis, Davis, California, USA
| | | | - Janis Ho
- Touro University California, Vallejo, California, USA
| | - Laura Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Au A, Yip HM, Lai S, Ngai S, Cheng ST, Losada A, Thompson L, Gallagher-Thompson D. Telephone-based behavioral activation intervention for dementia family caregivers: Outcomes and mediation effect of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2019; 102:2049-2059. [PMID: 31279613 DOI: 10.1016/j.pec.2019.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/05/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The study examined the effects of a telephone-administered psycho-education with behavioral activation intervention (TBA) for family caregivers of person's with Alzheimer's dementia to reduce levels of depressive symptoms and burden and to enhance relationship satisfaction with the care-recipient METHODS: A double-blinded randomized trial compared TBA with telephone-based psycho-education with general monitoring (TGM). Ninety-six dementia caregivers were randomized. Both conditions received four weekly psycho-education sessions led by a social worker. TBA participants then received eight bi-weekly behavioral activation practice sessions delivered by paraprofessionals. TGM participants received eight bi-weekly monitoring sessions by paraprofessionals. RESULTS As compared to TGM, TBA participants reported significantly larger reductions in depressive symptoms and burden and larger improvement in relationship satisfaction. Self-efficacy for controlling upsetting thoughts was found to have a partial meditation effect between TBA and the reduction of depressive symptoms. Qualitative feedback suggested that TBA participants expressed unique gains in awareness and developing new ways of reappraising the caregiving situation. CONCLUSION TBA was an effective intervention to reduce depressive symptoms and burden as well as to enhance relationship satisfaction in dementia caregivers. PRACTICE IMPLICATIONS The use of telephone and trained paraprofessionals can enhance the accessibility and sustainability of behavioral activation intervention for dementia family caregivers.
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Affiliation(s)
- Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.
| | - Ho-Ming Yip
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Simon Lai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Sammy Ngai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, People's Republic of China; Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
| | - Andrés Losada
- Andrés Losada, Psychology Department, Universidad Rey Juan Carlos, Spain
| | - Larry Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Betty Irene Moore School of Nursing/Family Caregiving Institute, University of California, Davis, USA
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Donath C, Luttenberger K, Graessel E, Scheel J, Pendergrass A, Behrndt EM. Can brief telephone interventions reduce caregiver burden and depression in caregivers of people with cognitive impairment? - long-term results of the German day-care study (RCT). BMC Geriatr 2019; 19:196. [PMID: 31345170 PMCID: PMC6659298 DOI: 10.1186/s12877-019-1207-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
Background Day-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment. Methods In a two-arm cluster-randomized trial involving multicomponent therapy for cognitively impaired persons in day-care centers and telephone counseling for their caregivers versus treatment as usual (TAU), we investigated long-term effects on caregivers’ burden and depressiveness. Person-caregiver dyads involving home-dwelling persons with MCI, mild dementia, or moderate dementia were eligible. Day-care centers were randomized into an intervention group (IG) or a control group (CG). Outcome assessors were blinded. Out of 359 caregivers who had completed a 6-month intervention phase (nIG = 205, nCG = 154), a total of 304 of them were available at the 12-month follow-up (nIG = 173, nCG = 131). Instruments for assessing were the Burden Scale for Family Caregivers – short version (BSFC-s) (caregiver burden) and the Well-Being Index Score (WHO-5) (depressiveness). Mixed ANOVAs were used for the main analyses; descriptive statistics and subgroup analyses were additionally performed; secondary analyses involved multiple linear regressions for the main outcomes that were significant in the unadjusted main analysis. Results At follow-up, crude mean differences showed a nonsignificant advantage for the IG in caregiver burden [IG: −.20 (SD = 5.39) vs. CG: .76 (SD = 5.49), p = .126, d = .177] and depressiveness (reverse scored) [IG: −.05 (SD = 5.17) vs. CG: −.98 (SD = 5.65), p = .136, d = .173]. For caregiver burden, a mixed ANOVA resulted in significant main effects of group (F (1, 302) = 4.40; p = .037) and time (F (1.88, 568.96) = 3.56; p = .032) but not a significant interaction. The largest effects were found for the “mild dementia” subgroup (d = .443 for caregiver burden and d = .520 for depressiveness). Discussion Positive long-term effects of a combined intervention involving telephone counseling for caregivers and multicomponent activation for patients were observed especially for mild dementia. However, the treatment effects washed out after the intervention ended. Trial registration ISRCTN16412551 (date: 30 July 2014, retrospectively).
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Affiliation(s)
- Carolin Donath
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katharina Luttenberger
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jennifer Scheel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Anna Pendergrass
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Elisa-Marie Behrndt
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Lee M, Ryoo JH, Chung M, Anderson JG, Rose K, Williams IC. Effective interventions for depressive symptoms among caregivers of people with dementia: A systematic review and meta-analysis. DEMENTIA 2019; 19:2368-2398. [DOI: 10.1177/1471301218822640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Caring for a family member with dementia puts caregivers at risk for depressive symptoms. Yet, interventions with promising effects on caregiver depressive symptoms are not well documented. Aims This review aimed to examine the quality and effectiveness of interventions to reduce depressive symptoms reported by caregivers of people with dementia. Design A systematic review and meta-analysis of nonpharmacological intervention trials was conducted. Methods The electronic databases searched included MEDLINE, CINAHL, and PsycINFO to find randomized controlled trials published between 2007 and 2017. A total of 31 randomized controlled trials were included in the meta-analysis. Results Cognitive-behavioral therapy (838 participants) showed a large, significant effect (standardized mean difference = −0.905; 95% CI = (−1.622, −0.187); p = 0.013) and mindfulness interventions (186 participants) showed moderate, significant effects (standardized mean difference = −0.578; 95% CI = (−0.881, −0.275); p < 0.001) on decreasing caregiver depressive symptoms, while psychoeducational interventions demonstrated small but significant effects (standardized mean difference = −0.244; 95% CI = (−0.395, −0.092); p = 0.002). Emotional support, cognitive rehabilitation, and multicomponent interventions showed less than small or nonsignificant effects related to depressive symptoms among caregivers. Conclusion Cognitive-behavioral therapy interventions, which focus on diminishing negative thoughts and increasing positive activities, can effectively decrease depressive symptoms for caregivers of individuals with dementia. Future research is recommended to assess the long-term effectiveness of cognitive-behavioral therapy in this population.
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Affiliation(s)
- Mijung Lee
- University of Virginia School of Nursing, USA
| | - Ji Hoon Ryoo
- University of Southern California Keck School of Medicine, USA
| | - Mihee Chung
- University of Virginia School of Nursing, USA
| | | | - Karen Rose
- University of Tennessee College of Nursing, USA
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Brief telephone counselling is effective for caregivers who do not experience any major life events - caregiver-related outcomes of the German day-care study. BMC Health Serv Res 2019; 19:20. [PMID: 30626439 PMCID: PMC6325874 DOI: 10.1186/s12913-018-3853-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 12/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background To date, there has been a dearth of scientifically tested, established intervention concepts focussed on supporting informal caregivers and embedded in routine health care structures. The aim of this study was to assess effects of a brief telephone intervention for caregivers of persons with cognitive impairment (PCIs) on caregivers’ depressiveness and subjective burden. Methods A two-arm cluster-randomised controlled intervention study was carried out at 32 German day-care centres. During the six-month intervention period, informal caregivers in the intervention group (n = 205) received counselling in three phone calls focussed on stress reduction, development of self-management strategies, and how to deal with challenging behaviours. Both the control group (n = 154) and the intervention group were free to take part in any support programmes offered by the German Health Care System (TAU). Caregivers’ subjective burden and depressiveness were measured with the Burden Scale for Family Caregivers – short version (BSFC-s) and the WHO-5 Well-Being Index (WHO-5). Outcomes were assessed by means of computer-assisted telephone interviews (CATIs) at baseline and at the end of the six-month intervention phase. Multiple regression analyses were used to show the influence of group allocation. Results After the intervention phase, group allocation was not found to significantly predict caregivers’ subjective burden or depressiveness. The baseline scores (p < 0.001) were the only significant predictors of change in both outcomes. However, sensitivity analyses for caregivers who did not experience any events that they felt were major (in a negative or positive sense) during the six months (n = 271) showed that group allocation (p < 0.05) was a significant predictor of positive change in both outcomes (BSFC-s: Δ-1.3, [− 2.4, − 0.3], Cohen’s d = 0.27; WHO-5: Δ1.5, [0.4, 2.7], Cohen’s d = 0.26). Effect sizes were highest in the subgroup of caregivers of people with mild dementia (BSFC-s: Cohen’s d = 0.43; WHO-5: Cohen’s d = 0.42). Conclusions A “low-dose” psychoeducative telephone intervention designed to empower caregivers is effective, especially in an early stage, if the overlap between the effect of the intervention and the effect of events that are experienced as major events in the caregiver’s life is considered. Trial registration Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively). Electronic supplementary material The online version of this article (10.1186/s12913-018-3853-8) contains supplementary material, which is available to authorized users.
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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: 133] [Impact Index Per Article: 22.2] [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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Wu B, Petrovsky DV, Wang J, Xu H, Zhu Z, McConnell ES, Corrazzini KN. Dementia caregiver interventions in Chinese people: A systematic review. J Adv Nurs 2018; 75:528-542. [DOI: 10.1111/jan.13865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/07/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Bei Wu
- New York University Rory Meyers College of Nursing; New York New York
- New York University NYU Aging Incubator; New York New York
- Hartford Institute for Geriatric Nursing; New York University Rory Meyers College of Nursing; New York New York
| | | | - Jing Wang
- Duke University School of Nursing; Durham North Carolina
- Duke Global Health Institute; Durham North Carolina
| | - Hanzhang Xu
- Duke University School of Nursing; Durham North Carolina
- Department Community and Family Medicine; Duke University School of Medicine; Durham North Carolina
| | - Zheng Zhu
- School of Nursing; Fudan University; Shanghai China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence; Shanghai China
| | - Eleanor S. McConnell
- Duke University School of Nursing; Durham North Carolina
- Durham VA Geriatric Research; Education and Clinical Center (GRECC); Durham North Carolina
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Woodford J, Farrand P, Watkins ER, LLewellyn DJ. "I Don't Believe in Leading a Life of My Own, I Lead His Life": A Qualitative Investigation of Difficulties Experienced by Informal Caregivers of Stroke Survivors Experiencing Depressive and Anxious Symptoms. Clin Gerontol 2018; 41:293-307. [PMID: 29185911 DOI: 10.1080/07317115.2017.1363104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Health and social care services are increasingly reliant on informal caregivers to provide long-term support to stroke survivors. However, caregiving is associated with elevated levels of depression and anxiety in the caregiver that may also negatively impact stroke survivor recovery. This qualitative study aims to understand the specific difficulties experienced by caregivers experiencing elevated symptoms of anxiety and depression. METHODS Nineteen semi-structured interviews were conducted with caregivers experiencing elevated levels of depression and anxiety, with a thematic analysis approach adopted for analysis. RESULTS Analysis revealed three main themes: Difficulties adapting to the caring role; Uncertainty; and Lack of support. CONCLUSIONS Caregivers experienced significant difficulties adapting to changes and losses associated with becoming a caregiver, such as giving up roles and goals of importance and value. Such difficulties persisted into the long-term and were coupled with feelings of hopelessness and worry. Difficulties were further exacerbated by social isolation, lack of information and poor long-term health and social care support. CLINICAL IMPLICATIONS A greater understanding of difficulties experienced by depressed and anxious caregivers may inform the development of psychological support targeting difficulties unique to the caring role. Improving caregiver mental health may also result in health benefits for stroke survivors themselves.
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Affiliation(s)
- Joanne Woodford
- a Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - Paul Farrand
- a Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - Edward R Watkins
- b Mood Disorders Centre, Psychology: College of Life and Environmental Sciences , University of Exeter , Exeter , United Kingdom
| | - David J LLewellyn
- c University of Exeter Medical School, University of Exeter , Exeter , United Kingdom.,d The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (NIHR PenCLAHRC) , Exeter, United Kingdom
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Abrahams R, Liu KPY, Bissett M, Fahey P, Cheung KSL, Bye R, Chaudhary K, Chu LW. Effectiveness of interventions for co-residing family caregivers of people with dementia: Systematic review and meta-analysis. Aust Occup Ther J 2018. [DOI: 10.1111/1440-1630.12464] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Rebecca Abrahams
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Karen P. Y. Liu
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Michelle Bissett
- School of Allied Health Sciences; Griffith University; Gold Coast QLD Australia
| | - Paul Fahey
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Karen S. L. Cheung
- Mindlink Research Centre; Hong Kong
- Sau Po Center on Ageing; The University of Hong Kong; Hong Kong
| | - Rosalind Bye
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Katrina Chaudhary
- School of Science and Health; Western Sydney University; Sydney NSW Australia
| | - Leung-Wing Chu
- Sau Po Center on Ageing; The University of Hong Kong; Hong Kong
- Division of Geriatric Medicine; Department of Medicine; The University of Hong Kong; Hong Kong
- Alzheimer's Disease Research Network; The University of Hong Kong; Hong Kong
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Merrilees J. The Impact of Dementia on Family Caregivers: What Is Research Teaching Us? Curr Neurol Neurosci Rep 2017; 16:88. [PMID: 27541750 DOI: 10.1007/s11910-016-0692-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dementia family caregiving has been the focus of research for decades. Much has been learned about the negative impact of caregiving as well as characteristics that may be protective. This paper explores themes in caregiving pertinent to clinicians and researchers working with dementia family caregivers: the psychological, subjective, and physical outcomes of caregiving, ways in which dementia alters relationships between the patient and caregiver, and strategies for improving outcomes for caregivers. Suggestions for next steps in research and clinical care are made.
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Affiliation(s)
- Jennifer Merrilees
- UCSF Department of Neurology, Memory and Aging Center, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158-1207, USA.
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Amspoker AB, Hersch G, Snow AL, Wilson N, Morgan RO, Sansgiry S, Kunik ME. A Psychometric Evaluation of the Pleasant Events Schedule-Alzheimer's Disease (Short Version): Among a Veteran Population. J Appl Gerontol 2017; 38:673-693. [PMID: 28380720 DOI: 10.1177/0733464817690675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Alzheimer's disease and other dementias are often associated with a gradual loss of the ability to participate in rewarding activities. Caregivers may struggle with spending quality time with the person with dementia (PWD) when the demands of caregiving dominate. However, the importance of activity participation among PWDs is internationally recognized. The Pleasant Events Schedule-Alzheimer's Disease (PES-AD) Short Form measures frequency of engagement in pleasant events. It has been used to assess overall frequency of engagement in 20 activities. The current study involves a psychometric evaluation of the PES-AD Short Form and reveals two separate activity domains: active and social events, each with preliminary evidence of reliability and construct validity. Furthermore, the frequency with which the PWD enjoys social and active events are not uniformly related to PWD and caregiver characteristics and well-being, which has measure- and practice-focused implications that should be considered when engaging PWDs.
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Affiliation(s)
- Amber B Amspoker
- 1 Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,2 Baylor College of Medicine, Houston, TX, USA
| | | | - A Lynn Snow
- 4 The University of Alabama, Tuscaloosa, USA.,5 Tuscaloosa VA Medical Center, Alabama, USA
| | - Nancy Wilson
- 1 Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,2 Baylor College of Medicine, Houston, TX, USA
| | - Robert O Morgan
- 6 The University of Texas Health Science Center at Houston, USA
| | - Shubhada Sansgiry
- 1 Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,2 Baylor College of Medicine, Houston, TX, USA.,7 VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Mark E Kunik
- 1 Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,2 Baylor College of Medicine, Houston, TX, USA.,7 VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
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Diaz LJR, Cruz DDALMD. Designing a telephone intervention program for family caregivers. Rev Esc Enferm USP 2017; 51:e03297. [PMID: 29562047 DOI: 10.1590/s1980-220x2017012903297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022] Open
Abstract
Objective Describing the development process of a nursing intervention program to promote the adaptation of family caregivers for people with chronic diseases in Colombia and Brazil. Method A developmental study in which an intervention program was created as proposed by the UK Medical Research Council for developing and evaluating complex interventions. Results The program was organized into five weekly sessions of 40 minutes duration applied over the telephone, which integrated the activities of Caregiver Support and Improvement in Coping. Conclusion Following the recommendations of the UK Medical Research Council allowed designing an intervention program of high methodological rigor based on existing scientific evidence, and based on a theoretical model from the nursing discipline which will increase the understanding of their mechanisms of action in improving the well-being of family caregivers.
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Pompeo DA, Carvalho AD, Olive AM, Souza MDGG, Galera SAF. Strategies for coping with family members of patients with mental disorders. Rev Lat Am Enfermagem 2016; 24:e2799. [PMID: 27627121 PMCID: PMC5048725 DOI: 10.1590/1518-8345.1311.2799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/15/2016] [Indexed: 12/05/2022] Open
Abstract
Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. Conclusion: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.
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Affiliation(s)
- Daniele Alcalá Pompeo
- PhD, Adjunct Professor, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Arélica de Carvalho
- Undegraduate student in Nursing, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil. Scholarship holder of the Scientific Initiation Program at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Aline Morgado Olive
- RN, student of the Obstetric Nursing of the Residency Program, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sueli Aparecida Frari Galera
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
PURPOSE OF REVIEW The number of informal caregivers providing assistance to adults is increasing commensurate with our aging society. Sleep disturbances are prevalent in caregivers and associated with negative physical, medical, and functional outcomes. Here, we describe the predisposing, precipitating, and perpetuating factors contributing to the development of sleep problems in caregivers, and discuss three understudied caregiving populations that have clinical importance and unique circumstances influencing sleep quality and health. RECENT FINDINGS There is clear evidence supporting the interaction between sleep loss, caregiving stress, and vulnerability to chronic disease. Telehealth and telemedicine sleep interventions for caregivers combined with assistive technologies targeting care-receivers have potential to be more individualized, affordable, and widely accessible than traditional in-person insomnia treatment approaches. Limited data exist describing the etiology and treatment of sleep problems in caregivers of veterans, medical patients newly discharged from the hospital, and developmentally disabled adults. SUMMARY There is a growing literature describing the general determinants of sleep disturbances in caregivers, the health consequences of these disturbances, and intervention strategies for treating them. Identifying effective sleep treatments suited to more specialized caregiving situations and increasing intervention access will help caregivers continue to provide quality care while protecting their own health and well-being.
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