Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review

Parker, Deborah, Mills, Sandra and Abbey, Jennifer (2008) Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. International Journal of Evidence-Based Healthcare, 6 2: 137-172.


Author Parker, Deborah
Mills, Sandra
Abbey, Jennifer
Title Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review
Journal name International Journal of Evidence-Based Healthcare   Check publisher's open access policy
ISSN 1744-1595
Publication date 2008-06
Year available 2008
DOI 10.1111/j.1744-1609.2008.00090.x
Volume 6
Issue 2
Start page 137
End page 172
Total pages 36
Editor Derek Frewin
Place of publication Australia
Publisher Blackwell Synergy
Collection year 2009
Subject 321106 Aged Care Nursing
C1
920202 Carer Health
111001 Aged Care Nursing
Abstract The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Types of participants Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. Interventions of formal approaches to care designed to support caregivers in their role, care planning, case management and specially designated members of the healthcare team – for example dementia nurse specialist or volunteers trained in caring for someone with dementia. Types of studies This review considered any meta-analyses, systematic reviews, randomised control trials, quasi-experimental studies, cohort studies, case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic databases. Only studies in English were considered for inclusion. The initial search was conducted of the databases, CINAHL, MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. A second more extensive search was then conducted using the appropriate Medical Subject Headings (MeSH) and keywords for other available databases. Finally, hand searching of reference lists of articles retrieved and of core dementia, geriatric and psycho geriatric journals was undertaken. Assessment of quality Methodological quality of each of the articles was assessed by two independent reviewers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Reviews and Dissemination. Data collection and analysis Standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each included study reported in the meta-analysis. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Heterogeneity between combined studies was tested using standard chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. Results A comprehensive search of relevant databases, hand searching and cross referencing found 685 articles that were assessed for relevance to the review. Eighty-five papers appeared to meet the inclusion criteria based on title and abstract, and the full paper was retrieved. Of the 85 full papers reviewed, 40 were accepted for inclusion, three were systematic reviews, three were meta-analysis, and the remaining 34 were randomised controlled trials. For the randomised controlled trials that were able to be included in a meta-analysis, standardised mean differences or weighted mean differences and their 95% confidence intervals were calculated for each. Results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test. Where statistical pooling was not appropriate or possible, the findings are summarised in narrative form. The results are discussed in two main sections. Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression, health, subjective well-being, self-efficacy and burden. Secondly, results are reported by main outcome category. For each of these sections, meta-analysis was conducted where it was possible; otherwise, a narrative summary describes the findings. Effectiveness of intervention type Four categories of intervention were included in the review – psycho-educational, support, multi-component and other. Psycho-educational Thirteen studies used psycho-educational interventions, and all but one showed positive results across a range of outcomes. Eight studies were entered in a meta-analysis. No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being, self-efficacy or health. However, small but significant results were found for the categories of depression and burden. Support Seven studies discussed support only interventions and two of these showed significant results. These two studies were suitable for meta-analysis and demonstrated a small but significant improvement on caregiver burden. Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy, depression, subjective well-being and burden. Unfortunately because of the heterogeneity of study designs and outcome measures, no meta-analysis was possible. Other interventions Other interventions included the use of exercise or nutrition which resulted in improvements in psychological distress and health benefits. Case management and a computer aided support intervention provided mixed results. One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour. Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies. In particular the impact of interventions on caregiver depression was available for meta-analysis from eight studies. This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression. Five studies using the outcome category of caregiver burden were entered into a meta-analysis and findings indicated that there were no significant effects of any of interventions. No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: • Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved • Encourage active participation in educational interventions for caregivers • Offer individualised programs rather than group sessions • Provide information on an ongoing basis, with specific information about services and coaching regarding their new role • Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: • Simply refer caregivers to support groups • Only provide self help materials • Only offer peer support
Keyword dementia, caregivers, meta-analysis, systematic review, interventions
References 1. Access Economics. Dementia Estimates and Projections: Australian States and Territories – Report by Access Economics Pty Limited for Alzheimer's Australia. Canberra: Alzheimer's Australia, 2005. 2. Peacock SC, Forbes DA. Interventions for caregivers of persons with dementia: a systematic review. Can J Nurs Res 2003; 35: 88–107. 3. Thompson Coon J, Spilsbury K. Support for carers of people with Alzheimer's type dementia. Cochrane Database Syst Rev 1998; (3): CD000454. DOI: 10.1002/14651858. 4. Acton G, Kang J. Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis. Res Nurs Health 2001; 24: 349–60. 5. Cooke D, McNally L, Mulligan K, Harrison J, Newman P. Psychosocial interventions for caregivers of people with dementia: a systematic review. Aging Ment Health 2001; 5: 120–35. 6. Brodaty H, Green A, Koschera A. Meta-analysis of psychosocial interventions for caregivers of people with dementia. J Am Geriatr Soc 2003; 51: 657–64. 7. Pinquart M, Sorensen S. Helping caregivers of persons with dementia: which interventions work and how large are their effects. Int Psychogeriatr 2006, 1–19. 8. Pusey H, Richards D. A systematic review of the effectiveness of psychosocial interventions for carers of people with dementia. Aging Ment Health 2001; 5: 107–19. 9. King AC, Baumann K, O'Sullivan P, Wilcox S, Castro CM. Effects of moderate intensity exercise on physiological, behavioural, and emotional responses to family caregiving: a randomised controlled trial. J Gerontol 2002; 57A: M26–36. 10. Diener E, Napa Scollon C, Lucas R. The evolving concept of subjective well-being: the multifaceted nature of happiness. Adv Cell Ageing Gerontol 2006; 15: 187–219. 11. Zarit SH, Reaver KE, Bach-Peterson J. Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 1980; 20: 649–55. 12. Martin-Cook K, Remakel-Davis B, Svetlik D, Hynan LS, Weiner MF. Caregiver attribution and resentment in dementia care. Am J Alzheimers Dis Other Demen 2003; 18: 366–74. 13. Hepburn KW, Lewis M, Narayan S et al. Partners in caregiving: a psychoeducation program affecting family caregivers distress and caregiving outlook. Clin Gerontol 2005; 29: 53–69. 14. Hepburn KW, Tornatore J, Center B, Ostwald SW. Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. J Am Geriatr Soc 2001; 49: 450–7. 15. Teri L, McCurry SM, Logsdon R, Gibbons LE. Training community consultants to help family members improve dementia care: a randomized controlled trial. Gerontologist 2005; 45: 802–11. 16. Coon DW, Thompson L, Steffen A, Sorocco K, Gallagher-Thompson D. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist 2003; 43: 678–89. 17. Gallagher-Thompson D, Coon DW, Solano N, Ambler C, Rabinowitz Y, Thompson L. Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH collaborative study. Gerontologist 2003; 43: 580–91. 18. Bourgeois MS, Schultz R, Burgio L, Beach S. Skills training for spouses of patients with Alzheimer's disease: outcomes on an intervention study. J Clin Geropsychol 2002; 8: 53–73. 19. Hebert R, Levesque L, Vezina J et al. Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial. J Gerontol B Psychol Sci Soc Sci 2003; 58: S58–67. 20. Done DJ, Thomas JA. Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet. Int J Geriatr Psychiatry 2001; 16: 816–21. 21. Huang HL, Lotus Shyu YI, Chen MC, Chen ST, Lin LC. A pilot study on a home based caregiver training program for improving caregiver self efficacy and decreasing the behavioural problems of elders with dementia in Taiwan. Int J Geriatr Psychiatry 2003; 18: 337–45. 22. Gerdner LA, Buckwalter KC, Reed D. Impact of a psychoeducational intervention on caregiver response to behavioural problems. Nurs Res 2002; 51: 363–74. 23. Stolley JM, Reed D, Buckwalter KC. Caregiving appraisal and interventions based on the progressively lowered stress threshold model. Am J Alzheimers Dis Other Demen 2002; 17: 110–20. 24. Beauchamp N, Blair Irvine A, Seeley J, Johnson B. Worksite-based internet multimedia program for family caregivers of person with dementia. Gerontologist 2005; 45: 793–801. 25. Nobili A, Riva E, Tettamanti M et al. The effect of a structured intervention on caregivers of patients with dementia and problem behaviors: a randomized controlled pilot study. Alzheimer Dis Assoc Disord 2004; 18: 75–82. 26. Wright LK, Litaker M, Laraia MT, DeAndrade S. Continuum of care for Alzheimer's disease: a nurse education and counseling program. Issues Ment Health Nurs 2001; 22: 231–52. 27. Pillemer K, Suitor J. Peer support for Alzheimer's caregivers. Res Aging 2002; 24: 171–92. 28. Mahoney DF, Tarlow BJ, Jones RN. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. Gerontologist 2003; 43: 556–67. 29. Senanarong V, Jamjumras P, Harmphadungkit K et al. A counseling intervention for caregivers: effect on neuropsychiatric symptoms. Int J Geriatr Psychiatry 2004; 19: 781–8. 30. Fung W, Chein W. The effectiveness of a mutual support group for family caregivers of a relative with dementia. Arch Psychiatr Nurs 2002; 16: 134–44. 31. Dooley NR, Hinojosa J. Improving quality of life for persons with Alzheimer's disease and their family caregivers: brief occupational therapy intervention. Am J Occup Ther 2004; 58: 561–9. 32. Gitlin L, Winter L, Cororan M, Dennis M, Schinfeld S, Hauck W. Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH initiative. Gerontologist 2003; 43: 532–46. 33. Gitlin LN, Hauck WW, Dennis MP, Winter L. Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer's disease and related disorders. J Gerontol A Biol Sci Med Sci 2005; 60: 368–74. 34. Eisdorfer C, Czaja SJ, Loewenstein DA et al. The effect of a family therapy and technology-based intervention on caregiver depression. Gerontologist 2003; 43: 521–31. 35. Burns R, Nichols LO, Martindale-Adams J, Graney MJ, Lummus A. Primary care interventions for dementia caregivers: 2-year outcomes from the REACH study. Gerontologist 2003; 43: 547–55. 36. Mittelman MS. Effect of support and counseling on caregivers of patients with Alzheimer's disease. Int Psychogeriatr 2000; 12: 341–6. 37. Mittelman MS, Roth DL, Coon DW, Haley WE. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. Am J Psychiatry 2004; 161: 850–6. 38. Mittelman MS, Roth DL, Haley WE, Zarit SH. Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial. J Gerontol B Psychol Sci Soc Sci 2004; 59: P27–34. 39. Roth DL, Mittelman MS, Clay OJ, Madan A, Haley WE. Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease. Psychol Aging 2005; 20: 634–44. 40. Gitlin LN, Corcoran M, Winter L, Boyce A, Hauck W. A randomized controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Gerontologist 2001; 41: 4–14. 41. Belle S, Burgio L, Burns R et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups. Ann Intern Med 2006; 145: 727–38. 42. Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer's disease. Neurology 2006; 67: 1592–9. 43. Eloniemi-Sulkava U, Notkola I, Hentinen M, Kivela S, Sivenius J, Sulkava R. Effects of supporting community-living demented patients and their caregivers: a randomised trial. J Am Geriatr Soc 2001; 49: 1282–7. 44. Marriott A, Donaldson C, Tarrier N, Burns A. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Br J Psychiatry 2000; 176: 557–62. 45. Quayhagen MP, Quayhagen M, Corbeil R et al. Coping with dementia: evaluation of four nonpharmacologic interventions. Int Psychogeriatr 2000; 12: 249–65. 46. Akkerman RL, Ostwald SK. Reducing anxiety in Alzheimer's disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. Am J Alzheimers Dis Other Demen 2004; 19: 117–23. 47. Brodaty H, Green A, Banerjee S et al. Towards harmonisation caregiver outcome measures. Brain Aging 2002; 2: 3–12. 48. Begg C, Cho M, Eastwood S et al. Improving the qaulity of reporting of randomized controlled trials. The CONSORT
Q-Index Code C1
Q-Index Status Confirmed Code

 
Versions
Version Filter Type
Citation counts: Google Scholar Search Google Scholar
Access Statistics: 488 Abstract Views  -  Detailed Statistics
Created: Wed, 14 May 2008, 15:58:13 EST by Vicki Percival on behalf of School of Nursing and Midwifery