Purpose: The purpose of this study was to determine the effectiveness of interventions for family caregivers of older adults. Design and Methods: Meta-analysis was used to synthesize the effects of 78 caregiver intervention studies for six outcome variables and six types of interventions. Results: The combined interventions produced a significant improvement of 0.14 to 0.41 standard deviation units, on average, for caregiver burden, depression, subjective well-being, perceived caregiver satisfaction, ability/knowledge, and care receiver symptoms. Intervention effects were larger for increasing caregivers’ ability/knowledge than for caregiver burden and depression. Psychoeducational and psychotherapeutic interventions showed the most consistent short-term effects on all outcome measures. Intervention effects for dementia caregivers were smaller than those for other groups. The number of sessions, the setting, care receiver age, caregiver age, gender, type of caregiver‐care receiver relationship (spouse vs adult child), initial burden, and study characteristics moderated the observed effects. Implications: Caregiver interventions are effective, but some interventions have primarily domain-specific effects rather than global effects. The differences between intervention types and moderators suggest ways of optimizing interventions.

/pdf/how-effective-are-interventions-with-caregivers-an-updated-2zq9v6wz8k.pdf

How Effective Are Interventions With Caregivers? An Updated Meta-Analysis

OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal CGs-persons providing unpaid care at home or in a noninstitutional setting. MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure. RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission. CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.

Meta-analysis of psychosocial interventions for caregivers of people with dementia.

Memory difficulties are a defining feature of Alzheimer's disease (AD), with significant implications for people with AD and family members. Interventions aimed at helping with memory difficulties, therefore, may be important in reducing excess disability and improving well-being. There is a long tradition of cognition-focused intervention in dementia care. In this review we offer broad definitions and descriptions of three approaches to cognition-focused intervention for people with dementia—cognitive stimulation, cognitive training and cognitive rehabilitation—and attempt to clarify the underlying concepts and assumptions associated with each. Cognitive training and cognitive rehabilitation are the main approaches used with people who have early-stage AD. We review a range of studies describing the implementation of these two approaches, and evaluate the evidence for their effectiveness. With regard to cognitive training, the evidence currently available does not provide a strong demonstration of effica...

Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: A review

Purpose: We reviewed intervention studies that reported dementia caregiver outcomes published since 1996, including psychosocial interventions for caregivers and environmental and pharmacological interventions for care recipients. Our goal was to focus on issues of clinical significance in caregiver intervention research in order to move the field toward a greater emphasis on achieving reliable and clinically meaningful outcomes. Design and Methods: MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health databases from 1996 through 2001 were searched to identify articles and book chapters mapping to two medical subject headings: caregivers and either dementia or Alzheimer’s disease . Articles were evaluated on two dimensions, outcomes in four domains thought to be important to the individual or society and the magnitude of reported effects for these outcomes in order to determine if they were large enough to be clinically meaningful. Results: Although many studies have reported small to moderate statistically significant effects on a broad range of outcomes, only a small proportion of these studies achieved clinically meaningful outcomes. Nevertheless, caregiving intervention studies have increasingly shown promise of affecting important public health outcomes in areas such as service utilization, including delayed institutionalization; psychiatric symptomatology, including the successful treatment of major and minor depression; and providing services that are highly valued by caregivers. Implications: Assessment of clinical significance in addition to statistical significance is needed in this research area. Specific recommendations on design, measurement, and conceptual issues are made to enhance the clinical significance of future research.

/pdf/dementia-caregiver-intervention-research-in-search-of-59ii2zmtw1.pdf

Dementia Caregiver Intervention Research In Search of Clinical Significance

Systematic review of the effect of psychological interventions on family caregivers of people with dementia.

There is an increasing demand for measures which permit the assessment of the effectiveness of psychosocial interventions in community care. Existing measures of objective and subjective burden have limited utility because they have not been adequately psychometrically evaluated. A full psychometric evaluation of two commonly used measures of objective and subjective burden was conducted amongst 114 dementia caregivers. The patterns of association obtained between the two measures suggest that the use of this technique in caregiver assessment may assist in the targeting of appropriate interventions.

Measuring the outcome of psychosocial intervention for family caregivers of dementia sufferers: A factor analytic study

A brief individualized intervention comprising of information about diagnosis and prognosis, reinforcement of coping strategies, crisis prevention advice and memory management programmes was offered to newly diagnosed people with dementia and their families, prior to referral to the services of their local psychogeriatric community support team. The control group received diagnosis and written advice and were referred directly to their local psychogeriatric community support team. At 18-month follow-up, improvements were found in the memory scores of the experimental group. Carer wellbeing was worse in the control group and this was associated with an increased likelihood of the breakdown of home care. We suggest that psychosocial variables may be important at the time of diagnosis and note an interesting relationship between memory ability in people with dementia and carer strain. Our results can only be fully understood in the context of methodological improvements. These are outlined, for the purpose o...

A preliminary study of the effects of early intervention with people with dementia and their families in a memory clinic

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Measuring the outcome of psychosocial intervention for family caregivers of dementia sufferers: A factor analytic study

A preliminary study of the effects of early intervention with people with dementia and their families in a memory clinic