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.

Introduction: Nonpharmacological therapies (NPTs) can improve the quality of life (QoL) of people with Alzheimer’s disease (AD) and their carers. The objective of this study was to evaluate the best evidence on the effects of NPTs in AD and related disorders (ADRD) by performing a systematic review and meta-analysis of the entire field. Methods: Existing reviews and major electronic databases were searched for randomized controlled trials (RCTs). The deadline for study inclusion was September 15, 2008. Intervention categories and outcome domains were predefined by consensus. Two researchers working together detected 1,313 candidate studies of which 179 RCTs belonging to 26 intervention categories were selected. Cognitive deterioration had to be documented in all participants, and degenerative etiology

/pdf/nonpharmacological-therapies-in-alzheimer-s-disease-a-4v6qod5q3r.pdf

Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy

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

A meta-analysis showed that 9–12 sessions of supportive help delivered in the home to family caregivers for dementia patients had a salutary effect for the patients' behavioral symptoms, such as screaming and aggression, similar in size to the effect of pharmacological interventions. Psychosis was much less responsive. There was a smaller, but significant amelioration of caregiver reactions to the patient's behavioral symptoms.

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.11101529

Meta-Analysis of Nonpharmacological Interventions for Neuropsychiatric Symptoms of Dementia

Background
Community mental health nurses (CMHNs) are the backbone of specialist mental health services in the UK. This study evaluated the effects of training CMHNs in a systematic psychosocial intervention (PSI), to help family carers manage behavioural changes in their relative with dementia.

Method
One hundred and thirteen family carers received PSI support from a ‘trained’ (experimental), or a ‘usual practice’ (control) CMHN. Primary (day-to-day behaviour problems and management) and secondary (carer mood) outcome measures were obtained at baseline, 6, 12 and 18 months. CMHN training and supervision commenced prior to, and continued throughout, the 18-month study.

Results
Patient cognition declined in both groups, but problem behaviour reduced in experimental group families. However this effect was associated with the practice of some, not all, CMHNs. Carer management and mood improved with PSI support. In contrast, by 18 months, families supported by conventional CMHNs reported reduced coping resources, increased problem behaviour and their level of depression worsened. Only two CMHNs adhered to the PSI-protocol.

Conclusions
Some, but not all, ‘trained’ CMHNs used the PSI to help family carers reduce behavioural problems. A relatively long but not intensive PSI of 12–18 months was needed to moderate carer mood. Dementia-specific practice arrangements, training and sustained clinical supervision are important for the delivery of effective psychosocial interventions in dementia. Copyright © 2007 John Wiley & Sons, Ltd.

Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial.

The effect of a brief in-service training programme on the psychosocial management of behavioural disturbance in residential care is described. Although the incidence of problematic behaviour did not change 3 months after training, staff in the experimental homes reported a significant improvement in their management of problematic behaviour, as compared to the control home. However, these effects were not maintained a year later. The importance of post-training supervision and the sociocultural context of the home in the maintenance of psychosocial intervention in residential settings is discussed.

Can staff training reduce behavioural problems in residential care for the elderly mentally ill

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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Can training community mental health nurses to support family carers reduce behavioural problems in dementia? An exploratory pragmatic randomised controlled trial.

Can staff training reduce behavioural problems in residential care for the elderly mentally ill

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