Research reportSystematic review of the effect of psychological interventions on family caregivers of people with dementia☆
Introduction
The number of people with dementia is increasing with significant public health implications including the linked psychological morbidity of caregivers (CG) in terms of burden, general psychological distress and depressive symptomatology (Pinquart and Sorensen, 2003). In one study, for example, 47% of those caring for someone with dementia were depressed compared to only 3% caring for someone with physical health problems (Livingston et al., 1996). This morbidity is associated with care breakdown and institutionalisation of the care recipient (CR) (Brodaty et al., 1993). A meta-analysis of psychological interventions to help CGs of older people with physical ailments or dementia suggested that interventions are less efficacious when targeted at those looking after people with dementia, and if delivered to groups rather than individuals (Sorensen et al., 2002). Thus dementia CGs may be a particularly difficult group to help, although there is evidence from meta-analysis that interventions can decrease CG psychological morbidity (Brodaty et al., 2003, Schulz et al., 2002) and that only multicomponent interventions reduce CG burden (Acton and Kang, 2001). Further good quality studies of the individual components of these interventions is needed to identify which psychologically based interventions, if any, are helpful for CGs of people with dementia (Cooke et al., 2001, Pusey and Richards, 2001, Brodaty et al., 2003). This is the first systematic review to categorise interventions, rate the study quality, evaluate all studies of such approaches on the psychological health of CGs for dementia and assess the level of confidence in the results, in order to compare the efficacy of different types of interventions using standardised criteria. This is in order to assist clinicians in the implementation of rational, evidence-based management and mirrors the approach we followed in a systematic review examining the benefits of psychological treatments for the neuropsychiatric symptoms of patients with dementia (Livingston et al., 2005).
Section snippets
Search strategy
We searched electronic databases until July 2003, reference lists from articles, the Cochrane Library and hand-searched four journals. We asked experts about additional studies (even if post-July 2003). We used search terms encompassing caregivers/carers, individual dementias and interventions. We included primary research studies with quantitative outcome measures of CG psychological health but did not include outcomes regarding the person with dementia. If a scale measured a mixture of
Results
We identified 244 references in our search, of which 62 met the inclusion criteria. References were excluded as: 74 were not primary research; 36 had qualitative outcomes; 35 reported no psychological intervention; 32 had no family CG outcome fitting the inclusion criteria and in 5 some CRs did not have dementia.
Discussion
The most important result from our study is that there is consistent, excellent evidence that iBMT for six or more sessions is efficacious both immediately and in the longer term in alleviating CG depression. There is also good evidence that iCS and gCS are effective in alleviating depression and distress immediately and for some months. These findings fit well with the results of our group's previous systematic review which found that BMT centred on changing the behavior of individual patients
References (78)
- et al.
A nursing intervention to decrease depression in family caregivers of persons with dementia
Arch. Psychiatr. Nurs.
(1999) - et al.
Effective caregiving approaches for patients with Alzheimer's disease
Geriatr. Nurs.
(1998) - et al.
A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention
Arch. Psychiatr. Nurs.
(2002) - et al.
Efficacy of a support group program for care-givers of demented patients in the community: a randomized controlled trial
Arch. Gerontol. Geriatr.
(1994) - et al.
Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists
Control. Clin. Trials
(1995) - et al.
Effects of two caregiver-training programs on burden and attitude toward help
Arch. Psychiatr. Nurs.
(1994) Anger management for dementia caregivers: a preliminary study using video and telephone interventions
Behav. Ther.
(2000)- et al.
Evaluating reminiscence for people with dementia: a pilot study
The Arts Psychother.
(2002) - et al.
Effectiveness of an educational program for demented person's relatives
Arch. Gerontol. Geriatr.
(1998) - et al.
Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis
Res. Nurs. Health
(2001)
A health education program lessens the burden of family caregivers of demented patients
J. Am. Geriatr. Soc.
Interventions for caregivers of patients with Alzheimer's disease: a review and analysis of content, process, and outcomes
Int. J. Aging Hum. Dev.
The effects of a special computer network on caregivers of persons with Alzheimer's disease
Nurs. Res.
Effect of a training programme to reduce stress in carers of patients with dementia
BMJ
Time until institutionalization and death in patients with dementia. Role of caregiver training and risk factors
Arch. Neurol.
Quasi-experimental evaluation of an educational model for dementia caregivers
Int. J. Geriatr. Psychiatry
Meta-analysis of psychosocial interventions for caregivers of people with dementia
J. Am. Geriatr. Soc.
Primary care interventions for dementia caregivers: 2-year outcomes from the REACH Study
Gerontologist
Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy and control conditions
Am. J. Psychiatry
An exercise program for women who are caring for relatives with dementia
Psychosom. med.
Cognitive-behavioral intervention for homebound caregivers of persons with dementia
Nurs. Res.
Dementia carer education and patient behaviour disturbance
Int. J. Geriatr. Psychiatry
Psychosocial interventions for caregivers of people with dementia: a systematic review
Aging Ment. Health
Anger and depression management: psychoeducational skill training interventions for women care givers of a relative with dementia
Gerontologist
The efficacy of a group treatment model in helping spouses meet the emotional and practical challenges of early stage caregiving
Clin. Gerontol.
Coping with caregiving
J. Psychosoc. Nurs.
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
Economic evaluation of a support program for caregivers of demented elderly
Int. J. Technol. Assess. Health Care
Changes in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia
Gerontologist
A psychoeducational intervention to reduce distress in Hispanic family caregivers: results of a pilot study
Clin. Gerontol.
Skills training with supporters of the demented
J. Am. Geriatr. Soc.
Cognitive-behavioural group intervention for spouse caregivers: findings and clinical considerations
Clin. Gerontol.
A meta-analysis of the effects of cognitive therapy in depressed people
J. Affect. Disord.
A users guide to the General Health Questionnaire
A model telephone information and support program for caregivers of Alzheimer's patients
Gerontologist
Life review: treating the dyadic family unit with dementia
Clin. Psychol. Psychother.
Experimental evaluation of the effectiveness of group intervention for dementia caregivers
Gerontologist
Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial.
J. Geront., Ser. B Psychol. Sci. Soc. Sci.
Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes
J. Am. Geriatr. Soc.
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On behalf of the Old Age Taskforce of the World Federation of Biological Psychiatry. We would like to acknowledge the particular help of Henry Brodaty and Carlos Lima. The authors are all clinicians. There is no other conflict of interest.