End-of-life care for patients with dementia was extremely demanding of family caregivers. Intervention and support services were needed most before the patient's death. When death was preceded by a protracted and stressful period of caregiving, caregivers reported considerable relief at the death itself.

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Ninety-one eldeis with a major depressive disorder (MOD) were treated for 16 to 20 sessions of behavioral, cognitive, or brief psychodynamic psychotherapy. Prior to treatment 20 of these subjects were assigned to a 6-week delayed treatment control condition. By the end of 6 weeks patients in the treatment conditions showed improvement, whereas controls did not. Overall, 52% of the treatment sample attained remission by termination; another 18% showed significant improvement. The remainder still met criteria for MDD at the conclusion of therapy. A number of outcome measures indicated no significant main effects for group and no significant Group X Time interactions, suggesting that all three modalities were equally effective in obtaining positive results. The number of elders responding to these treatments compares favorably with younger samples in other studies, indicating the efficacy of psychotherapy for the treatment of depression in the elderly.

This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers’ changing needs over time; development of interventions that can be flexibly administered and individually “tailored,” and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers’ lives.