Dementia caregivers do not relinquish their role after placing family
members in long-term care and they experience increased chronic grief. The
Chronic Grief Management Intervention (CGMI) is a12-week group-based program
that uses guided discussion to deliver knowledge of Alzheimer’s or a
related dementia and teach skills in communication, conflict resolution, and
chronic grief management in dementia caregivers who placed their family members
in long-term care. Using a quasi-experimental design, 83 caregivers from 15
long-term care facilities received either the CGMI (n =
34) or a comparison condition consisting of two check-in calls
(n = 49). In this pilot study, we examined the
feasibility of implementing the CGMI and evaluated the effects of the
intervention on caregivers’ knowledge and skill and their chronic grief
and depression. The intervention was feasible and resulted in significant
improvement in caregivers’ heartfelt sadness and longing at 3 months and
a significant drop in their guilt at the 6-month follow-up.
In recent years researchers have carried out an increasing number of clinical trials with family caregivers of the elderly. The results of these interventions have suggested that caregiver skill-building interventions may be more effective than information/support interventions. Although researchers have given considerable attention to the information and support needed by family caregivers, less is known about how this information and support translates into caregiver skills or into changes in behavior. This is the second in a series of three articles on a study in which researchers used qualitative methods to analyze summaries from the group component of a larger caregiver clinical trial. In this article we describe caregiver issues and concerns in five major areas: (a). dealing with change, (b). managing competing responsibilities and stressors, (c). providing a broad spectrum of care, (d). finding and using resources, and (e). experiencing emotional and physical responses to care. We identify specific skills needed by caregivers in addressing these caregiving issues and concerns, and we compare and contrast skilled with less skilled caregivers. Further work is needed concerning the focus and methods of future caregiver skill-based interventions.
Purpose
This study examined secondary benefits of an individualized physical
activity intervention on improving dementia family caregivers’
subjective burden, depressive symptoms and positive affect.
Design and Methods
A community-based randomized controlled trial (RCT) was implemented
with family caregivers of persons with dementia (N = 211) who
received the Enhanced Physical Activity Intervention (EPAI: treatment
intervention, n = 106) or the Caregiver Skill Building Intervention
(CSBI: control intervention, n = 105). Interventions were delivered
over 12 months, including a baseline home visit and regularly spaced
telephone calls. Data were collected in person at baseline, 6 and 12-months;
and telephonically at 3 and 9-months. The EPAI integrated physical activity
and caregiving content while the CSBI focused only on caregiving content.
Descriptive, bivariate and intention-to-treat analyses using generalized
estimating equations (GEE) were performed to examine secondary benefits of
the EPAI on family caregiver burden, depressive symptoms and positive
affect.
Results
Compared to caregivers in the CSBI group, caregivers in the EPAI
significantly increased their overall and total moderate physical activity
and showed a positive interaction between the intervention and time for
positive affect at both six (p = 0.01) and
12-months (p = 0.03). The EPAI was significantly
associated with improving burden at 3 months (p =
0.03) but had no significant effect on depressive symptoms.
Implications
Caregiver involvement in an individualized physical activity
intervention was associated with increased overall and total moderate
physical activity and improved positive affect from baseline to 12 months.
Improved positive affect may help caregivers to feel better about themselves
and their situation, and better enable them to continue providing care for
their family member for a longer time at lower risk to their own mental
health.
The PMH graduate faculty believes that they have developed strategies to meet this challenge and to help build a PMH workforce that will maintain the centrality of the relationship in PMH practice.
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