Effectiveness of an Internet Intervention for Family Caregivers of People with Dementia: Results of a Randomized Controlled Trial

Abstract

BackgroundThe World Health Organization stresses the importance of accessible and (cost)effective caregiver support, given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers.MethodsThis study assessed the effectiveness of the Internet intervention ‘Mastery over Dementia’. In a RCT, 251 caregivers, of whom six were lost at baseline, were randomly assigned to two groups. Caregivers in the experimental group (N = 149) were compared to caregivers who received a minimal intervention consisting of e-bulletins (N = 96). Outcomes were symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (Hospital Anxiety and Depression Scale: HADS-A). All data were collected via the Internet, and an intention-to-treat analysis was carried out.ResultsAlmost all caregivers were spouses or children (in-law). They were predominantly female and lived with the care recipient in the same household. Age of the caregivers varied from 26 to 87 years. Level of education varied from primary school to university, with almost half of them holding a bachelor’s degree or higher. Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression (p = .034) and anxiety (p = .007) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia. Effect sizes were moderate for symptoms of anxiety (.48) and small for depressive symptoms (.26).ConclusionsThe Internet course ‘Mastery over Dementia’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety. The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable. The findings are even more promising because future generations of family caregivers will be more familiar with the Internet.Trial RegistrationDutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/rctview.asp?TC=2051

RHAPSODY – Internet-based support for caregivers of people with young onset dementia: program design and methods of a pilot study

“…org/education/e-learning/), and patient organizations (http://www.scie.org.uk/dementia/ e-learning/). Few internet-delivered e-learning programs for informal dementia carers have been evaluated in randomized controlled trials, demonstrating benefits regarding caregiver empathy (Hattink et al, 2015), depression and anxiety (Blom et al, 2015), and perceived stress (Kajiyama et al, 2013). It is not clear to date whether this type of intervention can increase behavior management skills, alleviate psychological and interpersonal problems, enhance help-seeking competence, or improve self-care.…”

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews

“…The number of high quality trials evaluating a multi-component intervention for family carers of people with dementia continues to increase (Blom et al, 2015;Livingston et al, 2014) and it is interesting to compare our findings with the results of these recent trials in terms of the composition and delivery of the intervention being evaluated. In one RCT, where the intervention group showed significantly lower depressive symptoms and anxiety (Blom et al, 2015), the internet delivered intervention, Mastery over Dementia, developed from the results of systematic reviews (Pinquart and Sorensen, 2006) and with active carer participation via activities, comprised the key components we found most effective: education (on dementia and carer coping skills); CBT (cognitive reframing) and guidance on increasing social support (Blom et al, 2015). In contrast, a RCT of a multicomponent dyadic intervention (education, exercise and social activities) delivered by home visits but lacking the psychological component of cognitive reframing, revealed no significant benefits in any of the carer outcomes (Prick et al, 2015).…”

“…Nature of the intervention Seven reviews reported on studies of technology-based interventions; six were of moderate quality (Boots et al, 2014;Elvish et al, 2013;Olazaran et al, 2010;Peacock and Forbes, 2003;Pusey and Richards, 2001;Thompson et al, 2007) and one was high quality (Lins et al, 2014). Reviews varied considerably in the degree of definition of the intervention; 2 reviews did not specify any definition (Peacock and Forbes, 2003;Pusey and Richards, 2001).…”

“…Reviews varied considerably in the degree of definition of the intervention; 2 reviews did not specify any definition (Peacock and Forbes, 2003;Pusey and Richards, 2001). Two reviews included both computer and telephone based systems which provided information and support (Olazaran et al, 2010;Thompson et al, 2007); one review focused only on interventions delivered over the internet (Boots et al, 2014).…”

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…Although this may be a seductive option to consider, this type of dosage might be helpful for some clinical presentations, but would probably not be enough for sustained changes in behavioural symptoms, and associated distress in those with clinically significant CB. For example, a recent internet-based dementia support solution has been applied in family settings with good outcomes on some aspects of carer well-being, 351 but the authors do not report any impact on their measures of behavioural symptoms.…”