Evaluation of technology-based interventions for informal caregivers of patients with dementia – A meta-analysis of randomized controlled trials

Deeken, Friederike; Rezo, Anna; Rapp, Michael A.

doi:10.1055/s-0038-1667801

Cited by 12 publications

(21 citation statements)

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“…At the same time, 20 articles provided negative or mixed reviews. These included reviews on psychoeducation [12,23,58,62,70], CBT-based psychotherapeutic interventions [37], mindfulness [43], support interventions [12,24,62], respite [65,66], home care [56], physical activity interventions [70], multicomponent interventions [12,70,72], dyadic interventions [40,60], technology-based interventions [25,26,42,64,68], and miscellaneous (e.g., physical activity, dyadic) interventions [40,67,70]. Note that the same article might have provided both positive and negative reviews, depending on the intervention category concerned.…”

Section: Burdenmentioning

confidence: 99%

“…Forty-one reviews examined depression as an outcome. Of these, 35 found support for the interventions, including psychoeducation [12,28,34,41,51,53,58,62,66], counseling/psychotherapy [12,32,36,37,53,58,66], mindfulness [21,33,38,43], communication training [47], respite/ day care [12,63], multicomponent interventions [14,28,29,31], dyadic interventions [40], technology-based interventions [17,25,26,28,30,41,42,46,51,54,57], and miscellaneous/general interventions [19,35,44,67,69]. Only 11 articles provided negative/mixed reviews, covering psychoeducation [12,37,62], counseling/psychotherapy…”

Section: Depressionmentioning

confidence: 99%

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A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Cheng

Zhang

2020

BMC Geriatr

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Background: Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses. Methods: MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006-2018. Results: Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulnessbased interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings. (Continued on next page)Conclusions: This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers' changing needs in the course of dementia should be a priority for researchers and practitioners.

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Section: Burdenmentioning

confidence: 99%

Section: Depressionmentioning

confidence: 99%

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Cheng

Zhang

2020

BMC Geriatr

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“…FCs view caregiving as sustainable when they are able to strike a favourable balance between the rewards and demands of caregiving [37] amidst their other competing responsibilities. Technology-based interventions are showing the potential to support FCs caring for older adultsespecially those caring for persons with dementia [38][39][40]. For instance, internet-based monitoring systems --consisting of cameras and sensors and aimed at improving the safety of older adults with dementia as they continue to live at homehave improved outcomes for FCs.…”

Section: Introductionmentioning

confidence: 99%

The care capacity goals of family carers and the role of technology in achieving them

et al. 2020

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Background: As global populations age, governments have come to rely heavily on family carers (FCs) to care for older adults and reduce the demands made of formal health and social care systems. Under increasing pressure, sustainability of FC's unpaid care work has become a pressing issue. Using qualitative data, this paper explores FCs' care-related work goals, and describes how those goals do, or do not, link to technology. Methods: We employed a sequential mixed-method approach using focus groups followed by an online survey about FCs' goals. We held 10 focus groups and recruited 25 FCs through a mix of convenience and snowball sampling strategies. Carer organizations helped us recruit 599 FCs from across Canada to complete an online survey. Participants' responses to an open-ended question in the survey were included in our qualitative analysis. An inductive approach was employed using qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis. Results: We identified two care quality improvement goals of FCs providing care to older adults: enhancing and safeguarding their caregiving capacity. To enhance their capacity to care, FCs sought: 1) foreknowledge about their care recipients' changing condition, and 2) improved navigation of existing support systems. To safeguard their own wellbeing, and so to preserve their capacity to care, FCs sought to develop coping strategies as well as opportunities for mentorship and socialization. Conclusions: We conclude that a paradigm shift is needed to reframe caregiving from a current deficit frame focused on failures and limitations (burden of care) towards a more empowering frame (sustainability and resiliency). The fact that FCs are seeking strategies to enhance and safeguard their capacities to provide care means they are approaching their unpaid care work from the perspective of resilience. Their goals and technology suggestions imply a shift from understanding care as a source of 'burden' towards a more 'resilient' and 'sustainable' model of caregiving. Our case study findings show that technology can assist in fostering this resiliency but that it may well be limited to the role of an intermediary that connects FCs to information, supports and peers.

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“…Despite the increase in research in this area -it has been estimated that the number of publications in this eld increases by 13% each year, including several systematic reviews -we could nd very little published with respect to the implementation of web-based caregiver interventions. (9)(10)(11)(23)(24)(25)(26) Moreover, many of the interventions described in the literature do not appear to be more broadly accessible outside of their research context. To our knowledge, no previous research has used the CFIR framework to study webbased caregiver interventions.…”

Section: Discussionmentioning

confidence: 99%

“…7Various systematic reviews suggest that web-based interventions may result in a range of improved health outcomes for caregivers, including reductions in depression, stress, distress and anxiety. (8)(9)(10)(11) Other studies have identi ed that greater public education is needed for caregivers, and improved mechanisms are needed for busy clinicians to provide caregiver education. (12) We developed iGeriCare (www.igericare.ca), a multimodal e-learning intervention to help educate family caregivers of people with dementia.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education from the Clinician's Perspective: A Qualitative Study

Levinson¹,

Ayers

Butler

et al. 2020

Preprint

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Background Internet-based dementia caregiver interventions have been shown to be effective for a range of caregiver outcomes, yet little is known about how best to implement them. We developed iGeriCare, an evidence-based, multimedia, online educational resource for family caregivers of people living with dementia. The objectives of this study were to get feedback and opinions from experts and clinicians involved in dementia care and caregiver education about 1) iGeriCare, and 2) barriers and facilitators to implementing an online caregiver program.Methods We performed semi-structured interviews with individuals who had a role in dementia care/caregiver education in several key stakeholder settings in Southern Ontario, Canada. We queried participants’ perceptions of iGeriCare, caregiver education, the implementation process and their experience with facilitators and barriers. Transcripts were coded and analyzed using a grounded theory approach. The themes that emerged were organized using the Consolidated Framework for Implementation Research (CFIR).Results Twelve participants from a range of disciplines described their perceptions of iGeriCare, and identified barriers and facilitators to implementation of the intervention. The intervention was generally perceived as a high-quality resource for caregiver education and support, with many stakeholders highlighting the relative advantage of a web-based format. The intervention was seen to meet dementia caregiver needs, partially due to its flexibility, accessibility and compatibility within existing clinical workflows. Additionally, the intervention helps to overcome time constraints for both caregivers and clinicians.Conclusions Study findings indicate a generally positive response for the use of internet-based interventions for dementia caregiver education. Results suggest that iGeriCare may be a useful clinical resource to complement traditional face-to-face and print material caregiver education. More comprehensive studies are required to identify the effectiveness and longevity of online caregiver education interventions, and continue to better understand barriers and facilitators with respect to the implementation of technology-enhanced caregiver educational interventions in various healthcare settings.Contributions to the literature· The need for dementia caregiver education has been identified as a priority in numerous provincial, national, and global Dementia Strategies. Research has shown that web-based caregiver education interventions may result in a range of improved health outcomes for caregivers, including reductions in depression, stress, distress and anxiety.· Opinion leaders in dementia care were generally enthusiastic about implementing high quality web-based dementia caregiver education. · Our findings contribute to the gaps in the literature, including barriers and facilitators into implementation of web-based caregiver educational resources in traditional clinical workflows.

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Evaluation of technology-based interventions for informal caregivers of patients with dementia – A meta-analysis of randomized controlled trials

Cited by 12 publications

References 0 publications

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

The care capacity goals of family carers and the role of technology in achieving them

Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education from the Clinician's Perspective: A Qualitative Study

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