Interventions for reducing levels of burden amongst informal carers of persons with dementia in the community. A systematic review and meta-analysis of randomised controlled trials

Williams, Francesca; Moghaddam, Nima; Ramsden, Sarah; Boos, Danielle De

doi:10.1080/13607863.2018.1515886

Cited by 60 publications

(63 citation statements)

References 68 publications

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“…A 2012 report examined randomized, controlled studies of caregiver interventions and identified 44 interventions that benefited individuals with dementia as well as caregivers. More such interventions are emerging each year 411‐416 . A meta‐analysis examining the components of dementia caregiver interventions that are most beneficial found that interventions that initially enhance caregiving competency, gradually address the care needs of the person with dementia, and offer emotional support for loss and grief when needed appeared most effective 417 …”

Section: Caregivingmentioning

confidence: 99%

“…Created from data from Pinquart et al and Gaugler et al 346,409 interventions are emerging each year. [411][412][413][414][415][416] A meta-analysis examining the components of dementia caregiver interventions that are most beneficial found that interventions that initially enhance caregiving competency, gradually address the care needs of the person with dementia, and offer emotional support for loss and grief when needed appeared most effective. 417 Interventions for dementia caregivers that have demonstrated efficacy in scientific evaluations have been gradually implemented in the community, but are still not widespread or available to all family caregivers.…”

Section: Multicomponent Approachesmentioning

confidence: 99%

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2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

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653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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Section: Caregivingmentioning

confidence: 99%

Section: Multicomponent Approachesmentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,983

653

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“…Findings based on only one intervention study within each review do not appear in Table 2; thus this meta-review focuses on findings with a certain degree of replication, or lack of, at the time of publication of each of the reviews. The effectiveness of psychoeducation was addressed in 14 reviews [12,23,28,29,34,37,41,49,51,53,58,62,66,70], counseling and psychotherapy -10 reviews [12,22,29,32,36,37,53,57,58,66], occupational therapy (OT) interventions -2 reviews [16,66], mindfulness-based interventions (e.g., mantra repetition, meditation, yoga, mindfulness-based stress reduction) -5 reviews [21,22,33,38,43], support interventions (e.g., support groups, mobilizing informal networks) -5 reviews [12,24,49,59,62], communication skills training -3 reviews [27,47,48], respite -6 reviews [12,22,45,63,65,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Moreover, 4 articles provided reviews of dyadic interventions (involving caregiver and CR together) [39,40,55,60] while 15 covered technology-based (e.g, telephone, internet) interventions [17,22,25,26,28,30,41,42,46,51,54,57,62,64,68]. In addition, 12 "miscellaneous" reviews covered themes that cannot be classified into any of the above categories (e.g., counseling merged with case management, and interventions targeting resilience or grief) [12,18,19,22,40,44,52,53,61,67,70,71]. Two provided general overviews [35,69].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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%

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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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