Reappraising the Efficacy and Acceptability of Multicomponent Interventions for Caregiver Depression in Dementia: The Utility of Network Meta-Analysis

Liew, Tau Ming; Lee, Cia Sin

doi:10.1093/geront/gny061

Cited by 21 publications

(16 citation statements)

References 54 publications

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“…More such interventions are emerging each year 477–482 . 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 483 . Recent meta‐analyses suggest that specific intervention types (psychoeducation; see Table 11) may result in a small reduction in burden for caregivers, with other meta‐analyses reporting broader effects of various interventions across multiple dementia caregiver outcomes 484,485 .…”

Section: Caregivingmentioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,771

849

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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 challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, 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 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID‐19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes — costs that have been aggravated by COVID‐19. 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 2021 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain — both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID‐19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

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Section: Caregivingmentioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,771

849

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“…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%

“…[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. [418][419][420][421][422][423][424][425][426][427][428][429][430][431][432] When interventions are implemented, they are generally successful at improving how caregiver services are delivered, and have the potential to reach a large number of families while also helping caregivers cope with their responsibilities.…”

Section: Multicomponent Approachesmentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

1,958

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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“…5e7 Caregiver burden, in turn, has been shown to predict less desirable outcomes such as premature nursing home placement 8 and mortality in PWD. 9 Although many interventions are available to address caregiver burden and improve caregiving outcomes, 6,10 a critical issue that remains is the ability to identify caregivers with high burden in clinical care so that these caregivers can gain access to the necessary interventions.…”

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confidence: 99%

A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview

Liew

Yap

2019

Journal of the American Medical Directors Association

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Objectives: Brief screening scales for caregiver burden are much needed in routine dementia services to efficiently identify caregivers of persons with dementia (PWD) for further intervention. Although the 22item Zarit Burden Interview (ZBI) is often used, its available screening versions have not performed as well as the full version in distinguishing significant burden. We developed a brief screening scale that is valid and comparable to ZBI in distinguishing caregiver burden. Design and setting: Baseline data of an ongoing cohort study. Participants: Family careivers of community-dwelling PWD (n ¼ 394). Measures: Participants completed questionnaires containing ZBI and other caregiving scales. Initially, we split the study samples into 2dthe derivation sample (n ¼ 215) was used to develop a brief scale that best distinguishes significant burden (using the best-subset approach with 10-fold cross-validation), whereas the validation sample (n ¼ 179) verified its actual performance in distinguishing significant burden. We then evaluated the derived scale in its internal consistency reliability, factorial validity, known group validity, and construct validity, and mapped the scores between the brief scale and ZBI using the equipercentile equating method. Results: We derived a 3-item scale which had comparable performance to ZBI in distinguishing significant burden (area under the receiver operating characteristic curve 0.86, 95% confidence interval 0.81-0.92). It had a single dimension in exploratory factor analysis and maintained good psychometric properties similar to those of ZBI. It also explained 77.8% of the variability in ZBI, and had scores that could be mapped to ZBI with reasonable precision. Conclusions and Implications: We have derived a highly accessible tool to screen for caregiver burden, which can have a wider health system effect of expanding the reach of caregiver-focused interventions to services involved in the care of PWD. Notably, this screening tool was developed using rigorous methods and demonstrated comparability to ZBI in its validity, reliability, and total scores.

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Reappraising the Efficacy and Acceptability of Multicomponent Interventions for Caregiver Depression in Dementia: The Utility of Network Meta-Analysis

Cited by 21 publications

References 54 publications

2021 Alzheimer's disease facts and figures

2021 Alzheimer's disease facts and figures

2020 Alzheimer's disease facts and figures

A 3-Item Screening Scale for Caregiver Burden in Dementia Caregiving: Scale Development and Score Mapping to the 22-Item Zarit Burden Interview

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