Supporting Family Carers of Community-Dwelling Elder with Cognitive Decline: A Randomized Controlled Trial

Abstract

Objective. Caring for a patient with cognitive decline has an important impact on the general well-being of family caregivers. Although highly appreciated, interventions in dementia home care remain mainly ineffective in terms of well-being. Consequently, in spite of an extensive support system, abrupt ending of home care remains more rule than exception. Method. The hypothesis was that the intervention of a care counselor, coordinating care in quasi-unstructured way during one year, will alleviate caregivers' feelings of depression. The study population was composed of community-dwelling patients with cognitive decline. A care counselor was at the exclusive disposal of the intervention group. Primary outcome measure was caregiver depression. Results. Finally, depression was 6.25 times less frequent in the intervention group. The actual intervention appeared minimal with only ten applications for more support followed by only three interventions effectively carried out. Although caregivers felt burdened and depressed, formal support remained stable. On the other hand, the availability of the care counselor made caregivers feel less depressed with the same amount of support. Conclusion. Carers do not always need to be surrounded with more professionals, but they want to feel more supported. In terms of policy, this could have some important implications.

The relationship of the quality of life and burden of informal caregivers of patients with cancer in Lima, Peru

“…This syndrome is similar to what was found in this group of IC in which the most outstanding or above problems are related to sleep difficulties, fatigue, corroborated as mental health problems; other studies also report problems as depression, [22] anxiety [23] and anger. [24] However, many ICs show emotional problems without being necessarily ratified by clinical diagnostic criteria for the mood or anxiety disorder. So it is common the presence of symptoms such as difficulty to fall asleep, as evidenced in the present study, feelings/emotions of hopelessness, worry about the future, among others.…”

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

“…16,17 The effects on the needs for early diagnosis, financial and legal aspects of the disease, and meaningful activities were not studied. CM was not found to have any effect on patients' daily activities, cognition and depression.A meta-analysis of the effects of CM (Figure 1 and Supplemental Appendix 4, available at http:// 61,62,66,73,74,76,81,85,91,93,95,97 Canada 84 USA [14][15][16] Europe (21 studies) UK 20,52,53,64,69,72,77,78,83,84,99 The Netherlands The effect on depression of caregivers was uncertain (SMD -0.23, 95% CI, -0.46 to 0.01, P = .06), 14,17,18 and there was no effect on caregivers' burden (SMD 0.17, 95% CI, -0.18 to 0.52, P = .34). …”

“…15,16,20 Moreover, as the first point of contact for the dyad, they appear to be more easily reachable than family physicians. [14][15][16][17][18][20][21][22] Our previous studies demonstrated that the effectiveness of CM depends on a small caseload, regular and proactive follow-up, and transparent communication among health care professionals. …”

“…Holding interactive seminars and family meetings for patients and caregivers on relevant care issues 16,17 Providing information by phone to caregivers 17,18 Helping the patient and family understand the disease, prognosis, and rationale of treatment 19,21,22 Exploring problematic home care situations and attending case conferences 14,20 Connecting patients and their caregivers to support services 16,17,19 Operating in conjunction with any services patient already had Providing nonpharmacologic protocols that include mobility management, personal care concerns 14,15 No effect 14,18 Behavior management…”

“…Assessing patients' memory regularly In 2 studies, caregiver mood improved at 12 months (P = .03) 14,18 ; another found no effect at 18 months (P = .33) 14 Caregiver burden was not affected (P = .49) Caregiver confidence and mastery were greater in CM (P = .001) 16 Involvement in care planning…”