The effectiveness of nonpharmacological interventions for informal dementia caregivers: An updated systematic review and meta-analysis.

Abstract

This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers’ changing needs over time; development of interventions that can be flexibly administered and individually “tailored,” and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers’ lives.

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

“…It was not surprising to find counseling/psychotherapy to be effective for depression. However, as a number of reviews on CBT included psychoeducational programs with modules on CBT skills, results cannot be interpreted unambiguously [83]. It should be noted that these psychoeducation programs are quite different from CBT in a number of ways.…”

“…Therefore, merging these psychoeducation programs with CBT obscures important differences between them. In fact, it is not sure whether the beneficial effects noted for psychoeducation in general were due in large part to these programs with psychotherapeutic components [83]. Supporting this speculation were results showing that only those psychoeducation programs with caregivers actively involved in the practice and application of skills [12], epitomized by programs with psychotherapeutic components, were effective for caregiver burden, depression and wellbeing.…”

“…We acknowledge that meta-reviews are just one approach to synthesize the literature. For example, a comprehensive meta-analysis that synthesize data at the study level may reveal more (and slightly different) findings [83]. The conclusions possible with this metareview are limited by the quality and conclusions of the previous reviews.…”

“…Without such transparency and consistency, it would be difficult to translate review findings into practice recommendations for community or healthcare settings. A more appropriate and comprehensive taxonomy to classify interventions is needed by the field [11] (see Cheng et al [83] for such an example). To facilitate classification, intervention researchers should provide clear and sufficiently detailed descriptions of different intervention components/modules and how they are put into action.…”

Horticultural Therapy Programs Enhancing Quality of Life and Reducing Depression and Burden for Caregivers of Elderly with Dementia

“…However, the horticultural ther- The intensified caregiver burden due to chronic stress of caregivers of the elderly with dementia has negative effects on psychological and physical health of not only the dementia patient but also other family members and caregivers, which is why there is a need for intervention strategies to support them in lessening their burden (Schulz et al, 2020). A meta-analysis proved that non-pharmacological intervention programs for caregivers of the elderly with dementia such as mindfulness-based counseling and psychotherapy were effective in reducing depressive symptoms, stress and caregiver burden of subjects (Cheng et al, 2020). Like the results of non-pharmacological inter-vention programs applied as psychotherapy, horticultural therapy also proved its effects in lessening caregiver burden, especially the burden of social activity constraints, of dementia caregivers based on the results of this study.…”