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Acceptance and efficacy of interventions for family caregivers of elderly persons with a mental disorder: a meta-analysis

Published online by Cambridge University Press:  08 June 2016

Anna Weinbrecht ,
Nina Rieckmann  and
Babette Renneberg
Anna Weinbrecht*
Affiliation:
Department of Psychology, Freie Universität Berlin, Berlin, Germany
Nina Rieckmann
Affiliation:
Institute of Public Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
Babette Renneberg
Affiliation:
Department of Psychology, Freie Universität Berlin, Berlin, Germany
*
Correspondence should be addressed to: Anna Weinbrecht, MSc, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany. Phone: 0049 30 838 656 45; Fax: 0049 30 838 456 188. Email: [email protected].
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Abstract

Background:

The aim of the present study was to conduct an extended meta-analysis of the efficacy and acceptance of supportive interventions for alleviating depressive symptoms in family caregivers of elderly relatives with a mental disorder, including dementia. The second aim was to analyze intervention characteristics as potential moderators of the efficacy and acceptance of these interventions.

Methods:

We searched electronic databases for randomized controlled trials (RCTs) published between 2005 and 2014. Thirty-three studies were included in the meta-analysis with a total of 5,980 participants.

Results:

No RCTs that tested interventions for caregivers of elderly patients with mental disorders other than dementia were found. The weighted pooled effect size of the interventions for caregivers of dementia patients was positive but small (standardized mean difference = 0.13; CI0.95 [0.03; 0.23], p = 0.01). Meta-regression analysis revealed higher effect sizes for interventions that were individually customized. Intervention discontinuation rates were low (mean 11%, SD = 6.3) and independent of most intervention characteristics. If the intervention was delivered via telecommunication intervention discontinuation rates tended to be higher (r = −0.39, p = 0.07).

Conclusions:

Comparative research for caregivers of elderly patients with mental disorders other than dementia is lacking. RCTs of interventions for family caregivers of dementia patients of the last decade show good acceptance among intervention participants, but there is still a need to improve the efficacy of these interventions. Individual customization of intervention components might enhance efficacy. More research is needed on the acceptance of telecommunication interventions for family caregivers.

Keywords

meta-analysiscaregiverspsychosocial interventionsdementiadepression
Type
Review Article
Information
International Psychogeriatrics , Volume 28 , Issue 10 , October 2016 , pp. 1615 - 1629
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Beauchamp, N., Irvine, A. B., Seeley, J. and Johnson, B. (2005). Worksite-based internet multimedia program for family caregivers of persons with dementia. The Gerontologist, 45, 793–801.Google Scholar
Belle, S. H. et al. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Annals of Internal Medicine, 145, 727–738.CrossRefGoogle ScholarPubMed
Brodaty, H., Thomson, C., Thompson, C. and Fine, M. (2005). Why caregivers of people with dementia and memory loss don't use services. International Journal of Geriatric Psychiatry, 20, 537–546. doi: 10.1002/gps.1322.CrossRefGoogle ScholarPubMed
Bruvik, F. K., Allore, H. G., Ranhoff, A. H. and Engedal, K. (2013). The effect of psychosocial support intervention on depression in patients with dementia and their family caregivers: an assessor-blinded randomized controlled trial. Dementia and Geriatric Cognitive Disorders Extra, 3, 386–397. doi: 10.1159/000355912.CrossRefGoogle ScholarPubMed
Callahan, C. M. et al. (2006). Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. Journal of the American Medical Association, 295, 2148–2157. doi: 10.1001/jama.295.18.2148.Google Scholar
Charlesworth, G. et al. (2008). Befriending carers of people with dementia: randomised controlled trial. BMJ, 336, 1295–1297. doi: 10.1136/bmj.39549.548831.AE.CrossRefGoogle ScholarPubMed
Chien, L.-Y. et al. (2011). Caregiver support groups in patients with dementia: a meta-analysis. International Journal of Geriatric Psychiatry, 26, 1089–1098. doi: 10.1002/gps.2660.Google Scholar
Chu, H. et al. (2011). The effects of a support group on dementia caregivers' burden and depression. Journal of Aging and Health, 23, 228–241.Google Scholar
Collins, L. G. and Swartz, K. (2011). Caregiver care. American Family Physician, 83, 1309–1317.Google Scholar
Crimmins, E. M. and Beltrán-Sánchez, H. (2011). Mortality and morbidity trends: is there compression of morbidity? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 66, 75–86.Google Scholar
Czaja, S. J., Loewenstein, D., Schulz, R., Nair, S. N. and Perdomo, D. (2013). A videophone psychosocial intervention for dementia caregivers. American Journal of Geriatric Psychiatry, 21, 1071–1081. doi: 10.1016/j.jagp.2013.02.019.Google Scholar
Czaja, S. J., Schulz, R., Lee, C. C. and Belle, S. H. (2003). A methodology for describing and decomposing complex psychosocial and behavioral interventions. Psychology and Aging, 18, 385–395. doi: 10.1037/0882-7974.18.3.385.Google Scholar
De Rotrou, J. et al. (2011). Do patients diagnosed with Alzheimer's disease benefit from a psycho-educational programme for family caregivers? A randomised controlled study. International Journal of Geriatric Psychiatry, 26, 833–842. doi: 10.1002/gps.2611.CrossRefGoogle ScholarPubMed
Di Rosa, M. et al. (2011). A typology of caregiving situations and service use in family carers of older people in six European countries. The EUROFAMCARE study. The Journal of Gerontopsychology and Geriatric Psychiatry, 24, 5–18. doi: 10.1024/1662-9647/a000031.Google Scholar
Dias, A. et al. (2008). The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India. PLoS ONE, 3. doi: 10.1371/journal.pone.0002333.Google Scholar
Flint, A. J. and Rifat, S. L. (1996). Validation of the Hosiptal Anxiety And Depression Scale as a measure of severity of geriatric depression. International Journal of Geriatric Psychiatry, 11, 991–994.Google Scholar
Fortinsky, R. H., Kulldorff, M., Kleppinger, A. and Kenyon-Pesce, L. (2009). Dementia care consultation for family caregivers: collaborative model linking an Alzheimer's association chapter with primary care physicians. Aging & Mental Health, 13, 162–170. doi: 10.1080/13607860902746160.Google Scholar
Gallagher-Thompson, D., Gray, H. L., Dupart, T., Thompson, L. W. and Jimenez, D. (2008). Effectiveness of cognitive/behavioral small group intervention for reduction of depression and stress in non-hispanic white and hispanic/latino women dementia family caregivers: outcomes and mediators of change. Journal of Rational-emotive and Cognitive-behavior Therapy, 26, 286–303.Google Scholar
Gallagher-Thompson, D. et al. (2010). Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: results of a preliminary study. Aging & Mental Health, 14, 263–273. doi: 10.1080/13607860903420989.Google Scholar
Garand, L. et al. (2014). Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: a randomized controlled trial. The American Journal of Geriatric Psychiatry, 22, 771–781. doi: 10.1016/j.jagp.2013.07.007.CrossRefGoogle ScholarPubMed
Goy, E., Kansagara, D. and Freeman, M. (2010). A Systematic Evidence Review of Interventions for Non-professional Caregivers of Individuals with Dementia. Washington, DC: Department of Veterans Affairs.Google Scholar
Graff, M. J., Vernooij-Dassen, M. J., Thijssen, M., Dekker, J., Hoefnagels, W. H. and Olderikkert, M. G. (2007). Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. The journals of gerontology. Series A, Biological Sciences and Medical Sciences, 62, 1002–1009.CrossRefGoogle ScholarPubMed
Higgins, J. and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available at: www.cochrane-handbook.org; last accessed 7 April 2016.Google Scholar
Higgins, J. and Thompson, S. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558.Google Scholar
Jansen, A. P. D. et al. (2011). Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: a randomized clinical trial. International Journal of Nursing Studies, 48, 933–943.CrossRefGoogle ScholarPubMed
Jensen, M., Agbata, I. N., Canavan, M. and McCarthy, G. (2014). Effectiveness of educational interventions for informal caregivers of individuals with dementia residing in the community: systematic review and meta-analysis of randomised controlled trials. International Journal of Geriatric Psychiatry, 30, 130–143.CrossRefGoogle ScholarPubMed
Joling, K. J. et al. (2012). Does a family meetings intervention prevent depression and anxiety in family caregivers of dementia patients? A randomized trial. PLoS ONE, 7, e30936. doi: 10.1371/journal.pone.0030936.Google Scholar
Judge, K. S., Yarry, S. J., Looman, W. J. and Bass, D. M. (2013). Improved strain and psychosocial outcomes for caregivers of individuals with dementia: findings from project ANSWERS. Gerontologist, 53, 280–292.Google Scholar
Kajiyama, B. et al. (2013). Exploring the effectiveness of an internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program. Aging & Mental Health, 17, 544–554. doi: 10.1080/13607863.2013.775641.Google Scholar
Kuo, L. M. et al. (2013). A home-based training program improves Taiwanese family caregivers' quality of life and decreases their risk for depression: a randomized controlled trial. International Journal of Geriatric Psychiatry, 28, 504–513. doi: 10.1002/gps.3853.Google Scholar
Kurz, A., Wagenpfeil, S., Hallauer, J., Schneider-Schelte, H. and Jansen, S. (2010). Evaluation of a brief educational program for dementia carers: the AENEAS study. International Journal of Geriatric Psychiatry, 25, 861–869. doi: 10.1002/gps.2428.Google Scholar
Kurz, A. et al. (2012). CORDIAL: cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease: a multicenter, randomized, controlled trial. Alzheimer Disease and Associated Disorders, 26, 246–253. doi: 10.1097/WAD.0b013e318231e46e.Google Scholar
Lam, L. C., Lee, J. S., Chung, J. C., Lau, A., Woo, J. and Kwok, T. C. (2010). A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong. International Journal of Geriatric Psychiatry, 25, 395–402. doi: 10.1002/gps.2352.Google Scholar
Lipsey, M. W. and Wilson, D. B. (2001). Practical Meta-Analysis. Thousand Oaks, CA, USA: Sage Publications, Inc.Google ScholarPubMed
Livingston, G. et al. (2013). Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial. BMJ (Clinical research ed.), 347, f6276.Google ScholarPubMed
Logsdon, R. et al. (2011). Effectiveness of time-limited support groups for people with early-stage Alzheimer's disease. Alzheimer's & Dementia, 7, S279. doi: 10.1016/j.jalz.2011.05.804.Google Scholar
Losada, A., Marquez-Gonzalez, M. and Romero-Moreno, R. (2011). Mechanisms of action of a psychological intervention for dementia caregivers: effects of behavioral activation and modification of dysfunctional thoughts. International Journal of Geriatric Psychiatry, 26, 1119–1127.Google Scholar
Magliano, L. et al. (1998). Burden on the families of patients with schizophrenia: results of the BIOMED I study. Social Psychiatry and Psychiatric Epidemiology, 33, 405–412.Google Scholar
Martin-Carrasco, M., Dominguez-Panchon, A. I., Gonzalez-Fraile, E., Munoz-Hermoso, P. and Ballesteros, J. (2014). Effectiveness of a psychoeducational intervention group program in the reduction of the burden experienced by caregivers of patients with dementia: the EDUCA-II randomized trial. Alzheimer Disease and Associated Disorders, 28, 79–87. doi: 10.1097/wad.0000000000000003.Google Scholar
Martin-Carrasco, M. et al. (2009). Effectiveness of a psychoeducation intervention program in the reduction of caregiver burden in Alzheimer's Disease patients' caregivers. International Journal of Geriatric Psychiatry, 24, 489–499. doi: 10.1002/gps.2142.Google Scholar
Mohamed, S., Rosenheck, R., Lyketsos, C. G. and Schneider, L. S. (2010). Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. The American Journal of Geriatric Psychiatry, 18, 917–927.CrossRefGoogle ScholarPubMed
National Alliance for Caregiving and American Association of Retiered Persons (2009). Caregiving in the U.S., 2009. Available at http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf; last accessed 8 April 2015.Google Scholar
Perlick, D. A. et al. (2007). Prevalence and correlates of burden among caregivers of patients with bipolar disorder enrolled in the systematic treatment enhancement program for bipolar disorder. Bipolar Disorders, 9, 262–273. doi: 10.1111/j.1399-5618.2007.00365.x.CrossRefGoogle ScholarPubMed
Phung, K. T. T. et al. (2013). A three-year follow-up on the efficacy of psychosocial interventions for patients with mild dementia and their caregivers: the multicentre, rater-blinded, randomised Danish Alzheimer Intervention Study (DAISY). BMJ Open, 3. doi: 10.1136/bmjopen-2013-003584.Google Scholar
Pinquart, M. and Sörensen, S. (2006). Helping caregivers of persons with dementia: which interventions work and how large are their effects? International Psychogeriatrics, 18, 577–595.Google Scholar
Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.Google Scholar
Schoenmakers, B., Buntinx, F. and Delepeleire, J. (2010a). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66, 191–200.Google Scholar
Schoenmakers, B., Buntinx, F. and DeLepeleire, J. (2010b). Supporting the dementia family caregiver: the effect of home care intervention on general well-being. Aging & Mental Health, 14, 44–56. doi: 10.1080/13607860902845533.Google Scholar
Schreiner, A. S., Morimoto, T., Arai, Y. and Zarit, S. (2006). Assessing family caregiver's mental health using a statistically derived cut-off score for the Zarit Burden Interview. Aging & Mental Health, 10, 107–111. doi: 10.1080/13607860500312142.Google Scholar
Schulz, R. and Martire, L. M. (2004). Family caregiving of persons with dementia: prevalence, health effects, and support strategies. The American Journal of Geriatric Psychiatry, 12, 240–249.Google Scholar
Schulz, R., Martire, L. M. and Klinger, J. N. (2005). Evidence-based caregiver interventions in geriatric psychiatry. Psychiatric Clinics of North America, 28, 1007–1038.Google Scholar
Schulz, R. and Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. The American Journal of Nursing, 108, 23–27. doi: 10.1097/01.NAJ.0000336406.45248.4c.Google Scholar
Selwood, A., Johnston, K., Katona, C., Lyketsos, C. and Livingston, G. (2007). Systematic review of the effect of psychological interventions on family caregivers of people with dementia. Journal of Affective Disorders, 101, 75–89.Google Scholar
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health, 5, 165–173. doi: 10.1300/J018v05n01_09.Google Scholar
Sörensen, S., Pinquart, M. and Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. Gerontologist, 42, 356–372. doi: 10.1093/geront/42.3.356.Google Scholar
Spijker, A., Teerenstra, S., Wollersheim, H., Adang, E., Verhey, F. and Vernooij-Dassen, M. (2013). Influence of adherence to a systematic care program for caregivers of dementia patients. The American Journal of Geriatric Psychiatry, 21, 26–36. doi: 10.1016/j.jagp.2012.10.003.Google Scholar
Teri, L., McCurry, S. M., Logsdon, R. and Gibbons, L. E. (2005). Training community consultants to help family members improve dementia care: a randomized controlled trial. The Gerontologist, 45, 802–811.CrossRefGoogle ScholarPubMed
The R Core Team (2014). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.Google Scholar
Tierney, J. F. and Stewart, L. A. (2005). Investigating patient exclusion bias in meta-analysis. International Journal of Epidemiology, 34, 79–87. doi: 10.1093/ije/dyh300.Google Scholar
Torkamani, M. et al. (2014). A randomized controlled pilot study to evaluate a technology platform for the assisted living of people with dementia and their carers. Journal of Alzheimer's Disease, 41, 515–523. doi: 10.3233/JAD-132156.Google Scholar
Van't Leven, N., Prick, A.-E. J. C., Groenewoud, J. G., Roelofs, P. D. D. M., de Lange, J. and Pot, A. M. (2013). Dyadic interventions for community-dwelling people with dementia and their family caregivers: a systematic review. International Psychogeriatrics, 25, 1581–1603.CrossRefGoogle ScholarPubMed
Vernooij-Dassen, M., Draskovic, I., McCleery, J. and Downs, M. (2011). Cognitive reframing for carers of people with dementia. The Cochrane Database of Systematic Reviews, Cd005318. doi: 10.1002/14651858.CD005318.pub2.Google Scholar
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48.Google Scholar
Waldorff, F. B. et al. (2012). Efficacy of psychosocial intervention in patients with mild Alzheimer's disease: the multicentre, rater blinded, randomised Danish Alzheimer Intervention Study (DAISY). BMJ: British Medical Journal, 345, 1–14.Google Scholar
Winter, L. and Gitlin, L. N. (2006). Evaluation of a telephone-based support group intervention for female caregivers of community-dwelling individuals with dementia. American journal of Alzheimer's Disease and Other Dementias, 21, 391–397. doi: 10.1177/1533317506291371.Google Scholar
Woods, R. T. et al. (2012). REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technology Assessment, 16, v–xv, 1–116. doi: 10.3310/hta16480.Google Scholar
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