Interventions for Non-professional Caregivers of Individuals with Dementia:
A Synthesis of the Evidence
It is estimated that more than half a million Veterans suffer from dementia, and they are frequently cared for at home by a friend or family member. The progressive nature of the illness and intensity of care required for a person with dementia can have physical, emotional, and psychological impacts on the caregiver. Upon request from the VHA Dementia Steering Committee, investigators with the Evidence-based Synthesis Program (ESP) Center affiliated with the Portland VA Medical Center conducted a literature review to answer key questions on the effects of caregiver interventions on caregiver burden, mood, and the ability to manage problematic behavior, as well as the effects on the care recipient.
Investigators examined data from 15 systematic reviews of dementia caregiver interventions that were published from the inception of the literature database through July 2009 to answer two key questions.
Question #1: Do caregiver interventions affect the caregivers' knowledge and ability to manage problematic behavior, caregiver psychosocial burden, caregiver health and health behaviors, or outcomes in the individual with dementia?
Three areas were reviewed: 1) psychosocial interventions, 2) technology-based interventions, and 3) respite care.
Answer: Psychological interventions that appear to be effective are individually-tailored treatments that are more resource intensive, such as behavior management training and multi-component interventions. There was no strong evidence documenting the impact of individual skills training or exercise training. The evidence was insufficient to determine the effectiveness of technology-based interventions (e.g., computer-telephone support systems, GPS location systems). Respite care may offer some short-term benefits to caregivers, though long-term benefits have not been shown.
In addition, a recently completed VA study found positive effects of a multi-component intervention on caregiver burden and care recipient problem behaviors – and the intervention appears to be feasible in VA settings. The intervention includes caregiver support and skills training in safety, behavior management, and self-care delivered via in-home, telephone, and telephone support group sessions.
Question #2: What are the adverse effects of caregiver interventions?
Answer: Investigators found evidence in one study to suggest that caregivers using daycare service spend more time on caregiving activities on respite days than on non-respite days, usually in preparing or transporting the care recipient for the visit to the daycare setting. In addition, one small study showed evidence that some caregivers reported feelings of sadness, loneliness, or guilt when the care recipient was in respite care. No evidence of adverse effects from other caregiver interventions was found.
Overall, the strongest evidence supports multi-component interventions that are designed after individual in-home assessment – and that are tailored to the specific needs of the caregiver and care recipient. Loss to follow-up was a limitation for many of the studies in this review and may be clinically important. Reasons for drop-out should be assessed to help guide future implementation efforts in this field.
To view the full report, go to http://www.hsrd.research.va.gov/publications/esp/reports.cfm.
This report may be useful to VA managers as well as clinicians in their efforts to serve family caregivers, particularly through implementation of evidence-based programs. In addition, the VHA Dementia Steering Committee will consider the results of this evidence synthesis in its ongoing planning efforts to enhance dementia recognition, diagnosis, and care in the VA healthcare system.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
The VHA Dementia Steering Committee was convened by the Chief Officer for VA Patient Care Services and also is supported by the Office of Geriatrics and Extended Care, which has primary responsibility for VHA dementia initiatives.
Reference: Goy E, Freeman M, and Kansagara D. A Systematic Evidence Review of Interventions for Non-professional Caregivers of Individuals with Dementia. VA-ESP Project #05-225:2010.
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