Change in Indices of Distress Among Latino and Anglo Female Caregivers of Elderly Relatives With Dementia: Site-Specific Results From the REACH National Collaborative Study

Gallagher‐Thompson, Dolores; Coon, David W.; Solano, Nancy; Ambler, Christian; Rabinowitz, Yaron G.; Thompson, Larry W.

doi:10.1093/geront/43.4.580

Cited by 243 publications

(168 citation statements)

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“…and educational interventions, supply of information, training in problem solving, etc. Certain evidence has been found in the investigation about the efficiency in the relief of the caregiver burden and the delay in the institutionalization of the dependent person due to this type of programs (Gallagher-Thompson et al, 2003).…”

Section: Intervention Programs To Alleviate the Caregiver Burden: Thementioning

confidence: 99%

The informal caregiver's burden of dependent people: Theory and empirical review

Carretero

Garcés

Ródenas

et al. 2009

Archives of Gerontology and Geriatrics

273

211

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Section: Intervention Programs To Alleviate the Caregiver Burden: Thementioning

confidence: 99%

The informal caregiver's burden of dependent people: Theory and empirical review

Carretero

Garcés

Ródenas

et al. 2009

Archives of Gerontology and Geriatrics

273

211

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“…It is a manual-based, psychological intervention delivered in weekly group sessions. It was comprehensibly evaluated in the Resources for Enhancing Alzheimer's Caregiver Health project, which recruited carers from a range of clinical and community sources in the USA; depression scores were significantly decreased in treatment groups compared with controls in all of the studies [16][17][18][19] and self-efficacy scores were increased. 18 Although the impact of this therapy programme on rates of institutionalisation has not been tested, a recent systematic review finds that there is some evidence that carer support can reduce institutionalisation and that therapies such as the Coping with Caregiving programme, which include problem-solving strategies and offer carers a choice of support strategies which can be tailored to their individual needs, are most effective.…”

Section: The Coping With Caregiving Programmementioning

confidence: 99%

START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia

Livingston

Barber

Rapaport

et al. 2014

Health Technology Assessment

164

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BackgroundTwo-thirds of people with dementia live at home, receiving most care from family carers, about 40% of whom have clinically significant depression or anxiety. This impacts on the person with dementia, families and society, predicting care breakdown. There are currently no clinically effective and cost-effective NHS family carer interventions.ObjectivesTo assess the STrAtegies for RelaTives (START) intervention in the short (4 and 8 months) and long term (1 and 2 years) compared with treatment as usual (TAU).DesignRandomised, parallel-group, superiority trial with blinded assessment recruiting participants 2 : 1 (intervention to TAU) to allow for therapist clustering.SettingThree UK mental health services and one neurological service.ParticipantsFamily carers of people with dementia.InterventionEight-session manual-based coping intervention delivered by supervised psychology graduates to individuals.Main outcome measuresAffective symptoms [Hospital Anxiety and Depression Scale-total (HADS-T)] and cost-effectiveness. Secondary measures: anxiety and depression symptoms and caseness, quality of life (QoL), abusive behaviour and long-term care home admission.ResultsTwo hundred and sixty participants were randomised (173 intervention, 87 TAU). We used intention-to-treat analysis in the short term (152 intervention, 77 TAU) and in the long term (140 intervention, 69 TAU).In the short term, the intervention group had lower HADS-T [mean difference –1.80, 95% confidence interval (CI) –3.29 to –0.31;p = 0.02] and higher quality-adjusted life-years (QALYs) (mean difference 0.03, 95% CI –0.01 to 0.08). Costs were no different between groups [mean £252 (95% CI –£28 to £565) for intervention group]. The cost-effectiveness acceptability curve showed a greater than 99% chance of being cost-effectiveness at a £30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score. Carers in the intervention group had less case-level depression [odds ratio (OR) 0.24, 95% CI 0.07 to 0.76], a trend towards reduced case-level anxiety (OR 0.30, 95% CI 0.08 to 1.05), lower Hospital Anxiety and Depression Scale-anxiety (HADS-A) (–0.91, 95% CI –1.76 to –0.07;p = 0.03) and Hospital Anxiety and Depression Scale-depression (HADS-D) (–0.91, 95% CI –1.71 to –0.10;p = 0.03) and higher Health Status Questionnaire (HSQ) QoL (mean difference 4.09, 95% CI 0.34 to 7.83). Group differences in abusive behaviour (OR 0.48, 95% CI 0.18 to 1.27) and the person with dementia’s quality of life-Alzheimer’s disease (QoL-AD) (mean increase 0.59, 95% CI –0.72 to 1.89) were not significant.In the long term, the intervention group had lower HADS-T (mean difference –2.58, 95% CI –4.26 to –0.90;p = 0.03) and higher QALYs (mean difference 0.03, 95% CI –0.01 to 0.06). Carers in the intervention group had less case-level depression (OR 0.14, 95% CI 0.04 to 0.53), a trend towards reduced case-level anxiety (OR 0.57, 95% CI 0.26 to 1.24), lower HADS-A (–1.16, 95% CI –2.15 to –0.18) and HADS-D (1.45, 95% CI –2.32 to –0.57), and higher HSQ (mean difference 7.47, 95% CI 2.87 to 12.08). Thirty-two (18.7%) people with dementia in the intervention group and 17 (20.2%) in TAU were admitted to a care home (hazard ratio 0.83, 95% CI 0.44 to 1.56;p = 0.56). There were no significant differences between groups in abusive behaviour (OR 0.83, 95% CI 0.36 to 1.94), the person with dementia’s QoL-AD (0.17, 95% CI –1.37 to 1.70) or costs (£336, 95% CI –£223 to £895) for intervention group. The probability that the intervention would be seen as cost-effective at £30,000/QALY threshold and cost-effectiveness on the HADS-T remained high.ConclusionsThe START intervention was clinically effective and cost-effective in the short and longer term. The results are robust to the sensitivity analyses performed. Future work is needed to consider mechanism of action; the effects on people with dementia in clinical terms (cognition, neuropsychiatric symptoms, longer-term care home admission); and on health and social care costs. In addition, we will explore the effects of carer abusive behaviour on the care recipient’s care home admission and if this then reduces abusive behaviour. We would also like to implement START and evaluate this implementation in clinical practice.Trial registrationCurrent Controlled Trials ISCTRN70017938.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Group psychotherapy principles guide management of the often intense emotions which arise in the process. Thus, the method integrates proven group-based psychotherapeutic and educational clinical techniques [29] with an innovative hands-on experiential method employing professional SPs. Carers, guided by the expert clinical coaches, learn how to deal with challenging situations they are encountering at home.…”

Section: Interventionmentioning

confidence: 99%

“…[25] , mastery, role overload, role captivity, caregiving competence [26] , caregiver burden (12-item Zarit Burden Interview) [27] , and stress coping style (The Coping Inventory for Stressful Situations) [28,29] . Details of outcome measures are presented in Table 2.…”

Section: -9 Skills Training Simulationsmentioning

confidence: 99%

“…Coping inventory for stressful situations 48-item measure describes the manner in which an individual responds to stressful situations. It measures three forms of coping style: emotion-focused, task-oriented, avoidance-oriented [28,29] For each coping strategy, respondents rate the usage frequency on a 5-point Likert scale ranging from 1 (not at all) to 5 (very much).…”

Section: -Item Zarit Burden Interviewmentioning

confidence: 99%

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Improving caregiving competence, stress coping, and mental well-being in informal dementia carers

Chiu

Wesson²,

Sadavoy³

2013

WJP

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Author contributions: Chiu M was responsible for study design, data collection and analysis, and wrote the introduction, methods and results sections of the manuscript; Wesson V wrote the introduction, discussion and comments sections, is a co-developer of the CARERS program and has delivered the intervention to carers; Sadavoy J is the founding Reitman Centre program director, designed the intervention and evaluation framework, supervised the study design and edited the manuscript. Supported by Abstract AIM:To study the effectiveness of Reitman Centre "Coaching, Advocacy, Respite, Education, Relationship, and Simulation" (CARERS) program, which uses problem-solving techniques and simulation to train informal dementia carers. METHODS:Seventy-three carers for family members with dementia were included in the pilot study. Preand post-intervention data were collected from carers using validated measures of depression, mastery, role captivity and overload, caregiving competence and burden, and coping styles. To assess program effectiveness, mean differences for these measures were calculated. One-way ANOVA was used to determine if change in scores is dependent on the respective baseline scores. Clinical effects for measures were expressed as Cohen's D values. RESULTS:Data from 73 carers were analyzed. The majority of these participants were female (79.5%). A total of 69.9% were spouses and 30.1% were children of the care recipient. Participants had an overall mean age of 68.34 ± 12.01 years. About 31.5% of participating carers had a past history of psychiatric illness (e.g. , depression), and 34.2% sustained strained relationships with their respective care recipients. Results from carers demonstrated improvement in carers' selfperception of competence (1.26 ± 1.92, P < 0.0001), and significant reduction in emotion-focused coping (measured by the Coping Inventory of Stressful Situations, -2.37 ± 6.73, P < 0.01), Geriatric Depression scale (-0.67 ± 2.63, P < 0.05) and Pearlin's overload scale (-0.55 ± 2.07, P < 0.05), upon completion of the Program. Secondly, it was found that carers with more compromised baseline scores benefited most from the intervention, as they experienced statistically significant improvement in the following constructs: competence, stress-coping style (less emotion-oriented), sense of mastery, burden, overload. CONCLUSION:Study results supported the effectiveness of the CARERS Program in improving caregiving competence, stress coping ability and mental well-being in carers caring for family members with dementia. Chiu M et al . Piloting the Reitman Centre CARERS Program comprehensive package of evidence-based interventions for informal carers comprised of 3 integrated components: group psychotherapy, Problem-Solving Techniques and skill acquisition for specific current challenging interactions in caregiving. The demonstrated outcomes are reduction of emotion-based coping, enhanced mastery, and reduced burden. The Program is structured, and requires active participation of carers as they acqu...

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Change in Indices of Distress Among Latino and Anglo Female Caregivers of Elderly Relatives With Dementia: Site-Specific Results From the REACH National Collaborative Study

Cited by 243 publications

References 34 publications

The informal caregiver's burden of dependent people: Theory and empirical review

The informal caregiver's burden of dependent people: Theory and empirical review

START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia

Improving caregiving competence, stress coping, and mental well-being in informal dementia carers

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