Dementia caregivers’ coping with pre-death grief: effects of a CBT-based intervention

Meichsner, Franziska; Wilz, Gabriele

doi:10.1080/13607863.2016.1247428

Cited by 45 publications

(55 citation statements)

References 25 publications

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“…therapeutic touch; and (4) focusing on anticipatory grief and preparing the caregivers for potential future losses. 51,52,54 Ultimately, the goal of intervention would be to realign the dyadic relationship 55 by helping caregivers to adapt to the losses and maintain meaningful relationships with the PWD even when the PWD are no longer who they used to be.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Liew

Tai

Yap

et al. 2019

Journal of the American Medical Directors Association

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Objectives: Caregivers of persons with dementia can experience loss and grief long before the death of the person. Although the phenomenon of caregiver grief has been increasingly described, it is uncertain if caregiver grief has independent effectsdseparate from the well-studied construct of caregiver burdendon adverse outcomes such as caregiver depression. We sought to compare the effects of baseline grief and burden on caregiver depression at baseline and 2.5 years later. Design and Setting: A cohort study with 2.5 years of follow-up. Participants: Family caregivers of community-dwelling persons with dementia (n ¼ 183). Measures: Participants completed questionnaires with scales that assessed caregiver grief, burden, and depression. Baseline grief and burden scores were included in a path analysis to predict depression at baseline and at 2.5 years. Results: At baseline, grief and burden had synergistic relationships with each other (P ¼ .012), where the high levels of grief amplified the effect of burden on caregiver depression. Both grief and burden had longitudinal effects on caregiver depression at 2.5 years (P <.001 and P ¼ .047, respectively), albeit with some differences in mechanism; both had effects which were indirectly mediated through baseline depression (P < .001 and P ¼ .002, respectively), but only grief had a direct path toward depression at 2.5 years (P ¼ .030), which was distinct from baseline depression. Conclusions and Implications: The findings highlight the need to identify and address caregiver grief in dementia services. They present a window of opportunity to improve caregiving outcomes, especially during the "latent phase" when caregivers encounter loss and grief but have yet to fully experience the debilitating effects of depression.

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Section: Discussionmentioning

confidence: 99%

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Liew

Tai

Yap

et al. 2019

Journal of the American Medical Directors Association

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“…Figure 1 exploring the various aspects of loss related to the past, present, and future; and encouraging adaptive ways of coping with the losses (such as not avoiding grief reactions, finding new ways to remain connected with the PWD, and involving other family members in the grieving process). This approach bears much resemblance to the key strategies that have been employed in previous intervention studies for PDG, [39][40][41] which included 22,39,[41][42][43] (1) This study has several limitations. First, the participants were recruited from tertiary centers and may not fully represent community samples.…”

Section: Discussionmentioning

confidence: 99%

Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Liew

Tai

Yap

et al. 2018

Int J Geriat Psychiatry

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Background Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the person. While such phenomenon of pre‐death grief (PDG) has been increasingly described, we are uncertain how it can be distinct from the well‐studied construct of caregiver burden. Objective To determine whether there are differences in the risk factors of PDG and caregiver burden to aid in our understanding of the relationship between the two constructs. Methods Spouses or children of community‐dwelling PWD were consecutively sampled from two tertiary hospitals. They completed questionnaires containing a PDG scale, a caregiver burden scale, and information related to the caregiver and PWD. Risk factors of PDG and caregiver burden were identified using multivariate regression, within which PDG and caregiver burden scores were jointly included as two separate dependent variables. Results We recruited 394 caregivers with a mean age of 53.0 years (SD 10.7), majority were Chinese (86.6%), children caregivers (86.3%), and primary caregivers (70.8%). In the regression analyses, we identified three risk factors which were shared by both PDG and caregiver burden (later stage of dementia, behavioral problems in PWD, and primary caregiving role) and three other risk factors which were unique to PDG alone (younger age of PWD, lower educational attainment of caregivers, and spousal caregiver). Conclusions The different risk factor profiles evidence a distinction between PDG and caregiver burden. They may possibly be distilled into a framework to direct our approach to PDG interventions, which may include using caregiver burden as an opportunity to initiate conversations on grief, exploring the various aspects of losses and encouraging adaptive coping.

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“…Recently, the utility of CBT for managing loss and grief was evaluated. Meichsner and colleagues [ 71 ] developed a manualized telephone-CBT program in Germany that provided 12 50-min individual therapy sessions over 6 months. Compared with control, the program showed small but significant reductions in caregiver grief at post-intervention and 6-month follow-up.…”

Section: Effectiveness Of Psychological Interventions For Dementia Famentioning

confidence: 99%

Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned

Cheng

Losada

et al. 2019

Curr Psychiatry Rep

193

142

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With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver’s ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

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Dementia caregivers’ coping with pre-death grief: effects of a CBT-based intervention

Abstract: Results indicate that a cognitive-behavioral intervention including grief-specific strategies can successfully foster caregivers' coping with loss and reduce burden of pre-death grief.

Cited by 45 publications

References 25 publications

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years

Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis

Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned

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