Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses

Abstract

ObjectivesThis umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves.DesignAn umbrella review of systematic reviews was conducted.Data sourcesQuantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included.Eligibility criteriaReviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers.Data extraction and synthesisA total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method.ResultsThe evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified.ConclusionsLack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector.PROSPERO registration numberCRD42021252841; BMJ Open: doi:10.1136/bmjopen-2021-053117.

Innovative Approaches and Therapies to Enhance Neuroplasticity and Promote Recovery in Patients with Neurological Disorders: A Narrative Review

“…Regular practice encourages the release of growth factors, including BDNF, which supports neuronal survival, synaptic plasticity, and the production of new neurons. Along with sustaining cognitive function and lowering the risk of neurodegenerative disorders, exercise improves cerebral blood flow and boosts neurogenesis and general brain connectivity [ 27 ].…”

“…TMS and tDCS, two non-invasive brain stimulation methods, are potential therapies to modify neuroplasticity and ameliorate symptoms in neurodegenerative illnesses [ 27 , 28 ]. TMS alters neuronal activity and fosters neuroplastic changes by applying magnetic pulses to particular brain areas.…”

“…Along with sustaining cognitive function and lowering the risk of neurodegenerative disorders, exercise improves cerebral blood flow and boosts neurogenesis and general brain connectivity [27].…”

“…Through complementary mechanisms, combining modalities can accelerate neuroplastic changes and produce more significant and all-encompassing results in rehabilitation. However, figuring out the best mix and order of therapies for various neurological disorders and people still poses a challenge that necessitates more research [25][26][27][28][29][30].…”