Effectiveness of interventions to address the negative health outcomes of informal caregiving to older adults: protocol for an umbrella review

Abstract

IntroductionInformal (unpaid) caregivers play an essential role in caring for older people, whose care needs are often not fully met by formal services. While providing informal care may be a positive experience, it can also exert a considerable strain on caregivers’ physical and mental health. How to best support the needs of informal caregivers remains largely debated. This umbrella review (review of systematic reviews) aims to evaluate (1) whether effective interventions can mitigate the negative health outcomes of informal caregiving, (2) whether certain types of interventions are more effective than others, (3) whether effectiveness of interventions depends on caregiver/receiver, context or implementation characteristics and (4) how these interventions are perceived in terms of acceptability, feasibility and added value.Methods and analysisWe will include systematic reviews of primary studies focusing on the effectiveness of interventions (public or private, unifaceted or multifaceted, delivered by health or social care professionals or volunteers) aimed at reducing the impact of caregiving on caregivers’ physical or mental health. This will also include quantitative and qualitative syntheses of implementation studies. The literature search will include the following databases: Medline, CINAHL, PsycINFO and Web of Science. A key informant-guided search of grey literature will be performed. Quality appraisal will be conducted with the AMSTAR-2 checklist for quantitative reviews and with an ad hoc checklist for qualitative syntheses. Narrative and tabular summaries of extracted data will be produced, and framework synthesis will be employed for weaving together evidence from quantitative studies in effectiveness reviews with findings on implementation from qualitative studies.Ethics and disseminationThis umbrella review will use data from secondary sources and will not involve interactions with study participants; it is thus exempt from ethical approval. Results will be presented at international conferences and will be published in a peer-reviewed journal.PROSPERO registration numberCRD42021252841.

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

“…The protocol for this umbrella review was registered a priori in the PROSPERO database 22 and published in a peer-reviewed journal (doi:10.1136/bmjopen-2021-053117). 23 Online supplemental table 1 includes a list of all amendments made to the protocol after its registration, which will be mentioned in relevant sections below. The reporting of this umbrella review is based on the Preferred Reporting Items for Overviews of Reviews statement.…”

“…Inclusion and exclusion criteria used to select reviews are presented in box 1 and discussed in detail in the umbrella review protocol. 23 Due to the abundance of published systematic reviews, the eligibility criteria were amended to exclude reviews of critically low quality based on our risk-of-bias assessment. This amendment is documented in online supplemental table 1 .…”

“…Qualitative reviews were also assessed independently by two team members, who used an ad hoc quality appraisal checklist adapted from the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses 17 and available in the published protocol. 23 The tool was developed and piloted by all team members on a sample of five randomly selected reviews. Items #3, #4, #7 and #10 were considered as ‘critical’, with reviews exhibiting more than two critical flaws being excluded.…”

“…As a complementary output, we used parallel convergence approach (ie, synthesising quantitative and qualitative evidence separately and bringing them together at the final stage) to update our initial conceptual framework that was based exclusively on expert opinion and/or existing literature (see the published protocol 23 ). The resulting framework, From Support Interventions to Improved Caregiver Outcomes (SIICO), will be presented below and aims to substantiate the potential pathway (and its various modifiers and mediators) linking caregiver support interventions to improved health outcomes.…”

“…Based on our appraisal, the reviews were grouped into ‘critically low’, ‘low’, ‘moderate’ and ‘high-quality’ categories, and critically low-quality reviews were excluded from the umbrella review. Qualitative reviews were also assessed independently by two team members, who used an ad hoc quality appraisal checklist adapted from the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses17 and available in the published protocol 23. The tool was developed and piloted by all team members on a sample of five randomly selected reviews.…”