Peer support and reminiscence therapy for people with dementia and their family carers: a factorial pragmatic randomised trial

Abstract

ObjectiveThe objective of this study was to evaluate peer support and reminiscence therapy, separately and together, in comparison with usual care for people with dementia and their family carers.DesignFactorial pragmatic randomised trial, analysed by treatment allocated, was used for this study.SettingThe trial ran in Community settings in England.ParticipantsPeople with dementia and their family carers were the participants.InterventionsTreatment as usual (TAU) plus one of the following: one-to-one peer support to family carers from experienced carers (Carer Supporter Programme; CSP), group reminiscence therapy (Remembering Yesterday, Caring Today; RYCT) for people with dementia and carers, both or neither.Main outcome measuresPrimary outcomes included health-related quality of life (SF-12) for carers and quality of life (QoL-AD) for people with dementia; secondary outcomes included quality of relationship for carers and people with dementia; both were collected by blinded assessors at baseline, 5 and 12 months (primary end point).ResultsOf 291 pairs recruited, we randomised 145 (50%) to CSP (71% uptake) and 194 (67%) to RYCT (61% uptake). CSP and RYCT, separately or together, were not effective in improving primary outcomes or most secondary outcomes. For CSP versus ‘no CSP’, adjusted difference in means was 0.52 points on the SF-12 (95% CI −1.28 to 2.32) and −0.08 points on the QoL-AD (95% CI −1.70 to 1.56). For RYCT versus ‘no RYCT’, the difference was 0.10 points on the SF-12 (95% CI −1.72 to 1.93) and 0.51 points on the QoL-AD (95% CI −1.17 to 2.08). However, carers reported better relationships with the people with dementia (difference 1.11, 95% CI 0.00 to 2.21, p=0.05). Comparison of combined intervention with TAU, and of intervention received, suggested differential impacts for carers and persons with dementia.ConclusionsThere is no evidence from the trial that either peer support or reminiscence is effective in improving the quality of life.Trial registration numberISRCTN37956201; Results.

What is known from the existing literature about peer support interventions for carers of individuals living with dementia: A scoping review

“…In total 28 original studies were identified that tested an intervention comprising solely of peer support or had a peer support component. We examined the extent, nature and distribution of the studies included in this review and determined the following: the majority of studies ( n = 12) used a trial design including randomised controlled trials, pragmatic randomised trials, randomised controlled evaluations, randomised controlled two group design or randomised pilot studies (Charlesworth et al, ; Finkel et al, ; Gaugler et al, , , , ; Gaugler, Reese, Reese, & Mittelman, ; Hayden, Glynn, Hahn, Randall, & Randolph, ; Laakkonen et al, , ; Lai et al, ; Martindale‐Adams, Nichols, Burns, Graney, & Zuber, ; Mittelman et al, ; Núñez‐Naveira et al, ; Torkamani et al, ; Wai Tong & Lee, ; Wang & Chien, ; Wang et al, ; Winter & Gitlin, ), eight studies used a pre/post‐test design (Boots, de Vugt, Withagen, Kempen, & Verhey, ; Chenoweth et al, ; Chu et al, ; Dam, van Boxtel, Rozendaal, Verhey, & de Vugt, ; Gaugler, Hobday, et al, ; Hsu et al, ; Javadpour, Ahmadzadeh, & Bahredar, ; O'Connor, Arizmendi, & Kaszniak, ), four a quasi‐experimental design (Andren & Elmståhl, , ; Easom, Alston, & Coleman, ; Marziali & Garcia, ; Pagán‐Ortiz, Cortés, Rudloff, Weitzman, & Levkoff, ), two a quasi‐experiment with mixed methods design (Baily, Kingsyon, Alford, Taylor, & Tolhurst, ; Küçükgüçlü, Akpınar Söylemez, Yener, & Işık, ) and the final two studies used mixed methods (Hattink, Droes, Sikkes, Oostra, & Lemstra, ; McKechnie, Barker, & Stott, ).…”

“…Inherent in this directive is the need to strengthen services that reflect the needs of the person with dementia and their informal carers. In response to these concerns a number of studies have suggested that psycho‐educational care interventions, containing facilitated peer support, could be of significant value to reduce psychosocial stress of being a carer (Charlesworth et al, ). Such support may be more effective when provided by a peer i.e.…”

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

“…Cognitive impairment, behavioural and psychological symptoms, depression y y n y n n (Continues) ADL/IADL functioning for up to 4 months, relative to control conditions. 50 45 Multicomponent interventions were diverse in both delivery and results, with 2 of 3 small studies demonstrating functional benefits.…”

“…47,48 A reminiscence therapy study demonstrated no effects. 50 Cognitive training and stimulation therapies provided mixed results, with three out of six studies demonstrating evidence of efficacy of individual or group interventions (Tables 4, 5).…”

Effect of peer support on health outcomes in patients with cardiac pacemaker implantation: A randomized, controlled trial

“…Patients are not the only beneficiaries of peer support, and nurses or other caregivers can benefit from it (Charlesworth et al, ; Taylor, Gutteridge, & Willis, ). At the end of the program, three nurses were asked what impact peer support had on them.…”