Supporting dementia patients and their caregivers in daily life challenges: review of physical, cognitive and psychosocial intervention studies

Abstract

Due to the complex nature of cognitive and psychosocial interventions, their efficacy depends strongly on local settings. Thus, active components of these interventions are not always obvious, even in controlled randomized trials. Successful patient management includes (i) the safekeeping of basic support, (ii) the provision of a stable external milieu that is adjusted to the patients' cognitive resources and (iii) the provision of multimodal therapeutic concepts that are closely adapted to the practical needs of the patients and caregivers.

Effectiveness of Supporting Informal Caregivers of People with Dementia: A Systematic Review of Randomized and Non-Randomized Controlled Trials

“…Although many interventions demonstrated positive impacts on different outcomes such as burden [22,23], quality of life of the caregiver [24], and delay in hospitalization [25]; other similar studies did not find the same benefits [26][27][28]. Inconsistency of the current findings can be explained by the methodological issues caused by the complex nature of this type of research, e.g., [4,[29][30][31][32][33][34][35], such as: different duration of interventions, different intensity and characteristics of interventions, and the variety of caregivers and care-recipients characteristics. Additionally, these interventions often suffer from insufficient statistical power, short follow-up periods, and the use of various instruments to measure outcomes.…”

“…Second, many reviews excluded respite care as a type of caregiver support while this should also be recognized as a supportive strategy for caregivers. Third, some reviews only included a small number of studies potentially missing important evidence of non-included but eligible interventions [29]. Finally, many reviews included both controlled and uncontrolled studies making comparison between interventions difficult [12,45].…”

Supporting Elderly Patients at Risk in Hospital Environments

“…Identification of elderly patients at high risk for negative outcomes and adaption of routine patient care to meet the specific needs of elderly multimorbid patients with reduced functional reserve by interdisciplinary team work is urgently needed since multiple studies already demonstrated benefits by these approaches [8,9,18,19]. The feasibility and cost-effectiveness of such approaches in different settings still has to be evaluated as well as the effect on comprehensive patient outcomes after the hospital visit such as mortality, rehospitalization, institutionalization, use of home healthcare services and quality of life including psychological and social aspects.…”

“…The number of people with dementia worldwide will increase from 44 million in 2013 to 76 million in 2030 and 135 million by 2050 with aging being the main driver of dementia [7]. Dementia patients have an increased risk of in-hospital complications and need specific structures and treatment for optimized care [8,9]. However, routine care in hospitals today is mostly designed for young or middle-aged patients and focusses on the primary illness of interest, comorbid conditions like dementia which do not fall in the specialty are often not detected [10] but can lead to serious complications [8].…”

Psychological Adjustment of Elderly Caregivers of People with Dementia

“…Other authors have studied the burden and affectation of the physical and psychological health of caregivers [3][4][5] these authors show that caregivers have worse physical and psychological health than non-caregivers. Moreover, emotional management at critical times of care [6][7][8] also affects the burden and psychological health of caregivers [3,[9][10][11][12]. Dementia produces changes in the affected persons and these changes affect the health of their caregivers [3,[9][10]13], it is for this reason that caring a person with dementia requires the caregiver to do a psychological and emotional adjustment [14].…”