The Prince Henry Hospital Dementia Caregivers? Training Programme

Abstract

Objective. To describe the theory, elements and practice of a successful caregiver training programme; and report the 8‐year outcome. Design. Prospective, randomized control trial and longitudinal follow‐up over approximately 8 years. Setting. Psychiatry unit, general teaching hospital, Sydney, Australia. Participants. 96 persons less than 80 years old with mild to moderate dementia and their cohabiting caregivers. Interventions. All patients received a 10‐day structured memory retraining and activity programme. Caregivers in the immediate and wait‐list caregiver training groups received a structured, residential, intensive 10‐day training programme, boosted by follow‐ups and telephone conferences over 12 months. Those in the wait‐list group entered the programme after waiting 6 months. The third group of caregivers received 10 days’ respite (while patients underwent their memory retraining programme) and 12 months booster sessions as for the other groups. Main outcome measures. Nursing home admission; time until patient death. Main results. 64% of patients whose caregivers were in the immediate training group, 53% of wait‐list group patients and 70% of memory retraining patients had died. Nursing home admission had occurred in 79% of the immediate training, 83% of the delayed and 90% of the memory retraining group. Eight‐year survival analysis indicated that patients whose caregivers received training stayed at home significantly longer (p = 0.037) and tended to live longer (p = 0.08). Conclusions. Caregiver training programmes demonstrably can delay institutionalization of people with dementia. © 1997 John Wiley & Sons, Ltd.

Systematic review of respite care in the frail elderly

“…Brodaty et al 33 carried out a randomised trial comparing a carer training programme (either immediate or waiting list control subjects) with a 10-day respite intervention with no training. The 8-year survival analysis indicated that carer training delayed both death and institutionalisation; the respite intervention, in comparison, although coupled with memory retraining for dementia patients, was associated with a shorter mean time to institutionalisation.…”

“…One study reported that, compared with a carer training programme, 33 carers in receipt of respite tended to institutionalise care recipients faster. In contrast, Riordan and Bennett 49 found that respite users tended to keep the care recipient in the community for significantly longer than matched control subjects.…”

Dementia: issues in early recognition and intervention in primary care

“…33 A range of psychosocial approaches can be offered, primarily targeted at the family. Although the evidence on interventions to support families is mixed, 34 the conclusion from major studies is that a combination of family meetings and peer support is effective in reducing care-giver strain and delaying institutionalization, [35][36][37] and that the best outcomes are achieved by multidimensional interventions individually tailored to carer needs. 38,39 Cognitive rehabilitation-using for example memory aids and training-has been applied with promising results in mild/moderate dementia.…”

Dementia Caregiving: The Role of the Primary Care Physician

“…Many of the recommendations regarding the role of the family physician in supporting dementia caregivers can be subsumed under the three dimensions used by Brodaty et al 11 in designing their comprehensive program: (a) education, (b) psychological support and (c) assistance with social support.…”