The process of a group intervention for caregivers of demented persons living at home: Conceptual framework, components, and characteristics

Abstract

Most earlier group interventions for caregivers of demented persons lacked a theoretical basis to guide the intervention process and focused on providing information and practical advice and encouraging the expression of feelings. This article presents the process of a group intervention with emphasis on its conceptual framework, components and characteristics. As caregivers are exposed to numerous daily stressful demands, the intervention's conceptual framework was derived from Lazarus and Folkman's transactional theory of stress and coping and Folkman's Coping Effectiveness Training Program. The central aim of the intervention was to improve the ability of caregivers to cope with the stressful demands at the core of caring for a demented person, rather than to focus on information and the task-oriented aspects of caring. The two components of the intervention deal with the cognitive appraisal of stressors and coping strategies, with a view to determining which strategies are most appropriate on the basis of the changeability of stressors. Three coping strategies were proposed: problem solving (problem-focused coping to deal with changeable stressors), reframing (emotion-focused coping to manage the emotional response to unchangeable stressors), and seeking social support (problem- or emotion-focused coping). The most salient characteristics of this group intervention were its intensity (15 meetings) and its focus on the caregivers' daily reality, which provided concrete reference points for the discussion of conceptual notions.

Improving Depression and Enhancing Resilience in Family Dementia Caregivers: A Pilot Randomized Placebo-Controlled Trial of Escitalopram

“…The recent multi-site study referred to as REACH I and II (Resources for Enhancing Alzheimer’s Caregiver Health) (1, 4, 44, 45) is a unique, multi-site research program sponsored by the National Institute on Aging and the National Institute on Nursing Research, studied a total of 1,222 caregivers and care-recipients with various psycho-educational interventions, home-based interventions, support groups; counseling, behavioral skills training, and medications for care-recipient and caregiver with moderate effects on caregiver depression and stress (1, 4, 43–46). Evidence from these supportive and behavioral interventions indicates that combined interventions targeting multiple levels of the stress/health model and multiple individuals simultaneously (i.e., caregiver and patient) produce a significant improvement in caregiver depression/burden, subjective well-being, perceived caregiver satisfaction, ability/knowledge, and, sometimes care-recipient symptoms (39).…”

Ways of Coping and Biomarkers of an Increased Atherothrombotic Cardiovascular Disease Risk in Elderly Individuals

“…In fact, entire interventions are based on the idea that for instance dementia caregivers need to seek out additional support from their social environment in order to better cope with caregiving burden [47]. This might partially explain why there was no association between SSS and D-dimer levels in caregivers, whereas greater use of SSS was associated with elevated D-dimer levels in noncaregivers.…”

Understanding the outcomes of a psycho-educational group intervention for caregivers of persons with dementia living at home: A process evaluation

“…The experimental program aimed to improve caregivers' abilities to cope with the numerous daily stresses associated with caring for a relative with dementia, with a focus on the relative's dysfunctional behaviours (see Lévesque et al, 2002, for a detailed description of the program and its theoretical framework). The program was based on Lazarus and Folkman's (1984) transactional theory of stress and coping.…”

“…This compounds the problem, because in the absence of empirical research on the links between processes and outcomes, models are at least able to provide some ideas about the processes involved. When interventions are neither supported by empirical evidence nor by conceptual models, it is virtually impossible to understand by what processes outcomes were achieved (Lavoie, 1995;Lévesque et al, 2002;Schulz, 2001;Zarit & Leitsch, 2001). For psycho-educational groups in particular, there are only a small number of process evaluations in the literature.…”