Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals With Dementia Efficacy of psychosocial intervention in patients with mild Alzheimer’s disease: the multicentre, rater blinded, randomised Danish Alzheimer Intervention Study (DAISY) Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study. Reducing anxiety in Alzheimer's disease family caregivers: The effectiveness of a nine-week cognitive-behavioral intervention Helping carers to care--the 10/66 dementia research group's randomized control trial of a caregiver intervention in Russia. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial. Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. E-care: a telecommunications technology intervention for family caregivers of dementia patients. Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. Dementia care consultation for family caregivers: Collaborative model linking an Alzheimer's association chapter with primary care physicians A three-country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: effects on caregiver depression. Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. Can counseling and support reduce burden and depressive symptoms in caregivers of people with Alzheimer's disease during the transition to institutionalization? Results from the New York University caregiver intervention study. Mechanisms of action of a psychological intervention for dementia caregivers: effects of behavioral activation and modification of dysfunctional thoughts. Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study Caregiver attribution and resentment in dementia care Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers. A disease management program for families of persons in Hong Kong with dementia. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. The Resources for Enhancing Alzheimer's Caregiver Health (REACH): project design and baseline characteristics. Primary care interventions for dementia caregivers: 2-year outcomes from the REACH study. Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. The moderating effect of self-efficacy on intervention response in women family caregivers of older adults with dementia.
AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport  reported lower depression than control group caregivers did Objective To assess the efficacy at 12 months of an early psychosocial counselling and support programme for out patients with mild Alzheimer ’s disease and their primary care givers . Design Multicentre , r and omised , controlled , rater blinded trial . Setting Primary care and memory clinics in five Danish districts . Participants 330 out patients with mild Alzheimer ’s disease and their 330 primary care givers . Interventions Participating dyads ( patient and primary care giver ) were r and omised to control support during follow-up or to control support plus DAISY intervention ( multifaceted and semi-tailored counselling , education , and support ) . Main outcome measures Primary outcomes at 12 months for patients were change from baseline in mini mental state examination ( MMSE ) score , Cornell depression scale score , and proxy rated European quality of life visual analogue scale ( EQ-VAS ) score . For care givers , outcomes were change from baseline in geriatric depression scale ( GDS 30 items ) score and EQ-VAS score . Results Because of multiple testing , statistical significance was set at an adjusted P limit of < 0.0005 . At 12 months there were no significant differences between the two allocation groups in changes from baseline in the primary and secondary outcomes . However , although non-significant with the adjusted P limit , a small difference was observed for one of the primary patient outcomes ( Cornell depression scale score ) in patients in favour of the DAISY intervention group before and after adjusting for attrition ( P=0.0146 and P=0.0103 respectively ) . Conclusions The multifaceted , semi-tailored intervention with counselling , education , and support for patients with mild Alzheimer ’s disease and their care givers did not have any significant effect beyond that with well structured follow-up support at 12 months after adjustment for multiple comparisons . The small positive effect found in the unadjusted primary outcome addressing depressive symptoms in patients may call for further research focusing on patients with Alzheimer ’s disease and comorbid depression . Trial registration IS RCT N74848736 PURPOSE Few empirical studies have compared the efficacy between psychoeducational ( skill-building ) approaches for reducing  caregivers ' psychological distress  and interventions modeled after typical community-based support groups . We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia . DESIGN AND METHODS The change from pre assessment to post assessment ( baseline to 3 months ) for 213 female caregivers ( 122 Anglo and 91 Latino ) is presented . They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program ( instruction and practice in small groups to learn specific cognitive and behavioral skills ) or in the Enhanced Support Group condition ( guided discussion and empathic listening to develop reciprocal support within the group ) . Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers , and they were delivered in either English or Spanish by trained interventionists . RESULTS Overall , participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms , increased use of adaptive coping strategies , and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition . Results were similar for both ethnic groups : there were no main effects for ethnicity , and no significant ethnicity by treatment interaction effects . IMPLICATION S This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone . We find it very encouraging that the Latino caregivers responded well on key outcome variables , suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer 's disease ( AD ) family caregivers , a surprisingly small amount of research exists on anxiety . Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers , brief group cognitive-behavioral therapy ( CBT ) interventions may offer assistance . To assess CBT 's effectiveness , 38 anxious AD family caregivers were recruited and r and omly assigned to a nine-week group CBT intervention or to a waitlist control . Caregivers r and omized to CBT demonstrated less anxiety on self-report and clinician-administered question naires than waitlist group participants at posttreatment and six-week follow-up assessment s. A sub sample of caregivers also demonstrated improved sleep , as assessed through actigraph measurements . Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov Among the diverse group of interventions developed to help dementia family caregivers  cognitive-behavioural approaches show especially promising results . Objectives : This study describes a cognitive-behavioural group intervention aim ed principally at the modification of dysfunctional thoughts associated with caregiving ( MDTC ) . The efficacy of the MDTC intervention in reducing caregivers ’ depressive symptomatology , together with the frequency and appraisal of problem behaviours , is compared to that of a waiting-list control group ( WL ) . Furthermore , the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers ’ depressive symptomatology is analyzed . Of the 74 dementia caregivers who were r and omized to one of two conditions ( MDTC and WL ) , 39 completed the post-intervention assessment . Statistical analyses were performed on an intention-to-treat basis , using last observation carried forward . The results reveal that the MDTC intervention is successful in reducing  caregivers ’ level of depressive symptomatology and dysfunctional thoughts about caregiving , as well as in modifying their appraisal of their relative 's problem behaviours . Furthermore , a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology . The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted Dementia induces morbidity not only in the patients but also in the families taking care of them . Many studies described the impact of care-giving on physical and psychological health . Support groups were design ed to alleviate the burden of care-givers . The objective of this study was to measure the efficacy of a support group programme for care-givers of demented patients in the community . Forty-one primary care-givers were r and omly assigned to a study ( n=23 ) or a control group ( n=18 ) . Subjects of the study group attended a structured programme of eight 2-h sessions . These weekly sessions consisted of information on the disease , role-playing on management of behavior problems , discussion on emotional impact of care-giving , and learning of stress management techniques . Subjects of the control group were referred to informal monthly meetings of the Alzheimer  's Society  .  Subjects of both groups were evaluated at the entry ( T1 ) , after 8 weeks ( T2 ) and after 8 months ( T3 ) . The outcome variables were the Burden Interview , the Revised Memory and Behavior Problems Checklist , the Brief Symptoms Inventory , the Alzheimer 's Disease Knowledge Test and a question naire on health care utilization . Compared with the control group , subjects of the study group yielded only a significant increase in knowledge about the disease ( p<0.0001 ) but no significant difference on the other outcome variables . It is concluded that this type of support group programme seems to have only a minimal impact on morbidity and on the burden of care-givers . These results are similar with two other studies examining the same issue Background Family caregivers of dementia patients are at increased risk of developing depression or anxiety . A multi-component program design ed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers . However , the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated . This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients . Methods A r and omized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients . Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline . Participants were r and omized to the family meetings intervention ( n = 96 ) or usual care ( n = 96 ) condition . The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year . Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms ( primary outcomes ) , caregiver burden and quality of life ( secondary outcomes ) . Intention-to-treat as well as per protocol analyses were performed . Results A substantial number of caregivers ( 72/192 ) developed a depressive or anxiety disorder within 12 months . The intervention was not superior to usual care either in reducing the risk of disorder onset ( adjusted IRR 0.98 ; 95 % CI 0.69 to 1.38 ) or in reducing depressive ( r and omization-by-time interaction coefficient = −1.40 ; 95 % CI −3.91 to 1.10 ) or anxiety symptoms ( r and omization-by-time interaction coefficient = −0.55 ; 95 % CI −1.59 to 0.49 ) . The intervention did not reduce caregiver burden or their health related quality of life . Conclusion This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers . Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose , when applied for therapeutic purpose s or targeted towards subgroups of caregivers . Trial Registration Controlled-Trials.com IS RCT PURPOSE This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers , and it also examines the role of specific moderator and mediator variables on caregiver outcomes . DESIGN AND METHODS Female participants ( N = 169 ) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were r and omly assigned to one of three treatment interventions : anger management , depression management , or a wait-list control group . These interventions took place over a 3- to 4-month period . The primary outcomes examined were anger or hostile mood , depressed mood , frequency of use of positive and negative coping strategies , and perceived caregiving self-efficacy . RESULTS Significant main effects in the expected direction were found for changes in most of these measures . Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group . Use of positive cognitive coping strategies increased in the anger management group only . Self-efficacy significantly increased for participants in both intervention groups , and it was also demonstrated to function as a mediator of intervention effects . Pretreatment levels of depressive symptoms and anger expression style ( Anger Expression-Out ) moderated the relative effects of the two interventions on mood and coping . IMPLICATION S These data are consistent with a growing body of evidence supporting the effectiveness of skills training , in small groups , to improve both the affective states and the type of coping strategies used by caregivers . In addition , this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals OBJECTIVE This study evaluated the effectiveness of a  technology-based psychoeducational intervention for family caregivers of dementia patients . An additional objective was to determine if the intervention could be implemented by a community-based social service agency . METHODS Forty-six caregivers were r and omly assigned to either a technology-based intervention or an information-only control condition . RESULTS Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidence d high depression at baseline experienced a significant decline in depression . CONCLUSION This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers OBJECTIVES To test the efficacy of a psychoeducative group program for informal caregivers of persons with dementia . METHODS The study was a multicenter r and omized controlled trial . R and omization was stratified according to sex and kinship . Participants r and omized to the control group were referred to the traditional support groups . Participants in the study group had fifteen 2-hr weekly sessions focusing on stress appraisal and coping .  Eligible participants ( primary caregivers of community-dwelling persons with dementia ) were blindly assessed before the r and omization and after 16 weeks on the following measures : frequency and reactions to behavioral problems ( primary outcome ) , burden , psychological distress , anxiety , perceived social support , and personal efficacy . RESULTS A total of 158 participants were r and omized to the study ( n = 79 ) and control ( n = 79 ) groups in 12 successive waves . Results show that study participants presented a 14 % decrease in their reactions to the behavioral problems of the care-receivers as opposed to a 5 % decrease in the control group ( p = .04 ) . The frequency of behavior problems also decreased ( p = .06 ) , as did the cross-product frequency/reaction ( p = .02 ) . There was no significant effect on the secondary outcome variables . DISCUSSION This is one of the first studies showing a significant effect of this type of support group program on the caregivers of participants with dementia PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences Objective : The primary objective is to report on the efficacy of an individualized dementia care consultation intervention for family caregivers of patients with diagnosed dementia living in the community . The secondary objective is to present evidence on the intervention process to inform the feasibility and sustainability of the model featuring collaboration between primary care physicians and a voluntary sector organization . Method : R and omization was based on primary care physician practice site . In the intervention group , dementia care consultants located at an Alzheimer 's association chapter  provided individualized counseling and support over a 12-month period , and sent copies of care plans developed with family caregivers to referring primary care physicians . In the control group , family caregivers received educational and community re source information but no care consultation . Nursing home admission of patients during the 12-month study period was the primary outcome ; secondary outcomes included measures of caregiver self-efficacy for managing dementia , caregiver depressive symptoms , and caregiver burden . Results : A total of 84 family caregivers participated . After adjusting for baseline characteristics , patients whose family caregivers were in the intervention group were less likely than their control group counterparts to be admitted to a nursing home ( Adjusted odds ratio = 0.40 ; 95 % C.I. = 0.14–1.18 ; p = 0.10 ) . No other outcomes were significantly different between treatment groups ; however , intervention group caregivers reporting greater satisfaction with the intervention showed improved self-efficacy for managing dementia compared to their less satisfied counterparts . Medical record review s found that care plans were found in most patient records , but that only 27 % of intervention group caregivers reported discussing these care plans with physicians . Three different individuals occupied the dementia care consultant position during the study period , and this turnover led to family caregiver dissatisfaction . Conclusion : The dementia care consultation intervention showed favorable effects on nursing home admission and on caregiver outcomes among intervention group caregivers more satisfied with the intervention , but there are important barriers to sustaining this collaboration between primary care physicians and a voluntary sector organization such as an Alzheimer 's association chapter OBJECTIVE To evaluate the effectiveness of a combination of cholinesterase inhibitor therapy for patients with Alzheimer disease ( AD ) and psychosocial intervention  , for their spouse caregivers compared with drug treatment alone in three countries simultaneously . DESIGN R and omized controlled trial . Structured question naires were administered at baseline and at regular follow-up intervals for 24 months by independent raters blind to group assignment . SETTING Outpatient research clinics in New York City , U.S. , Manchester , U.K. and Sydney , Australia . PARTICIPANTS Volunteer sample of 158 spouse caregivers of community dwelling patients with AD . INTERVENTIONS Five sessions of individual and family counseling within 3 months of enrollment and continuous availability of ad hoc telephone counseling were provided for half the caregivers . Donepezil was prescribed for all patients . MAIN OUTCOME MEASURE Depressive symptoms of spouse caregivers measured at intake and follow-up assessment s for 24 months using Beck Depression Inventory ( revised ) . RESULTS Depression scores of caregivers who received counseling decreased over time , whereas the depression scores for caregivers who did not receive counseling increased . The benefit of the psychosocial intervention was significant after controlling for site , gender and country was not accounted for by antidepressant use and increased over 2 years even though the individual and family counseling sessions occurred in the first 3 months . CONCLUSION Effective counseling and support interventions can reduce symptoms of depression in caregivers when patients are taking donepezil . Harmonized multinational psychosocial interventions are feasible . Combined drug and supportive care approaches to the management of people with AD should be a priority OBJECTIVE Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress . However , few studies evaluate treatments for them . This study evaluated the efficacy of in-home intervention , based on cognitive behavior therapy principles , to relieve stress and depression in female Chinese American caregivers ( CGs ) . METHODS Fifty-five CGs who met inclusion criteria were r and omly assigned to a telephone support condition ( TSC ) or to an in-home behavioral management program ( IHBMP ) for 4 months . In the TSC , biweekly calls were made and relevant material was mailed . In the IHBMP , specific psychological skills were taught to deal with caregiving stress . CGs were assessed before and after treatment . Outcome measures evaluated overall perceived stress , caregiving-specific stress , and depressive symptoms . RESULTS CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC . There was no difference in overall stress . CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP , but showed little improvement in the TSC . CGs with higher self-efficacy benefited from both treatments . CONCLUSION This intervention is promising and warrants replication in future studies . Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement OBJECTIVES To test the effects of an intervention that helps families manage  distressing behaviors in family members with dementia . DESIGN Two-group r and omized trial . SETTING In home . PARTICIPANTS Two hundred seventy-two caregivers and people with dementia . INTERVENTION Up to 11 home and telephone contacts over 16 weeks by health professionals who identified potential triggers of patient behaviors , including communication and environmental factors and patient undiagnosed medical conditions ( by obtaining blood and urine sample s ) and trained caregivers in strategies to modify triggers and reduce their upset . Between 16 and 24 weeks , three telephone contacts reinforced strategy use . MEASUREMENTS Primary outcomes were frequency of targeted problem behavior and caregiver upset with and confidence managing it at 16 weeks . Secondary outcomes were caregiver well-being and management skills at 16 and 24 weeks and caregiver perceived benefits . Prevalence of medical conditions for intervention patients were also examined . RESULTS At 16 weeks , 67.5 % of intervention caregivers reported improvement in targeted problem behavior , compared with 45.8 % of caregivers in a no-treatment control group ( P=.002 ) , and reduced upset with ( P=.03 ) and enhanced confidence managing ( P=.01 ) the behavior . Additionally , intervention caregivers reported less upset with all problem behaviors ( P=.001 ) , less negative communication ( P=.02 ) , less burden ( P=.05 ) , and better well-being ( P=.001 ) than controls . Fewer intervention caregivers had depressive symptoms ( 53.0 % ) than control group caregivers ( 67.8 % , P=.02 ) . Similar caregiver outcomes occurred at 24 weeks . Intervention caregivers perceived more study benefits ( P<.05 ) , including ability to keep family members home , than controls . Blood and urine sample s of intervention patients with dementia showed that 40 ( 34.1 % ) had undiagnosed illnesses requiring physician follow-up . CONCLUSION Targeting behaviors up setting to caregivers and modifying potential triggers improves symptomatology in people with dementia and caregiver well-being and skills OBJECTIVE The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer 's disease . METHOD The participants were 406 spouse-caregivers of Alzheimer 's disease patients who lived at home at baseline . The caregivers were r and omly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care ( control group ) . Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling , agreed to join support groups 4 months after enrollment , and received ongoing ad hoc counseling . The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study . RESULTS After baseline differences were controlled for , caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects . These effects were sustained for 3.1 years after baseline , similar across gender and patient severity level , and sustained after nursing home placement or death of the patient . CONCLUSIONS Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer 's disease patients and should be widely available to provide effective , evidence -based intervention for family caregivers OBJECTIVES To determine whether counseling and support reduce the burden and depressive symptoms of spouse caregivers of patients with Alzheimer 's disease ( AD ) during the transition to institutionalization . DESIGN A r and omized , controlled trial of an enhanced counseling and support program for spouse caregivers of persons with AD . Structured interviews were conducted with spouse caregivers at baseline , every 4 months during Year 1 , and every 6 months thereafter for up to 16 years . SETTING Outpatient research clinic in the New York City metropolitan area . PARTICIPANTS Referred volunteer sample of 406 spouse caregivers of community-dwelling patients with AD enrolled over a 9.5-year period . INTERVENTION Enhanced counseling and support consisting of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . MEASUREMENTS Outcome measures included burden ( modified Zarit Burden Interview ) and depressive symptoms ( Geriatric Depression Scale ) . RESULTS Burden and depressive symptoms were significantly lower for caregivers in the treatment group than for controls receiving usual care at the time of and after institutionalization . Nursing home admission itself significantly reduced burden and depressive symptoms in the intervention and control groups . CONCLUSION Institutionalization alone can reduce caregiver burden and depressive symptoms , but enhanced counseling provides additional long-term benefits . The results offer some of the first clinical evidence of the benefits of enhanced counseling during the transition to institutionalization for caregivers of people with AD OBJECTIVE Different studies show the negative effects on caregivers ' health of maladaptive thoughts and the positive effects of engaging in pleasurable activities on distress . The aim of this study is to ( a ) test the efficacy of a cognitive-behavioral intervention aim ed at training caregivers to flexibilize maladaptive thoughts regarding caregiving and increasing their leisure activities and to ( b ) analyse the mediator role in the effects of the intervention of caregivers ' change in dysfunctional thoughts and behavioral activation . METHODS A total of 170 caregivers were contacted and r and omly distributed to the intervention condition or to the control group .  Depression , behavioral activation , and dysfunctional thoughts were assessed at baseline and post-intervention by ' blinded ' interviewers . The intervention consisted in twelve group based sessions in which in addition to cognitive-behavioral techniques , caregivers ' were trained in basic principles for caring for a relative with dementia . RESULTS Significant intervention by time effects were found for depression , dysfunctional thoughts and frequency of leisure activities . Only significant positive effects were found for the intervention group . The regression analysis for testing mediational effects of dysfunctional thoughts and leisure activities on the relationship between participating on the intervention and changes in depressive symptomatology show that mediation is established in both cases . CONCLUSIONS The results of our study contribute to the literature on interventions for dementia caregivers highlighting the positive mediator effect that modifying caregivers ' dysfunctional thoughts and increasing their behavioral activation has on caregivers ' depressive symptomatology Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs The caregivers of 37 patients with a dementing illness completed rating scales regarding the frequency and severity of their care recipient 's general behavioral disturbance and manipulative behaviors , as well as their own resentment and depression . Caregivers were r and omized to a four-week psychoeducational group intervention or control group to investigate the effect of dementia caregiving education on the caregiving experience . Findings indicated that , while care recipient behavioral disturbance was correlated with caregiver resentment and depression , the primary relationship was between behaviors perceived by the caregiver as manipulative or willful and caregiver resentment and depression . We found no significant differences in caregiver attribution , resentment , or depression between the caregivers who participated in the group session and those in the control group . The study supports the existence of resentment among dementia caregivers , and an important relationship between caregiving outcomes and attributions made by caregivers regarding their care recipients ' actions . These results are discussed in relation to existing research on  caregiver distress and intervention PURPOSE The neuropsychiatric symptoms associated with Alzheimer 's disease are a major contributor to caregiver  distress and burden . Despite recent efforts to teach caregivers skills to manage neuropsychiatric symptoms and reduce burden , there continues to be limited evidence that these strategies have helped caregivers of individuals with Alzheimer 's disease to effectively manage neuropsychiatric symptoms . We report here on Project CARE , a r and omized controlled trial design ed to test the effectiveness of a caregiver-based multicomponent behavioral intervention aim ed to reduce caregiver distress related to neuropsychiatric symptoms , as well as general caregiver burden , and to decrease neuropsychiatric symptom severity among individuals with Alzheimer 's disease . DESIGN AND METHODS The behavioral intervention involved five weekly sessions design ed to teach caregivers specific techniques for managing patient neuropsychiatric symptoms in the home environment . Through the use of a r and omized control trial , 80 caregivers were assigned to either the behavioral intervention group or a psychoeducational control group and were assessed both before and after the intervention . RESULTS Compared with caregivers in the control group , caregivers in the behavioral intervention group displayed significantly greater reductions in caregiver distress related to neuropsychiatric symptoms ( p=.005 ) . Global caregiver burden , however , did not decrease significantly for caregivers in either group ( p>.05 ) . Although it was not statistically significant , there was a trend toward greater reductions in care recipients ' neuropsychiatric symptom severity in the intervention group ( p=.10 ) . IMPLICATION S The current findings suggest that targeted , group-based behavioral interventions are effective for reducing distress related to neuropsychiatric symptoms among caregivers of individuals with Alzheimer 's disease and for reducing care recipients ' neuropsychiatric symptoms OBJECTIVES This study tested the effectiveness of a dementia care management program for Chinese families of relatives with dementia on  caregivers ' and  patients  ' health outcomes over a 12-month follow-up period . METHODS The dementia care management program is an educational and supportive group for caregivers that lasts six months . A controlled trial was conducted with 88 primary caregivers of persons with dementia in two dementia care centers in Hong Kong . Family members were assigned r and omly to either the dementia care program or st and ard care . The two groups were compared for patients ' symptoms and institutionalization rates and caregivers ' quality of life , burden , and social support upon recruitment and six and 12 months after group assignment . RESULTS Over the 12-month follow-up period , patients with family members in the dementia care program showed significantly greater improvements in symptoms and institutionalization rates and their caregivers reported significantly greater improvements in quality of life and burden compared with the control group . CONCLUSIONS The findings provide evidence that the dementia care management program can improve the psychosocial functioning of Chinese persons with dementia and their caregivers BACKGROUND The majority of patients with Alzheimer 's disease live outside institutions and there is considerable serious psychological morbidity among their carers . AIMS To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer 's disease and produces clinical benefits in the patients . METHOD A prospect i ve single-blind r and omised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups . RESULTS There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up . There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group . Based on an improvement on the General Health Question naire result ing in a carer converting from a case to a non-case , the number to treat was three immediately post-treatment and two at follow-up . CONCLUSIONS Family intervention can have significant benefits in carers of patients with Alzheimer 's disease and has a positive impact on patient behaviour The Re sources for Enhancing Alzheimer 's Cargiver Health ( REACH ) project was design ed to test promising interventions for enhancing  family caregiving for persons with dementia . The purpose of this article is to describe the research design , interventions , and outcome measures used in REACH and to characterize the sample recruited for the study . Nine interventions and 2 control conditions were implemented at 6 sites ; 1,222 dyads were r and omly assigned to an intervention or a control condition . The caregiver sample was 18.6 % male with an average age of 62.3 years ( 56 % Caucasian , 24 % Black , and 19 % Hispanic ) . Caregivers reported high levels of depressive symptoms and moderate burden . Care recipients were older , with a mean age of 79 , and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30 PURPOSE This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer 's disease . The interventions , using targeted educational material s , were patient behavior management only , and patient behavior management plus caregiver stress-coping management . We hypothesized that the addition of the stress-coping component would improve caregiver outcomes . DESIGN AND METHODS A r and omized clinical trial of 167 caregiver-care recipient dyads was run , of whom 76 completed the study without bereavement or placement . RESULTS During 24 months , caregivers who received the patient behavior management component only , compared with those who also received the stress-coping component , had significantly worse outcomes for general well-being and a trend toward increased risk of depression ( i.e. , a score of > 16 on the Center for Epidemiological Studies Depression scale ) . There was a study wide improvement for bother associated with care recipient behaviors ( according to the Revised Memory and Behavior Problems Checklist ) . IMPLICATION S Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient . They further suggest that interventions that focus only on care recipient behavior , without addressing caregiving issues , may not be as adequate for reducing caregiver distress This 3-year r and omized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers ' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems , and in decreasing caregiver burden and depression . The intervention consisted of seven weekly , 2-hour multimedia training sessions that included education , family support , and skills training for 94 primary caregivers and their families . Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period . The intervention was successful in reducing caregivers ' negative reactions to disruptive behaviors and in reducing caregiver burden over time This study performed moderator analyses to determine if self-efficacy predicted differential outcome in a r and omized trial comparing a cognitive behavior psychoeducational intervention and an enhanced support group ( ESG ) . The four key outcomes were depression , anxiety , social support , and coping . Low baseline self-efficacy scores were hypothesized to be more predictive of positive response in the psychoeducational intervention than in the support group . Change from pre- to posttreatment ( baseline to three months ) for 213 female caregivers of older adult relatives with dementia ( 122 Anglos and 91 Latinos ) are presented . Caregivers were r and omly assigned to either the coping with caregiving class ( CWC ) , a skill-building , small group intervention design ed to reduce caregiving stress , or to an enhanced support group ( ESG ) , which used guided discussion and empathic listening to develop within-group reciprocal support . The findings showed that low baseline self-efficacy scores better predicted positive response to treatment in the CWC intervention than in the ESG intervention . This study supports the use of self-efficacy as a screening tool for appropriate caregiver intervention assignment
INTRODUCTION With the aging of the population , an increasing number of people have dementia , most of whom are receiving home care .
Caregivers are exposed to a variety of stressors , which may lead to feeling burdened , or to depression and anxiety .
Various programs or structured interventions have been developed to prevent or lessen these negative consequences .
The efficacy of these interventions is debated , mainly due to method ological differences between studies .
Review studies so far have presented important discrepancies , thus perpetuating a lack of clarity regarding this important geriatric care problem .
The effectiveness of interventions design ed to prevent or reduce the burden and /or symptoms of anxiety and depression in informal caregivers are review ed precisely and rigorously .