A randomized trial of family caregiver support in the home management of dementia. Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals With Dementia Development of the risk appraisal measure: a brief screen to identify risk areas and guide interventions for dementia caregivers. Worksite-based internet multimedia program for family caregivers of persons with dementia. Effectiveness of an Internet Intervention for Family Caregivers of People with Dementia: Results of a Randomized Controlled Trial Implementation fidelity of Multidimensional Family Therapy in an international trial. Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: a randomized clinical trial. Family care as collaboration: effectiveness of a multicomponent support program for elderly couples with dementia. Randomized controlled intervention study. The Effect of a Personalized Dementia Care Intervention for Caregivers From Australian Minority Groups Predictors of adherence to a skill-building intervention in dementia caregivers. A videophone psychosocial intervention for dementia caregivers. Efficacy of a support group programme for care-givers of demented patients in the community: a randomized controlled trial. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Process evaluation of a multicomponent dyadic intervention study with exercise and support for people with dementia and their family caregivers Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups Cost Analysis of Early Psychosocial Intervention in Alzheimer's Disease Impact of two psychosocial interventions on white and African American family caregivers of individuals with dementia. The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care An Exercise Program for Women Who Are Caring for Relatives With Dementia Acceptability of a Clinician-Assisted Computerized Psychological Intervention for Comorbid Mental Health and Substance Use Problems: Treatment Adherence Data from a Randomized Controlled Trial Resourcefulness Training for Women Dementia Caregivers: Acceptability and Feasibility of Two Methods Preserving health of Alzheimer caregivers: impact of a spouse caregiver intervention. Stages of Change and the Group Treatment of Batterers: A Randomized Clinical Trial Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. REMCARE: Pragmatic Multi-Centre Randomised Trial of Reminiscence Groups for People with Dementia and their Family Carers: Effectiveness and Economic Analysis The two-year incidence of depression and anxiety disorders in spousal caregivers of persons with dementia: who is at the greatest risk? Tailored nutritional guidance for home-dwelling AD families: The feasibility of and elements promoting positive changes in diet (NuAD-trial)
A r and omized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario . Thirty caregivers were allocated to receive the experimental intervention consisting of : caregiver-focused health care , education about dementia and caregiving , assistance with problem solving , regularly scheduled in-home respite , and a self-help family caregiver support group .  Thirty control subjects received conventional community nursing care . Before completion of the intervention , 18 ( 30 % ) were withdrawn , almost equally from each group . The most frequent reason was long-term institutionalization of the demented relative ( n = 10 ) . At baseline , caregivers in both groups were suffering from above-average levels of depression and anxiety . After the six-month intervention period , we found neither experimental nor control group improved in these areas . However , the experimental group showed a clinical ly important improvement in quality of life , experienced a slightly longer mean time to long-term institutionalization , found the caregiver role less problematic , and had greater satisfaction with nursing care than the control group 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 OBJECTIVES To develop and vali date a brief screening measure for use in research , healthcare , and community setting s to systematic ally assess well-being and identify needed areas of support for caregivers of patients with dementia . DESIGN This study used data from Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH II ) , a multisite r and omized clinical trial of a behavioral intervention design ed to improve the quality of life of caregivers in multiple domains . SETTING REACH II . PARTICIPANTS Two hundred twelve Hispanic , 211 black , and 219 white family caregivers providing in-home care to patients with dementia . MEASUREMENT Based on conceptual and psychometric analyses , a 16-item measure was developed that assesses six domains linked to caregiver risk and amenable to intervention : depression , burden , self-care and health behaviors , social support , safety , and patient problem behaviors . The reliability and validity of the instrument was evaluated with 642 dementia caregiver dyads from the REACH II program . RESULTS The measure was found to have acceptable internal consistency for a multidimensional scale and similar measurement properties for each of the racial and ethnic groups . Concurrent validity was also demonstrated for the measure . CONCLUSION The REACH Risk Appraisal Measure developed in this study shows promise as an assessment tool that can be used in research , clinical , and community setting s to guide , prioritize , and target needed areas of support for caregivers of patients with dementia PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Implementation fidelity , a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocol s , is also essential to the successful implementation of effective programs into new practice setting s. Although infrequently studied in the drug abuse field , stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers . In the INternational CAnnabis Need for Treatment ( INCANT ) multi-national r and omized clinical trial , investigators tested the effectiveness of  Multidimensional Family Therapy ( MDFT )  in comparison to individual psychotherapy ( IP ) in Brussels , Berlin , Paris , The Hague , and Geneva with 450 adolescents with a cannabis use disorder and their parents . This study reports on the implementation fidelity of MDFT  across these five Western European sites in terms of treatment adherence , dose and program differentiation , and discusses possible implication s for international implementation efforts BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 OBJECTIVES To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services . DESIGN R and omized controlled trial . SETTING Community-dwelling couples with one spouse caring for the other spouse with dementia . PARTICIPANTS Couples with dementia ( N=125 ) were allocated at r and om to the intervention ( n=63 ) or control group ( n=62 ) . INTERVENTION Intervention couples were provided with a multicomponent intervention program with a family care coordinator , a geriatrician , support groups for caregivers , and individualized services . MEASUREMENTS Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples . RESULTS At 1.6 years , a larger proportion in the control group than in the intervention group was in long-term institutional care ( 25.8 % vs 11.1 % , P=.03 ) . At 2 years , the difference was no longer statistically significant . The 2-year adjusted hazard ratio for the intervention group was 0.53 ( 95 % confidence interval (CI)=0.23 - 1.19 , P=.12 ) . Intervention led to reduction in use of community services and expenditures . The difference for the benefit of intervention group was -7,985 Euro ( 95 % CI=-16,081 to -1,499 , P=.03 ) . When the intervention costs were included , the differences between the groups were not significant . CONCLUSION Although the intervention did not result in a significant difference in the need for institutional care after 2 years , individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services Most caregiver interventions in a multicultural society are design ed to target caregivers from the mainstream culture and exclude those who are unable to speak English . This study addressed the gap by testing the hypothesis that personalized caregiver support provided by a team led by a care coordinator of the person with dementia would improve competence for caregivers from minority groups in managing dementia . A r and omised controlled trial was utilised to test the hypothesis . Sixty-one family caregivers from 10 minority groups completed the trial . Outcome variables were measured prior to the intervention , at 6 and 12 months after the commencement of trial . A linear mixed effect model was used to estimate the effectiveness of the intervention . The intervention group showed a significant increase in the caregivers ’ sense of competence and mental components of quality of life . There were no significant differences in the caregivers ’ physical components of quality of life BACKGROUND Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research . This study examines caregiver sociodemographic and psychological characteristics , patient illness severity , and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home . METHODS The sample consisted of 105 caregivers r and omized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health ( NIH ) Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH I ) . The intervention , implemented by occupational therapists , consisted of education , problem solving , communication , environmental and task simplification techniques , and home modifications . Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention ( Strategy Use ) . RESULTS Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health ( p < .001 ) , greater treatment exposure ( p < .001 ) , more problem areas addressed ( p = .012 ) , and for whom more active therapeutic techniques ( role play ) were used ( p = .004 ) demonstrated greater adherence . Other caregiver characteristics , patient cognitive impairment , and troublesome behaviors were not significantly related to caregiver adherence . CONCLUSIONS Modifiable caregiver and treatment implementation factors , including active engagement of caregivers , were associated with adherence , whereas patient characteristics were not . Caregivers with poor health may be at risk for not benefiting from intervention , suggesting that efforts , including instruction in preventive care and allocating time to attend to their own health care needs , be directed towards improving their health BACKGROUND / OBJECTIVES Available services and intervention programs for dementia caregivers are often underutilized because of issues such as cost , logistics , lack of knowledge about available services , or insufficient support from others . Information technologies offer the potential of removing these barriers and facilitating the ability of caregivers to access needed support . This project evaluated the feasibility and efficacy of technology-based psychosocial intervention among minority family caregivers of dementia patients . DESIGN A feasibility and efficacy trial . SETTING Participants ' homes in the Greater Miami Community . PARTICIPANTS One hundred ten ( 56 Hispanic American and 54 African American ) caregivers of patients with dementia . INTERVENTION A technology-based multi-component psychosocial intervention was delivered in-home and via videophone technology over 5 months . The intervention was modeled after the REACH II intervention and targeted known areas of caregiver risk . MEASUREMENT St and ardized measures of depression , caregiver burden , social support , and the caregivers ' perception of the caregiver 's experience were administered at baseline and 5 months post-r and omization . RESULTS Overall , caregivers who received the intervention reported a decrease in burden , an increase in perceived social support and positive perceptions of the caregiving experience . No effect was observed for depression . Most participants indicated that the intervention improved their caregiving skills and found the technology to be easy to use . CONCLUSIONS A technology-based format was feasible for delivering a multi-component intervention to minority family dementia caregivers . The intervention improved caregiver outcomes for both Hispanic and African American caregivers . The results suggest that technology may help eliminate disparities in access to caregiver intervention programs 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 Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care . Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective . However , evidence about the cost-effectiveness of such interventions is scarce . The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months . Methods The economic evaluation was conducted from a societal perspective alongside a r and omized trial of 192 primary caregivers with community-dwelling dementia patients . Outcome measures included the Quality Adjusted Life-Years ( QALY ) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers . Missing cost and effect data were imputed using multiple imputations . Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio ( ICER ) . The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves . Results No significant differences in costs and effects between the groups were found . At 12 months , total costs per patient and primary caregiver dyad were substantial : € 77,832 for the intervention group and € 75,201 for the usual care group ( adjusted mean difference per dyad € 4,149 , 95 % CI -13,371 to 21,956 , ICER 157,534 ) . The main cost driver was informal care ( 66 % of total costs ) , followed by patients ’ day treatment and costs of hospital and long-term care facility admissions ( 23 % ) . Based on the cost-effectiveness acceptability curves , the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers ’ incidence of depression and /or anxiety disorders regardless of the willingness to pay . Conclusions The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs . Based on this study , family meetings can not be considered a cost-effective intervention strategy in comparison with usual care . Trial registration IS RCT N register , 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 Background A r and omized controlled trial of a multicomponent dyadic intervention ( a translated and adapted version of an intervention that has been shown to be effective for people with dementia in the USA ) was performed . The exercise and support intervention was intended to reduce depressive symptoms of people with dementia and their caregivers . The purpose of this process evaluation is to create in-depth insight into the delivery of the intervention and the effect analysis , to prevent drawing inappropriate conclusions on the efficacy or effectiveness of the intervention , and to formulate recommendations for future studies on complex geriatric interventions . Methods Qualitative and quantitative data were collected . The process evaluation was performed according to the model presented by Reelick and colleagues , which encompasses the following three process components : ( 1 ) success rate of recruitment and quality of the study population ; ( 2 ) the quality of execution of the complex intervention ; and ( 3 ) the process of acquisition of the data . Results The study design met high research st and ards and the intervention was carefully delivered . Evaluation of the study population quality revealed a profound recruitment process result ing in a reasonable sample size . Attrition rate during follow-up was acceptable . With regard to the evaluation of the intervention quality , most interviewed participants experienced benefits of the intervention . Attendance at the home visits was high and attrition to homework was moderate . Evaluation of the data acquisition showed the positive value of the use of a mixed design ; qualitative analysis of the intervention revealed outcomes not measured in the quantitative analysis . Conclusions The process evaluation revealed a carefully and soundly performed study . The mixed design contributed to valuable insights . However , there were some restrictions worth considering . The intervention components may have a different feasibility by moderate attrition to homework and some negative experiences of participants , which may be an indication of too intensive an intervention for this frail population in this specific country . As a result , the results of the statistical effect analysis should be interpreted with caution .Trial registration The study has been registered at the Netherl and s National Trial Register : NTR1802 , registration date 6 May 2009 Context Providing care for patients with dementia can pose enormous burdens that may be eased with assistance and support . Needs may differ by race or ethnicity . Contributions The investigators r and omly assigned Hispanic , black , and white dementia caregivers to receive written educational material s or an intensive intervention to improve caregiver quality of life .  The specific interventions were determined by caregivers , were delivered via trained personnel and telephone support groups , and targeted several dimensions of need . The study found that quality of life improved for Hispanic and white caregivers and for black spousal caregivers in the intervention group but not in the control group . The intervention had no detectable effect on the number of care recipients who were institutionalized . Caution s The study used only a single 6-month follow-up assessment , combined heterogeneous cultures and ethnicities into 3 groups , and excluded some ethnicities . Implication s An intensive intervention targeting several dimensions of caregiver need improved caregiver quality of life without an apparent effect on care recipient institutionalization . The effect did not differ by caregiver race or ethnicity . The Editors Caring for a family member with dementia is extremely stressful , contributes to psychiatric and physical illness , and increases the risk for death ( 1 , 2 ) . The accumulating evidence on the personal , social , and health effects of dementia caregiving has generated a broad range of intervention studies , including r and omized trials aim ed at decreasing the burden and stress of caregiving . Several studies have demonstrated statistically significant effects in reducing caregiver burden , lowering caregiver depression , and delaying institutionalization of care recipients ( 1 , 3 , 4 ) through either targeted interventions that treat a specific caregiver problem , such as depression , or broad-based multicomponent interventions that include counseling , case management , and telephone support . Persistent limitations of caregiver intervention research are the paucity of well-controlled r and omized trials , the limited range of outcomes examined , small sample sizes and insufficient power , geographic limitations , inadequate racial or ethnic variation , and a scarcity of comprehensive multicomponent interventions ( 4 ) . Indeed , none of the 41 r and omized clinical trials published in the last 5 years met Consoli date d St and ards of Reporting Trials ( CONSORT ) recommendations for reporting r and omized trials ( 5 ) , and many have serious method ologic problems that call into question the reported findings ( 4 ) . To address these limitations , the National Institute on Aging and the National Institute of Nursing Research funded a multisite research program design ed to develop and test an effective caregiver intervention : the Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) study . We performed the study in 2 phases . In the first phase ( REACH I ) , we tested several different interventions at 6 U.S. sites to identify the most promising approaches to decreasing  caregiver burden and depression ( 6 ) . Results from the study showed that active treatments were superior to control conditions in reducing caregiver burden and that active engagement in skills training statistically significantly reduced  caregiver depression ( 7 , 8) . The existing literature and findings from REACH I helped guide the design of the REACH II intervention ( 7 , 8) . We based the REACH II study on the premise that caregivers can have problems in several areas at varying levels of intensity , and thus , interventions must be responsive to variations in needs among caregivers . The findings from REACH I also suggest that interventions that use active techniques , such as role-playing and interactive practice , are more effective at improving outcomes , such as depression symptoms , compared with more passive methods , such as providing information ( 7 ) . We based the REACH II intervention on these assumptions and design ed the intervention to maximize outcomes by systematic ally targeting several problem areas , tailored the intervention to respond to the needs of each individual , and actively engaged the caregiver in the intervention process . We hypothesized that participants assigned to the intervention would do better than those in the control group on several indicators of caregiver quality of life , including depression , burden , self-care , and social support and care recipient problem behaviors , and that these differences would be largest among Hispanic or Latino persons because they have lower access to support services ( 8) . In additional analyses , we assessed the effects of treatment on rates of caregiver clinical depression and care recipient institutional placement , as well as the benefits derived from study participation . Methods Caregivers Eligibility criteria for caregivers included the following : Hispanic or Latino , white or Caucasian , or black or African-American race or ethnicity ; age 21 years or older ; living with or sharing cooking facilities with the care recipient ; providing care for a relative with diagnosed Alzheimer disease or related disorders for at least 4 hours per day for at least the past 6 months ; and reported distress associated with caregiving ( reported at least 2 of the following 6 items at baseline assessment : felt overwhelmed , felt like they often needed to cry , were angry or frustrated , felt they were cut off from family or friends , reported  moderate to high levels of general stress , or felt their health had declined ) . We excluded caregivers who were involved in another caregiver intervention study , who had participated in REACH I , or who had an illness that would prevent 6 months of study participation . Other requirements were logistic , including having a telephone , planning to remain in the geographic area for at least 6 months , and competency in either English or Spanish ( see Appendix Table 1 for a detailed list of exclusions ) . Appendix Table 1 . Reasons for In eligibility Care Recipients To be eligible for the study , caregivers had to confirm that their relative had diagnosed Alzheimer disease or related disorders . In addition , we screened care recipients for a history of severe mental illness , head injury , Parkinson disease , or stroke , and we administered the  MiniMental State Examination ( MMSE )  ( 9 ) . We excluded patients who were bedbound with MMSE scores of 0 because we felt that our intervention had little to offer caregivers who were caring for such patients . Moreover , being bedbound is a risk factor for institutional placement or death , and we sought to exclude caregivers who were likely to transition out of the caregiving role within the 6-month study . For patients who scored more than 23 on the MMSE or had other conditions , such as head injury , we required a physician 's diagnosis of Alzheimer disease or related disorders . Procedures We recruited caregiver and care recipient dyads at 5 sites : Birmingham , Alabama ; Memphis , Tennessee ; Miami , Florida ; Palo Alto , California ; and Philadelphia , Pennsylvania . Enrollment began in June 2002 , and follow-up ended in August 2004 . Recruitment occurred in memory disorder clinics , primary care clinics , social service agencies , physician offices , churches , and community centers and by using professionally design ed brochures , public service announcements on radio stations , newspaper articles , television , targeted newsletters , and community presentations . We translated all intervention material s and assessment instruments into Spanish for the Hispanic or Latino participants by using established techniques for forward- and -back translation and allowing for regional variation in language expression . We used bilingual and bicultural staff at the 3 sites that recruited Hispanic or Latino participants : Palo Alto , Philadelphia , and Miami . At all sites , assessors and interventionists received cultural sensitivity training and were certified before entering the field . Certified assessors were blinded to group assignment of study participants . The institutional review boards of all 5 site institutions and the coordinating center in Pittsburgh , Pennsylvania , approved the study . We obtained written informed consent from all caregivers and from care recipients whenever possible . Caregivers provided consent on behalf of care recipients who could not do so on their own . After telephone screening ( n= 995 ) and baseline assessment ( n= 670 ) , we r and omly assigned participants ( n= 642 ) to the intervention or control group ( Figure ) . We stratified r and omization by using a block size of 2 or 4 within strata defined by the 5 intervention sites , 3 racial or ethnic groups ( Hispanic or Latino , white or Caucasian , and black or African American ) , and 2 caregivercare recipient relationships ( spouse or nonspouse ) . We performed r and omization at the coordinating center by using a computer-generated algorithm and a st and ard protocol for transmitting r and omization information between the coordinating center and the study sites . We administered 1 of 3 follow-up batteries , on the basis of care recipient status at follow-up ( full follow-up , bereavement battery , or placement battery ) , to study participants 6 months after r and omization when the intervention was completed . To maximize the number of individuals who could be included in the outcome analyses , we ensured that the 3 batteries were as similar as possible . We did not ask caregivers about caregiver burden and care recipient functional status if their care recipients had died ; thus , we could not include these caregivers in the primary outcome analysis ( 10 ) . Figure . Study flow diagram . * See Appendix Table 1 for reasons for in eligibility . See Appendix Table 2 ( for reasons for unavailable end points and types of 6-month follow-up . Appendix Table 2 . Reasons for Unavailable End Points and Types of 6-Month Follow-up Trial Groups Intervention The intervention involved a range of strategies : provision of Background / Aim : To investigate the impact of early psychosocial intervention aim ed at patients with Alzheimer 's disease ( AD ) and their caregivers on re source use and costs from a societal perspective . Methods : Dyads of patients and their primary caregiver were r and omised to intervention ( n = 163 ) or control ( n = 167 ) and followed for 3 years . Health care use was extracted from national registers , and the Re source Utilisation in Dementia question naire was used to measure informal care and productivity loss . Multiple imputation was used to replace missing data , and non-parametric bootstrapping was used to estimate st and ard errors . Results : Overall , there were no statistically significant differences because of large variation in the observations . The average additional cost of psychosocial intervention  provision was estimated at EUR 3,401 per patient . This cost masked a reduced use of formal health care and an increased use of informal care . Conclusions : Early psychosocial intervention in AD could be cost-saving from a health care perspective , whereas the opposite seems to be true from a broader societal perspective PURPOSE We developed manual-guided , replicable interventions based on common needs and cultural preferences of White and African American family caregivers ( CGs ) of individuals with dementia , and we evaluated these interventions after a 6-month follow-up . DESIGN AND METHODS We r and omly assigned White ( n = 70 ) and African American ( n = 48 ) CGs of individuals with dementia to either a skills training condition or a minimal support control condition . RESULTS The degree of treatment implementation was method ically assessed , and findings demonstrated that both interventions were delivered according to protocol and were well received by CGs . CGs in both groups reported decreasing levels of problem behaviors and appraisal s of behavioral bother , and increased satisfaction with leisure activities over time . On a measure of appraisal of distress related to behavior problems , White CGs showed more improvement in the minimal support control condition , and African American CGs showed the greatest improvements in the skills training condition . Spouse and nonspouse CGs also showed differential responses to intervention . IMPLICATION S Brief manual-guided interventions can be effective with White and African American CGs , and greater attention should be paid to possible differential responses to interventions by race and relationship to care recipient Context Dementia is an incurable chronic disease , but assistance to caregivers can reduce the severity of patients ' symptoms and delay institutionalization . Because this assistance requires provision of multiple health care and social services , patients and caregivers might benefit from a coordinated system of care . Contribution The investigators r and omly assigned patients with dementia and their caregivers to usual care or to a coordinated system of care . In the coordinated system , care managers regularly assessed patient and caregiver pairs and coordinated guideline -recommended provision of services by health care providers and community agencies using computerized information systems . The study found that pairs cared for in the coordinated system received higher- quality health care and more needed assistance than those who received usual care . Caution s The study focused on a relatively homogeneous population of white , well-educated , otherwise healthy , noninstitutionalized patients with health insurance . The findings might not apply to other population s. Implication s The quality of care for patients with dementia and their caregivers can be improved with a model of care in which services provided by the health system and community agencies are coordinated by a care manager . The Editors Dementia has enormous health and financial consequences for affected individuals , their family caregivers , and society ( 15 ) . Although most dementia is currently neither preventable nor reversible , existing practice guidelines reflect evidence from r and omized , controlled trials that caregiver assistance and support can delay institutionalization ( 68 ) , and nonpharmacologic management of problem behaviors and depression can reduce symptom severity and improve patient health ( 9 , 10 ) . Yet , adherence to published dementia care guidelines ( 1114 ) is poor ( 15 ) , including inappropriate use of psychoactive medications for initial management of agitation ( 16 ) ; low referral rates to community agencies ( 17 , 18 ) ; and underdetection of elder abuse , for which cognitive impairment is a risk factor ( 19 ) , and of depression ( 20 ) , a common comorbid condition ( 21 ) . There are few controlled trials of improvement interventions for dementia care . An opinion leader intervention improved neurologists ' reported adherence to dementia care guidelines ( 18 ) , and a recent trial using advanced practice nurses within primary care improved care quality ( 22 ) ; other trials reported limited impacts ( 23 , 24 ) . All studies were conducted primarily within or outside of health care delivery systems ; to date , trials of comprehensive , guideline -based dementia care interventions that incorporate all chronic care model components , including substantive collaboration between health systems and community agencies ( 25 , 26 ) , have not been reported . Yet , this would seem to be a well-suited approach because of the multifaceted nature of dementia care management and the need for coordinated efforts across health care delivery systems and community agencies to provide recommended medical , behavioral , and social services and support . To address gaps in care quality for persons with dementia , we design ed and tested a guideline -based , comprehensive dementia care management intervention in a clinic-level , cluster r and omized , controlled trial ( 27 ) . Intervention components were based on the chronic care model and emphasized linkages with community re sources and multiagency coordination ( 25 , 26 , 28 ) . Key components included dementia care managers , formal procedures for communication within and between organizations and agencies , Internet-based care management , collaborative care planning with caregivers , caregiver self-management support , ongoing follow-up , and provider education . We hypothesized that patient and caregiver dyads in intervention clinics would receive care in higher accordance with guidelines ; receive more community re sources and services ; have fewer unmet caregiving assistance needs ; and have better patient and caregiver health and caregiving quality , social support , and perceived care quality than dyads receiving usual care . Methods The institutional review boards of the University of California , Los Angeles , and all participating health care organizations approved the study procedures . All enrolled patient and caregiver dyads provided written informed consent . Three health care organizations ( Kaiser Permanente San Diego , Scripps Clinic , University of California , San Diego , Healthcare ) and 3 community agencies ( Alzheimer 's AssociationSan Diego Chapter , Southern Caregiver Re source Center , Meals on WheelsGreater San Diego ) providing services for persons with dementia and their informal caregivers in the San Diego metropolitan area participated . Private group practice , academic group practice , and health maintenance organization practice types were represented by the 3 health care organizations . Study Participants The study included 18 clinics from the participating health care organizations ( 4 to 8 per organization ) ( Table 1 ) . The inclusion criterion was that these be primary care clinics . Table 1 . Characteristics of Participating Health Care Organizations * Patients with dementia who were age 65 years or older and receiving Medicare were identified by querying health care organization administrative data bases for occurrence during the previous year of a dementia diagnosis code ( 29 ) at an outpatient visit or hospitalization or a cholinesterase inhibitor prescription . Patient lists were grouped by primary provider and were circulated to those providers for confirmation of dementia diagnosis and identification of additional potential participants from his or her practice ( generating < 5 % of the sample ) . Patients had to have an informal caregiver ( age 18 years ) . Patients were recruited by mail with English- and Spanish- language letters from their physician and an opt-out postcard , followed by up to 3 mailings of a patient consent or assent form ( depending on the physician 's design ation of the patient 's ability to provide consent ) , a caregiver consent form ( containing a proxy consent for the patient if he or she was judged unable to provide consent ) , and a baseline caregiver survey . R and omization was conducted at the clinic level , based on the clinic-focused design of the care management intervention . Within each health care organization , we paired clinics by patient volume ; within each pair , we r and omly assigned 1 clinic to the intervention and the other clinic to usual care using a computerized r and om-number generator operated by a study statistician . Participants were unaware of clinic r and omization status at enrollment and at completion of the baseline survey and were not reminded of r and omization status at follow-up . Intervention A steering committee that included a physician from each health care organization , a leader from each community agency , a community caregiver , and investigators used a formal method ( 30 ) to identify 23 existing dementia guideline recommendations as care goals ( 11 , 12 , 14 ) . They also design ed a structured assessment , algorithms linking specific care management actions to assessment results , and interorganization care coordination and referral protocol s. A key intervention element was health care organization and community agencybased dementia care managers ( primarily social workers ) who received formal training and used an Internet-based care management software system for care planning and coordination ( 25 , 26 , 28 ) . Every enrolled patient and caregiver dyad in the intervention group was assigned 1 health care organization care manager , who contacted them to schedule a structured home assessment . Assessment responses were entered into the software system , generating a preliminary problem list and guides to care-plan actions . The care manager collaborated with the caregiver to prioritize problem areas ; teach problem-solving skills ; initiate care plan actions ; and send an assessment summary , a problem list , and selected recommendations to the patient 's primary care physician and other design ated providers . A menu of potential care plan actions ( for example , referral for respite care services ) was documented in a comprehensive care management manual . The care management protocol included ongoing follow-up , usually by telephone , with frequency based on need and a formal in-home re assessment every 6 months to assess the need for major care-plan revisions . The software system had a feature to enable efficient tracking of multiple cases and tasks . Referrals to a particular community agency were guided by flagged problem areas . With patient and caregiver consent , referrals were communicated through the software system to that agency , whose design ated care manager subsequently received system access to the assessment , problem list , and care plan . Each dyad could have 1 or more community agency care managers . Care managers from the health care organizations and community agencies received the same formal education and training program , which was conducted jointly , and met monthly to refine care coordination procedures . Care management began within a month after enrollment of the first dyads and was active throughout the study follow-up unless a case was closed , for example , because a patient moved out of the study area and no longer was enrolled in the health care organization . At each intervention clinic , more than 90 minutes of st and ardized , interactive seminars ( in up to 5 sessions ) on relevant care issues , including  evaluation of acute behavioral changes , depression management  , and determination of decision-making capacity  ( 31 ) , were offered to primary care providers . Selected intervention tools and documents with more detailed descriptions can be accessed at www.adc.ucla.edu/access/access.swf . Patients , caregivers , and providers in the usual care group were not offered study interventions . Outcome Measures Primary Outcome The study 's primary outcome was Objective This study describes factors related to retention and adherence to an exercise program for women caregivers . Methods One hundred sedentary women ( average age = 62 years ) caring for relatives with dementia were r and omly assigned to an exercise program or an attention control ( nutrition education ) condition . Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week , for at least 30 minutes per session . Adherence was tracked through monthly exercise logs , vali date d in a sub sample by ambulatory heart rate and motion monitors . Participants also completed a psychosocial question naire battery at baseline and 12 months after r and omization . Results Participants achieved a 12-month average exercise adherence rate of 74 % ( ie , three exercise sessions per week ) with an average of 35 minutes per session . At 12 months , the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition . Both groups significantly improved in perceived stress , burden , and depression from baseline to posttest . Women who were older , less depressed , and more anxious at baseline showed better program retention , and lower baseline depression was associated with better exercise adherence . Conclusions This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population . Given the independent risk factors of caregiving and physical inactivity on mortality , programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role Background Computer-delivered psychological treatments have great potential , particularly for individuals who can not access traditional approaches . Little is known about the acceptability of computer-delivered treatment , especially among those with comorbid mental health and substance use problems . Objective The objective of our study was to assess the acceptability of a clinician-assisted computer-based ( CAC ) psychological treatment ( delivered on DVD in a clinic- setting ) for comorbid depression and alcohol or cannabis use problems relative to a therapist-delivered equivalent and a brief intervention control . Methods We compared treatment acceptability , in terms of treatment dropout/participation and therapeutic alliance , of therapist-delivered versus CAC psychological treatment . We r and omly assigned 97 participants with current depression and problematic alcohol/cannabis use to three conditions : brief intervention ( BI , one individual session delivered face to face ) , therapist-delivered ( one initial face-to-face session plus 9 individual sessions delivered by a therapist ) , and CAC interventions ( one initial face-to-face session plus 9 individual CAC sessions ) . R and omization occurred following baseline and provision of the initial session , and therapeutic alliance ratings were obtained from participants following completion of the initial session , and at sessions 5 and 10 among the therapist-delivered and CAC conditions . Results Treatment retention and attendance rates were equal between therapist-delivered and CAC conditions , with 51 % ( 34/67 ) completing all 10 treatment sessions . No significant differences existed between participants in therapist-delivered and CAC conditions at any point in therapy on the majority of therapeutic alliance subscales . However , relative to therapist-delivered treatment , the subscale of Client Initiative was rated significantly higher among participants allocated to the BI ( F2,54 = 4.86 , P = .01 ) and CAC participants after session 5 ( F1,29 = 9.24 , P = .005 ) , and this domain was related to better alcohol outcomes . Linear regression modeled therapeutic alliance over all sessions , with treatment allocation , retention , other demographic factors , and baseline symptoms exhibiting no predictive value . Conclusions Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage , bond , and commit to treatment , despite comorbidity typically being associated with increased treatment dropout , problematic engagement , and complexities in treatment planning . The extent to which a client feels that they are directing therapy ( Client initiative ) may be an important component of change in BI and CAC intervention , especially for hazardous alcohol use . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12607000437460 ; http://www.anzctr.org.au/trial_view.aspx?ID=82228 ( Archived by WebCite at http://www.webcitation.org/5ubuRsULu Almost 10 million women in the United States are caregivers for elders with dementia and many experience extreme stress that compromises their health . Acceptable and feasible interventions to teach them re source fulness skills for managing stress may improve their health and facilitate continued caregiving . This study examined two commonly used methods for practicing skills taught during re source fulness training ( RT ) to women caregivers of elders with dementia ( n=63 ) : journaling and digital voice recording . It also explored whether providing caregivers a choice between the two methods made it more acceptable or feasible . Qualitative and quantitative data were collected before , during , and after RT . Caregivers who recorded used more words ( M=5446 ) but recorded fewer days ( M=17 ) than those who journaled ( M=2792 words and M=27 days ) . Similar concerns in relation to time management and practice method were expressed by women caregivers irrespective of practice method ( journal versus recorder ) or r and om versus choice condition . While journaling was more frequent than recording , more words were expressed during recordings . Perceived stress and depressive symptoms were unrelated to the number of practice days or word counts , suggesting RT acceptability and feasibility even for highly stressed or depressed caregivers . Because intervention feasibility is important for RT effectiveness testing , alternatives to the journaling and recording methods for practicing RT skills should be considered OBJECTIVE The objective of this study was to determine the effects of counseling and support on the physical health of caregivers of spouses of people with Alzheimer disease . METHODS A r and omized controlled trial , conducted between 1987 and 2006 at an outpatient research clinic in the New York City metropolitan area compared outcomes of psychosocial intervention to usual care . Structured question naires were administered at baseline and regular follow-ups . A referred volunteer sample of 406 spouse caregivers of community dwelling patients with Alzheimer disease enrolled over a 9.5-year period .  Enhanced counseling and support consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad-hoc telephone counseling . Indicators of physical health included self-rated health ( SRH ) of caregivers and the number of reported illnesses . RESULTS Controlling for baseline SRH ( mean : 7.24 ) , intervention group caregivers had significantly better SRH than control group caregivers based upon model predicted mean scores four months after baseline ( 6.87 versus 7.21 ) , and this significant difference was maintained for two years ( 6.70 versus 7.01 ) . The effect of the intervention on SRH remained significant after controlling for the effects of patient death , nursing home placement , caregiver depressive symptoms and social support satisfaction . Similar benefits of intervention were found for number of illnesses .  CONCLUSION Counseling and support preserved SRH in vulnerable caregivers . Enhancing caregivers ' social support , fostering more benign appraisal s of stressors , and reducing depressive symptoms may yield indirect health benefits . Psychosocial intervention studies with biological measures of physical health outcomes are warranted A stages-of-change motivational interviewing ( SOCMI ) treatment approach was compared with a st and ard cognitive behavioral therapy gender reeducation ( CBTGR ) approach in a sample of 528 English-speaking and Spanish-speaking male batterers who were r and omly assigned to 49 26-week groups in either condition . Blind ratings of therapist adherence differentiated the two conditions . Language spoken neither predicted outcome nor interacted with treatment . The SOCMI curriculum led to significant reductions in female partners ’ reports of physical aggression at follow-up , but not to changes in self-reported aggression . Men who were initially less ready to change benefited more from the SOCMI approach while men who were more ready to change benefited more from the CBTGR approach . Results suggest the importance of tailoring abuser intervention programs to individuals ’ initial readiness to change BACKGROUND Two-thirds of people with dementia live at home supported mainly by family carers . These carers frequently develop clinical depression or anxiety , which predicts care breakdown . We aim ed to assess the clinical effectiveness ( long-term reduction of depression and anxiety symptoms in family carers ) and cost-effectiveness of a psychological intervention called START ( STrAtegies for RelaTives ) . METHODS We did a r and omised , parallel-group trial with masked outcome assessment s in three UK mental-health services and one neurological-outpatient dementia service . We included self-identified family carers of people with dementia who had been referred in the previous year and gave support at least once per week to the person with dementia . We r and omly assigned these carers , via an online computer-generated r and omisation system from an independent clinical trials unit , to either START , an 8-session , manual-based coping intervention delivered by supervised psychology graduates , or treatment as usual ( TAU ) . The primary long-term outcomes were affective symptoms ( Hospital Anxiety and Depression Scale total score [ HADS-T ] ) 2 years after r and omisation and cost-effectiveness ( health and social care perspectives ) over 24 months . Analysis was by intention to treat , excluding carers with data missing at both 12 and 24 months . This trial is registered ISCTRN70017938 . FINDINGS From November 4 , 2009 , to June 8 , 2011 , we recruited 260 carers . 173 carers were r and omly assigned to START and 87 to TAU .  Of these 260 participants , 209 ( 80 % ) were included in the clinical efficacy analysis ( 140 START , 69 TAU ) . At 24 months , compared with TAU the START group was significantly better for HADS-T ( mean difference -2·58 points , 95 % CI -4·26 to -0·90 ; p=0·003 ) . The intervention is cost effective for both carers and patients ( 67 % probability of cost-effectiveness at the £ 20 000 per QALY willingness-to-pay threshold , and 70 % at the £ 30 000 threshold ) . INTERPRETATION START is clinical ly effective , improving carer mood and anxiety levels for 2 years . Carers in the control TAU group were seven times more likely to have clinical ly significant depression than those receiving START . START is cost effective with respect to carer and patient outcomes , and National Institute for Health and Care Excellence ( NICE ) thresholds . The number of people with dementia is rapidly growing , and policy frameworks assume that their families will remain the frontline providers of ( unpaid ) support . This cost-neutral intervention , which substantially improves family-carers ' mental health and quality of life , should therefore be widely available . FUNDING National Institute for Health Research Health Technology Assessment programme 08/14/06 Background Joint reminiscence groups , involving people with dementia and family carers together , are popular , but the evidence -base is limited . This study aim ed to assess the effectiveness and cost-effectiveness of joint reminiscence groups as compared to usual care . Methods This multi-centre , pragmatic r and omised controlled trial had two parallel arms : intervention group and usual-care control group . A restricted dynamic method of r and omisation was used , with an overall allocation ratio of 1:1 , restricted to ensure viable sized intervention groups . Assessment s , blind to treatment allocation , were carried out at baseline , three months and ten months ( primary end-point ) , usually in the person 's home . Participants were recruited in eight centres , mainly through NHS Memory Clinics and NHS community mental health teams . Included participants were community resident people with mild to moderate dementia ( DSM-IV ) , who had a relative or other care-giver in regular contact , to act as informant and willing and able to participate in intervention . 71 % carers were spouses . 488 people with dementia ( mean age 77.5)were r and omised : 268 intervention , 220 control ; 350 dyads completed the study ( 206 intervention , 144 control ) . The intervention evaluated was joint reminiscence groups ( with up to 12 dyads ) weekly for twelve weeks ; monthly maintenance sessions for further seven months . Sessions followed a published treatment manual and were held in a variety of community setting s. Two trained facilitators in each centre were supported by volunteers . Primary outcome measures were self-reported quality of life for the person with dementia ( QoL-AD ) , psychological distress for the carer ( General Health Question naire , GHQ-28 ) . Secondary outcome measures included : autobiographical memory and activities of daily living for the person with dementia ; carer stress for the carer ; mood , relationship quality and service use and costs for both . Results The intention to treat analysis ( ANCOVA ) identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes ( self-reported QoL-AD mean difference 0.07 ( -1.21 to 1.35 ) , F = 0.48 , p = 0.53 ) . Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a General Health Question naire-28 sub-scale at the ten month end-point ( mean difference 1.25 ( 0.25 to 2.26 ) , F = 8.28 , p = 0.04 ) . Compliance analyses suggested improved autobiographical memory , quality of life and relationship quality for people with dementia attending more reminiscence sessions , however carers attending more groups showed increased care-giving stress . Economic analyses from a public sector perspective indicated that joint reminiscence groups are unlikely to be cost-effective . There were no significant adverse effects attributed to the intervention . Potential limitations of the study include less than optimal attendance at the group sessions — only 57 % of participants attended at least half of the intervention sessions over the 10 month period , and a higher rate of study withdrawal in the control group . Conclusions This trial does not support the clinical effectiveness or cost-effectiveness of joint reminiscence groups . Possible beneficial effects for people with dementia who attend sessions as planned are offset by raised anxiety and stress in their carers . The reasons for these discrepant outcomes need to be explored further , and may necessitate re appraisal of the movement towards joint interventions . Trial Registration IS RCT N Registry IS RCT OBJECTIVE  Caregivers of persons with dementia play an important and economically valuable role within society , but many may do so at a considerable cost to themselves . Knowing which caregivers have the highest risk of developing a mental disorder may contribute to better support of ultra-high-risk groups with preventive interventions . This study aims to describe the incidence of depression and anxiety disorders in caregivers and to identify its significant predictors . DESIGN Prospect i ve cohort study with a follow-up of 24 months . PARTICIPANTS 181 spousal caregivers of persons with dementia without a clinical depression or anxiety disorder at baseline . SETTING Memory clinics , case management services , and primary care setting s in the Netherl and s. MEASUREMENTS The onset of depression and anxiety was measured every 3 months with the MINI International Neuropsychiatric Interview , a structured diagnostic instrument for DSM-IV mental disorders . Potential predictors were assessed at baseline . RESULTS 60 % of the caregivers developed a depressive and /or anxiety disorder within 24 months : 37 % a depression , 55 % an anxiety disorder , and 32 % both disorders . Sub-threshold depressive symptoms ( Wald χ2=6.20 , df=1 , OR : 3.2 , 95 % CI : 1.28 - 8.03 , p=0.013 ) and poor self-reported health of the caregiver ( Wald χ2=5.56 , df=1 , OR : 1.17 , 95 % CI : 1.03 - 1.34 , p=0.018 ) at baseline were significant predictors of disorder onset . CONCLUSION Spousal caregivers of persons with dementia have a high risk to develop a mental disorder . Indicators related to the caregiver 's ( mental ) health rather than environmental stressors such as patient characteristics or interruption of caregivers ' daily activities predict disorder onset and can be used to identify caregivers for whom supporting preventive interventions are indicated Objectives To describe the process and feasibility of our r and omised , controlled intervention study ( NuAD trial ) that positively affected the nutrition and quality of life , and prevented falls of home-dwelling persons with Alzheimer disease ( AD ) . Design , setting , participants This qualitative study comprised 40 persons with AD and spousal caregivers of our trial . Our intervention during one year involved tailored nutritional guidance for these couples . The nutritionist ’s field notes ( about 100 pages ) and the participant feedback question naires ( N = 28 ) served to analyse the feasibility of intervention , factors promoting the application of intervention and challenges hindering it . Thematic content analysis served to analyse our data with the grounded theory approach . Results We identified several positive elements promoting better nutrition : positive attitudes on nutrition to participants including a participant-centred approach , positive feedback , findings of food diaries and practical suggestions . Home visits by the nutritionist were convenient and participants felt that someone cares . Group meetings which included protein-rich snacks strengthened the nutritional message by enabling discussion s and socialising . The oral nutritional supplements ( ONS ) helped participants to regain their energy and to motivate them to exercise and make changes in their diets . Obstacles to making changes in diets included participants ’ false ideas about nutrition , especially with regard to weight gain . Health problems and functional limitations hampered food management , and some families had inveterate eating habits . The positive feedback from participants indicated the feasibility of our tailored nutritional guidance . Conclusions Assessment -based , tailored nutritional guidance implemented with a personal and positive approach may inspire and empower AD families to make positive changes in their diets , leading them to improved nutrition and quality of life
Background Most of patients with dementia are cared for by family members .
Caring for people with dementia is challenging ; approximately 30–55 % of caregivers suffered from anxiety or depressive symptoms .
A range of studies have shown that psychosocial interventions are effective and can improve caregivers ’ quality of life , reduce their care burden , and ease their anxiety or depressive symptoms .
However , information on the acceptability of these interventions , despite being crucial , is under-reported .