[Differential efficacy of two psychoeducational interventions for dementia family caregivers]. Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention "Easing the way" for spouse caregivers of individuals with dementia: a pilot feasibility study of a grief intervention. Patient and caregiver characteristics and nursing home placement in patients with dementia. The effect of telephone support groups on costs of care for veterans with dementia. A quasi-experimental design trial exploring the effect of a partnership intervention on family and staff well-being in long-term dementia care A Stress‐Busting Program for Family Caregivers Preserving health of Alzheimer caregivers: impact of a spouse caregiver intervention. Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs Long-term care placement of dementia patients and caregiver health and well-being. Improving Burden and Coping Skills in Frontotemporal Dementia Caregivers: A Pilot Study Follow-up of an intervention program for caregivers of a relative with dementia living in a long-term care setting: Are there any persistent and delayed effects? A Pilot Evaluation of Psychosocial Support for Family Caregivers of Relatives with Dementia in Long-Term Care: The Residential Care Transition Module. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. The Resources for Enhancing Alzheimer's Caregiver Health (REACH): project design and baseline characteristics. Effectiveness of a Psychoeducational Intervention Group Program in the Reduction of the Burden Experienced by Caregivers of Patients With Dementia: The EDUCA-II Randomized Trial Effects of a Psychosocial Intervention on Caregivers of Recently Placed Nursing Home Residents: A Randomized Controlled Trial Cognitive Behavioral Group Intervention for Alzheimer Caregivers Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care A comprehensive support program: effect on depression in spouse-caregivers of AD patients.
INTRODUCTION AND OBJECTIVES The aim of this work is to compare the effectiveness of two psychoeducational interventions for dementia caregivers : a cognitive behavioral one ( PCC ) , aim ed at the modification of dysfunctional thoughts about caregiving , and another one consisting in problem solving skills training ( PSP ) for caregivers , with the aim of modifying the behavioral problems of their relative . SUBJECTS AND METHODS Seventy five caregivers were asked to participate in an intervention program , of whom 31 finally completed the study . Both group interventions are compared with a control group ( CG ) . The caregiver groups were r and omly assigned to each experimental condition . Pre , post intervention , and follow up assessment s of the following variables have been made : depression , perceived stress , frequency of behavioral problems , perceived stress associated with the behavioral problems and dysfunctional thoughts about caregiving . RESULTS Following the intervention , caregivers in the PCC program show significantly less perceived stress than the other two groups . In the same direction , a trend exists to a significant reduction of the stress associated with the behavioral problems . In the follow up assessment , caregivers of the PCC program significantly report less relative 's behavioral problems than the other two groups . Caregivers of the PCC program have less dysfunctional thoughts than the other two groups , differences almost reaching significance . CONCLUSIONS Benefits of a psychoeducational intervention vary as a function of the contents it includes . The importance of intervening on the caregiver dysfunctional thoughts for an adequate coping with caregiving is highlighted ABSTRACT Objectives : Evaluation of long-term effects of an individualized short-term telephone intervention ( seven sessions ) , based on a comprehensive cognitive behavioral therapy ( CBT ) approach . The study goal was to evaluate the maintenance of intervention effects regarding well-being , quality of life , and health at two years post treatment . Method : Participants ( n = 105 ) were ( partly ) r and omized after baseline assessment in a two-arm study ( intervention , control group/usual care ) .  Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Caregivers ’ physical complaints were measured with the Gießener Beschwerdebogen ( GBB-24 ) , and quality of life with the World Health Organization quality of life -BREF ( WHOQOL-BREF ) . Emotional well-being and perceived health status were assessed using thermometer scaling . Data were analyzed by intention-to-treat analyses , including for those who terminated the intervention prematurely but still delivered data , using ANCOVAs . Results : Long-term intervention effects were found for emotional well-being ( p = 0.019 ) . For the subgroup of caregivers who were still caring at home at follow-up , the intervention led to an increased health status ( p = 0.023 ) , fewer bodily complaints ( global measure p= 0.014 , rheumatic pain p = 0.027 , heart trouble p = 0.042 ) , and a higher quality of life ( overall p = 0.044 and subscale environment p = 0.030 ) . Conclusion : The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being , health status , bodily complaints , and quality of life A multicomponent intervention targeting grief symptoms in spouse caregivers of individuals with dementia was pilot tested in this feasibility study . Twenty spouse caregivers completed the study within the 5-month protocol . The five-component intervention , deduced from Meuser , Marwit , and S and ers ' Dementia Caregiver Grief Model and tailored to participants ' grief , mental health , and learning needs , included supportive grief counseling , emotional support , education , skill building , and referral to community re sources . Significant changes were found from baseline to intervention completion for the measures of grief , depression , anxiety , positive states of mind , and self-efficacy , result ing in a moderate effect size of -0.43 for grief to a large effect size of -2.40 for anxiety . Increases in quality of life and decreases in grief persisted at the 8-month follow up for caregivers who continued to provide care in the home . The Easing the Way intervention protocol is a promising caregiver program that warrants further testing in a r and omized controlled study CONTEXT The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers . Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone . OBJECTIVE To develop and vali date a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia . DESIGN , SETTING , AND PARTICIPANTS The Medicare Alzheimer 's Disease Demonstration and Evaluation study , a prospect i ve study at 8 sites in the United States , with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia . MAIN OUTCOME MEASURES Time to nursing home placement throughout a 36-month follow-up period , assessed by interview and review of Medicare records , and its association with patient and caregiver characteristics , obtained by interview at enrollment . RESULTS Patients were divided into a development ( n = 3859 ) and validation ( n = 1929 ) cohort . In the development cohort , the Kaplan-Meier estimates of nursing home placement throughout 1 , 2 , and 3 years were 22 % , 40 % , and 52 % , respectively . After multivariate adjustment , patient characteristics that were associated with nursing home placement were as follows : black ethnicity ( hazard ratio , 0.60 ; 95 % confidence interval [ CI ] , 0.48 - 0.74 ) , Hispanic ethnicity ( HR , 0.40 ; 95 % CI , 0.28 - 0.56 ) ( both ethnicities were inversely associated with placement ) , living alone ( HR , 1.74 ; 95 % CI , 1.49 - 2.02 ) , 1 or more dependencies in activities of daily living ( HR , 1.38 ; 95 % CI , 1.20 - 1.60 ) , high cognitive impairment ( for Mini-Mental Status Examination score < or = 20 : HR , 1.52 ; 95 % CI , 1.33 - 1.73 ) , and 1 or more difficult behaviors ( HR , 1.30 ; 95 % CI , 1.11 - 1.52 ) . Caregiver characteristics associated with patient placement were age 65 to 74 years ( HR , 1.17 ; 95 % CI , 1.01 - 1.37 ) , age 75 years or older ( HR , 1.55 ; 95 % CI , 1.31 - 1.84 ) , and high Zarit Burden Scale score ( for highest quartile : HR , 1.73 ; 95 % CI , 1.49 - 2.00 ) . Patients were assigned to quartiles of risk based on this model . In the development cohort , patients in the first , second , third , and fourth quartile had a 25 % , 42 % , 64 % , and 91 % rate of nursing home placement at 3 years , respectively . In the validation cohort , the respective rates were 21 % , 50 % , 64 % , and 89 % . The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort . CONCLUSIONS Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia . Interventions directed at delaying placement , such as reduction of caregiver burden  or  difficult patient behaviors  , need to take into account the patient and caregiver as a unit PURPOSE Few studies have addressed the effects of  caregiver interventions  on the costs of care for the care recipient . This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost . DESIGN AND METHODS The Telehealth Education Program ( TEP ) is a manualized program of education and support design ed for caregivers of veterans with moderate-to-severe dementia . One hundred fifty-eight spousal caregivers were r and omly assigned to either the ten 1-hr sessions of TEP or the usual care ( UC ) .  Health care utilization and cost data were extracted from veterans Information System Technology Architecture data bases and included outpatient , inpatient , and nursing home data within the VA . RESULTS Total health care cost data showed a significant ( p = .039 ) average cost savings of $ 2,768 per patient at 6 months for TEP as compared with UC , but these were not maintained at 1 year . All costs included in the total costs measure contributed to this difference . Inpatient , outpatient , and nursing home costs were all assessed separately , but only nursing home costs reached significance ( p = .009 ) , with a savings of $ 1,057 per patient at 6 months . IMPLICATION S The TEP caregiver intervention result ed in short-term cost savings for veteran care recipients . Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes Objectives : This study sought to explore the effect of the family involvement in care ( FIC ) intervention on  family and staff well-being over a nine-month period in a long-term care ( LTC ) facility providing dementia care . Method : A quasi-experimental design with r and omised allocation of two LTC sites but not the participants was employed . Family caregivers ( n = 57 ) of residents with dementia and staff ( n = 59 ) from two LTC facilities in Queensl and , Australia , were recruited . Participants were assessed once pre-intervention and three times post-intervention for knowledge , stress and satisfaction outcomes . Between-group and within-group effects were analysed using ANOVAs at < 0.05 level of significance . Pre- and post-intervention interviews from a purposive sample of family caregivers were also conducted to enhance underst and ing of FIC benefits . Results : Beneficial intervention effects associated with family caregivers ’ knowledge of dementia were found ( p < 0.001 ) . Negative intervention effects were also found for family satisfaction outcomes in relation to staff consideration of their relatives and management effectiveness ( p < 0.05 ) . In addition , staff well-being and job satisfaction were found to be negatively affected by their perceived inappropriate behaviour of residents with dementia ( p < 0.05 ) . Conclusion : Participation in the FIC intervention improved family caregiver knowledge . The major barrier to the success of the partnership intervention in achieving beneficial long-term psychosocial effects for family and staff caregivers was lack of re sources and leadership required to support collaboration between family and staff , mainly due to environment and structural changes . This study contributes to our underst and ing of the importance of partnerships in promoting family involvement in dementia care & NA ; Aging baby boomers , longer life spans , and rising levels of Alzheimer 's disease and related dementias ( ADRD ) will result in a caregiver crisis in the near future . The ways in which caregivers deal with stresses related to caregiving will be critical to both their own well‐being and their ability to care for others . The purpose of this article is to describe the Stress‐Busting Program ( SBP ) for family caregivers and its effectiveness . The essential components of the SBP are education , stress management , problem solving , and support delivered in a group setting for 9 weeks . Results of the SBP indicate that throughout the program , caregivers experienced significant improvements in general health , vitality , social function , and mental health scores and decreases in anxiety , anger/hostility , depression , perceived stress , and caregiver burden . The SBP is a cost‐effective health‐promotion strategy for caregivers who have substantial ongoing stress 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 Purpose : The aim of this study was to examine the impact on dementia caregivers ’ experienced stress and health status of 2 Internet-based intervention programs . Design and methods : Ninety-one dementia caregivers were given the choice of being involved in either an Internet-based chat support group or an Internet-based video conferencing support group . Pre-post outcome measures focused on distress , health status , social support , and service utilization . Results : In contrast to the Chat Group , the Video Group showed significantly greater improvement in mental health status . Also , for the Video Group , improvements in self-efficacy , neuroticism , and social support were associated with lower stress response to coping with the care recipient ’s cognitive impairment and decline in function . Implication s : The results show that , of 2 Internet-based intervention programs for dementia caregivers , the video conferencing intervention program was more effective in improving mental health status and improvement in personal characteristics were associated with lower caregiver stress response CONTEXT Placing a  relative with dementia  into a long-term care facility is common among caregivers . Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described . OBJECTIVE To assess the impact of placing a relative with dementia  in a long-term care facility on caregivers ' health and well-being . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites . A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period . Data collected before and after placement were analyzed to identify factors associated with placement , the nature of contact between caregivers and their institutionalized relatives after placement , and the relation of both of these factors to health outcomes among dementia caregivers . MAIN OUTCOME MEASURES Caregiver depression ( symptoms on the Center for Epidemiological Studies -Depression [ CES-D ] scale ; range , 0 - 60 ) and anxiety ( State Trait Inventory ; range , 10 - 40 ) and use of prescription medications for depression and anxiety . RESULTS Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers . Overall CES-D scores for depression did not change from before to after placement ( median [ IQR ] , 15.0 [ 8 - 24.5 ] and 15.0 [ 7.7 - 28 ] ; P = .64 ) . Overall anxiety scores on the State Trait Inventory also did not change significantly ( median [ IQR ] , 22.0 [ 19 - 27 ] before vs 21.1 [ 18 - 27 ] after ; P = .21 ) . These effects were most pronounced among caregivers who were married to the patient ( P = .02 for depression ) , visited more frequently ( P = .01 for depression and P<.001 for anxiety ) , and were less satisfied with the help they received from others ( P = .003 for depression and P<.001 for anxiety ) . The use of antidepressants did not change significantly before ( 21.1 % ) to after ( 17.9 % ) placement ( P = .16 ) . The use of anxiolytics before to after placement increased from 14.6 % to 19 % ( P = .02 ) , and nearly half of caregivers ( 48.3 % ) were at risk for clinical depression following placement of their relative . CONCLUSIONS The transition to institutional care is particularly difficult for spouses , almost half of whom visit the patient daily and continue to provide help with physical care during their visits . Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals Caregivers of people with frontotemporal dementia ( FTD ) show higher levels of burden than do those caring for people with Alzheimer disease.1,2 This almost certainly reflects several factors , including symptoms of the patient , rate of disease progression,3 caregiver depression,3,4 or coping style . Moreover , caregivers often find themselves deprived of specialist care in the community , and most programs , when available , focus on memory problems , which are less relevant in FTD . Despite emergent literature and clinical relevance , no studies , to our knowledge , have explored  caregiver interventions to reduce  burden and enhance coping skills in FTD . To address this gap , the current study aim ed to verify the utility of a specific intervention in FTD caregivers , based on an adapted Canadian program targeting problem solving , reframing , and seeking support.5 Primary outcomes were reduction of caregiver burden and reaction to patient behavior ; secondary outcomes were decreasing caregiver depression , anxiety , stress , and changing coping strategy where necessary The purpose of this r and omized study was to test the persistent and delayed effects of an intervention program entitled “ Taking Care of Myself ” on selected mental health outcomes of daughter caregivers of a relative with dementia living in a long-term care setting . One group of caregivers took part in the experimental program ( EG , n = 45 ) , one in a comparison program offered by an Alzheimer Society ( AG , n = 51 ) , and another constituted a control group ( CG , n = 41 ) . Effects were verified at the end of the program and 3 months later . Results from prediction analyses reveal that competence dealing with healthcare staff and use of the coping strategy of reframing were persistent effects unique to the EG condition , whereas perceived availability of informal and formal support was a persistent effect in the EG and in the AG . A delayed effect was observed in the AG regarding competence dealing with healthcare staff . These results underline the importance of follow-up assessment s of intervention programs and suggest avenues to support caregivers of institutionalized seniors This multiple method pilot evaluation aim ed to generate preliminary data on the effectiveness of the Residential Care Transition Module ( RCT M ) . The RCT M is a six-session , 4-month psychosocial intervention design ed to help families manage their emotional and psychological distress  following residential care placement of a cognitively impaired relative . Seventeen family caregivers of relatives in a nursing home or assisted living memory care unit were r and omly assigned to the RCT M treatment condition and 19 family caregivers were assigned to a usual care control group .  Caregivers in the treatment condition reported significantly ( p < 0.05 ) less emotional distress at 4 and 8 months on self-reported surveys than those in the control group . Post- RCT M focus groups emphasized the importance of readily available psychosocial support for families following the placement transition . The findings suggest that the provision of skilled psychosocial support can help families manage emotional distress and crises in the months following a cognitively impaired relative 's admission to residential long-term care OBJECTIVES The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . INCLUSION CRITERIA Types of participants Adult caregivers who provide support for people with dementia living in the community ( non-institutional care).Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta-analyses , systematic review s , r and omised control trials , quasi-experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . SEARCH STRATEGY The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . ASSESSMENT OF QUALITY Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . DATA COLLECTION AND ANALYSIS St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta- analysis . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . RESULTS A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty-five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta- analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta- analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well-being , self-efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta- analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . EFFECTIVENESS OF INTERVENTION TYPE Four categories of intervention were included in the review - psycho-educational , support , multi-component and other . Psycho-educational Thirteen studies used  psycho-educational interventions  , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta- analysis . No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being , self-efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta- analysis and demonstrated a small but significant improvement on caregiver burden . Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy , depression , subjective well-being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta- analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits . Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . EFFECTIVENESS OF INTERVENTIONS USING SPECIFIC OUTCOME CATEGORIES In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on caregiver depression was available for meta- analysis from eight studies . This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta- analysis and findings indicated that there were no significant effects of any of interventions . No meta- analysis was possible for the outcome categories of health , self-efficacy or subjective well-being . IMPLICATION S FOR PRACTICE From this review there is evidence to support the use of well- design ed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Factors which do not appear to have benefit in interventions are those which 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 We conducted a multicenter , prospect i ve , evaluator-blinded , 2-arm parallel r and omized trial to compare the effectiveness of a group psychoeducational intervention ( PIP ) with that of st and ard care in dementia caregivers . The primary outcome was the burden experience evaluated by the Zarit Burden Interview .  Secondary outcomes were psychological distress evaluated with the scaled General Health Question naire-28 items , and quality of life evaluated with the Short-Form Health Survey 12 . Effectiveness endpoint was at 4 months since inception . Statistical analyses used complete case and intention-to-treat analysis ( ITT ) . The trial recruited 238 caregivers from 22 research sites ( 115 r and omized to PIP , 123 r and omized to st and ard care ) . No differences were found in the Zarit Burden Interview scores ( complete case analysis : mean difference=−1.02 , 95 % confidence interval=−4.41 to 2.37 ; ITT analysis : MD=−0.55 , 95 % confidence interval=−3.64 to 2.55 ) , the Short-Form Health Survey 12 domain scores ( all P>0.05 ) , and total General Health Question naire-28 items scores and some of its subscales ( all P>0.05 ) except the anxiety and insomnia subscale for the ITT analysis ( P=0.03 ) . In summary , PIP in modality of group intervention was not better than st and ard care to reduce caregiver burden and overall psychological distress or to improve quality -of-life domains . EDUCA-II trial registry : IS RCT N14411440 Many caregivers continue to provide care and support to their care recipients after institutional placement . A two-group r and omized controlled trial was carried out to test the efficacy of a psychosocial intervention for informal caregivers whose care recipients resided in a long-term care facility . The intervention was delivered during the 6-month period following baseline assessment . Follow-up assessment s were carried out at 6 , 12 , and 18 months . Primary outcomes were caregiver depression , anxiety , burden , and complicated grief . Significant time effects were found for all three primary outcomes showing that caregiver depression , anxiety , and burden improved over time . No treatment effects were found for these outcomes . However , complicated grief was significantly lower for caregivers in the treatment condition Long-term caregiving of patients with Alzheimer disease ( AD ) frequently induces a relevant distress enhanced by inadequate coping strategies . This study aim ed to explore the impact of cognitive and behavioral therapy ( CBT ) group intervention on AD patients ’ caregivers . In particular , reduction in caregivers ’ global care needs and in anxiety and depression has been investigated . About 100 caregivers were divided into the following groups : CBT group intervention , self-help manual , and control have been enrolled in the study . CBT group intervention seems to be more effective than the other 2 conditions in reducing caregivers ’ anxiety . Furthermore , only caregivers of the CBT group showed significant needs related to reduction in care . The proposed treatment could be the core of a more structured and systematic intervention for AD patients ’ caregivers in Italy Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits . This 6-month , prospect i ve , r and omized trial tested the effect of an intervention consisting of a face-to-face , structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia . A comparison group received only social contact via telephone . Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals , and provision of psychosocial support . Psychosocial support was also provided via telephone at three 2-month intervals . Family members participated in three telephone interviews : baseline , 3 , and 6 months . Specific advance directives for persons with dementia were extracted from medical records . Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point , and they were more likely to have decided on medical options listed in residents ' advance directives ( Do Not Resuscitate , Intubate , Hospitalize ) over time . Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia Caregivers of Alzheimer 's disease patients often suffer from depression . Using a longitudinal treatment/control study , we examined the effects of a comprehensive support program on  depression in spouse-caregivers . This psychosocial intervention program treats the primary caregiver and family members over the entire course of the disease through individual and family counseling , the continuous availability of ad hoc counseling , and support group participation . In the first year after intake , the control group became increasingly more depressed , whereas the treatment group remained stable . By the eighth month , treated caregivers were significantly less depressed than those in the control group . These results suggest that enhancing long-term social support can have a significant impact on depression in caregivers
Objective : To identify , appraise and synthesize existing evidence regarding the effectiveness of psychosocial interventions on the psychological health and emotional well-being of family carers of people with dementia who have moved into residential care .
Introduction : Many carers experience stress , guilt , grief and depression following placement of a relative with dementia into residential care .
Psychosocial interventions to support family carers may help to improve psychological health and emotional well-being ; however , evidence for such interventions delivered to family carers following placement has yet to be appraised and synthesized .