Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. Translation of a dementia caregiver support program in a health care system--REACH VA. Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals With Dementia Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: a single-blinded randomized controlled trial Helping carers to care--the 10/66 dementia research group's randomized control trial of a caregiver intervention in Russia. The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme Befriending carers of people with dementia: randomised controlled trial Does a Family Meetings Intervention Prevent Depression and Anxiety in Family Caregivers of Dementia Patients? A Randomized Trial An experimental study on the effectiveness of a mutual support group for family caregivers of a relative with dementia in mainland China Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups E-care: a telecommunications technology intervention for family caregivers of dementia patients. Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. A randomized, controlled study of an Alzheimer's caregiver skills training program Coping with dementia: evaluation of four nonpharmacologic interventions. Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer's disease. Training community consultants to help family members improve dementia care: a randomized controlled trial. Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers. The Savvy Caregiver program: the demonstrated effectiveness of a transportable dementia caregiver psychoeducation program. Changes in social support as mediators of the impact of a psychosocial intervention for spouse caregivers of persons with Alzheimer's disease. Telephone-delivered psychosocial intervention reduces burden in dementia caregivers Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. The Coping with Caregiving Group Program for Chinese caregivers of patients with Alzheimer's disease in Hong Kong. Primary care interventions for dementia caregivers: 2-year outcomes from the REACH study. Effects of a Telephone-Based Exercise Intervention for Dementia Caregiving Wives Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet. A comprehensive support program: effect on depression in spouse-caregivers of AD patients. Influence of regular exercise on subjective sense of burden and physical symptoms in community-dwelling caregivers of dementia patients: a randomized controlled trial.
AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures BACKGROUND Based on the National Institute on Aging/National Institute of Nursing Research Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH ) r and omized controlled trial ( REACH II ) , REACH VA ( Department of Veterans Affairs ) was the first national clinical translation of a proven behavioral intervention for dementia caregivers , running from September 2007 through August 2009 . This article describes the population and outcomes of the REACH VA translation of REACH II into the VA . METHODS Clinical staff members from 24 VA Medical Center Home-Based Primary Care programs in 15 states delivered the intervention to stressed caregivers of patients with dementia . Like REACH II , the 6-month REACH VA intervention , structured through a protocol and individualized through a risk assessment , targeted education , support , and skills training to address caregiving risk areas of safety , social support , problem behaviors , depression , and health through 12 individual in-home and telephone sessions and 5 telephone support group sessions . Staff members of the Memphis VA Medical Center , Memphis , Tennessee , collected data on burden , depression , health and healthy behaviors , caregiving frustrations , social support , dementia-related behaviors , and time spent providing care and on duty . RESULTS From baseline to 6 months , caregivers reported significantly decreased burden , depression , impact of depression on daily life , caregiving frustrations , and number of troubling dementia-related behaviors . A 2-hour decrease in hours per day on duty approached significance . Caregivers ( 96 % ) believed that the program should be provided by the VA to caregivers . CONCLUSIONS This clinical translation achieved outcomes similar to the REACH II r and omized controlled trial , providing clinical ly significant benefits for caregivers of a veteran with a progressive dementing disease . This model of caregiver support can inform public policy in providing assistance to caregivers 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 Purpose Many family caregivers of persons with dementia ( PWD ) are unable to participate in community center-based caregiver support services because of logistical constraints . This study evaluated the effectiveness of a telephone-delivered psychoeducational intervention for family caregivers of PWD in alleviating caregiver burden and enhancing caregiving self-efficacy . Subjects and methods In a single-blinded r and omized controlled trial , 38 family caregivers of PWD were r and omly allocated into an intervention group or a control group . The intervention group received psychoeducation from a registered social worker over the phone for 12 sessions . Caregivers in the control group were given a DVD containing educational information about dementia caregiving . Outcomes of the intervention were measured by the Chinese versions of the Zarit Burden Interview and the Revised Scale for Caregiving Self-efficacy . Mann – Whitney U tests were used to compare the differences between the intervention and control groups . Results The level of burden of caregivers in the intervention group reduced significantly compared with caregivers in the control group . Caregivers in the intervention group also reported significantly more gain in self-efficacy in obtaining respite than the control group . Conclusion A structured telephone intervention can benefit dementia caregivers in terms of self-efficacy and caregiving burden . The limitations of the research and recommendations for intervention are discussed OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Objectives To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden , promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia . Methodology and Principal Findings This was a r and omised controlled trial in which the person with dementia-caregiver dyad was r and omly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months . It was carried out in communities based in two talukas ( administrative blocks ) in Goa , India . Mild to moderate cases with dementia ( diagnosed using the DSM IV criteria and grade d using the Clinical Dementia Rating scale ) and their caregivers were included in the trial . Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist , focusing on supporting the caregiver through information on dementia , guidance on behaviour management , a single psychiatric assessment and psychotropic medication if needed . We measured caregiver mental health ( General Health Question naire ) , caregiver burden ( Zarit Burden Score ) , distress due to behavioural disturbances ( NPI-D ) , behavioural problems in the subject ( NPI-S ) and activities of daily living in the elder with dementia ( EASI ) . Outcome evaluations were masked to the allocation status . We analysed each outcome with a mixed effects model . 81 families enrolled in the trial ; 41 were r and omly allocated to the intervention . 59 completed the trial and 18 died during the trial . The intervention led to a significant reduction of GHQ ( −1.12 , 95 % CI −2.07 to −0.17 ) and NPI-D scores ( −1.96 , 95%CI −3.51 to −0.41 ) and non-significant reductions in the ZBS , EASI and NPI-S scores . We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm ( OR 0.34 , 95 % CI 0.01 to 1.03 ) . Conclusion Home based support for caregivers of persons with dementia , which emphasizes the use of locally available , low-cost human re sources , is feasible , acceptable and leads to significant improvements in caregiver mental health and burden of caring . Clinical Trials.gov Among the diverse group of interventions developed to help dementia family caregivers  cognitive-behavioural approaches show especially promising results . Objectives : This study describes a cognitive-behavioural group intervention aim ed principally at the modification of dysfunctional thoughts associated with caregiving ( MDTC ) . The efficacy of the MDTC intervention in reducing caregivers ’ depressive symptomatology , together with the frequency and appraisal of problem behaviours , is compared to that of a waiting-list control group ( WL ) . Furthermore , the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers ’ depressive symptomatology is analyzed . Of the 74 dementia caregivers who were r and omized to one of two conditions ( MDTC and WL ) , 39 completed the post-intervention assessment . Statistical analyses were performed on an intention-to-treat basis , using last observation carried forward . The results reveal that the MDTC intervention is successful in reducing  caregivers ’ level of depressive symptomatology and dysfunctional thoughts about caregiving , as well as in modifying their appraisal of their relative 's problem behaviours . Furthermore , a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology . The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted Objective To evaluate the effectiveness of a voluntary sector based befriending scheme in improving psychological wellbeing and quality of life for family carers of people with dementia . Design Single blind r and omised controlled trial . Setting Community setting s in East Anglia and London . Participants 236 family carers of people with primary progressive dementia . Intervention Contact with a befriender facilitator and offer of match with a trained lay volunteer befriender compared with no befriender facilitator contact ; all participants continued to receive “ usual care . ” Main outcome measures Carers ’ mood ( hospital anxiety and depression scale — depression ) and health related quality of life ( EuroQoL ) at 15 months post-r and omisation . Results The intention to treat analysis showed no benefit for the intervention “ access to a befriender facilitator ” on the primary outcome measure or on any of the secondary outcome measures . Conclusions In common with many carers ’ services , befriending schemes are not taken up by all carers , and providing access to a befriending scheme is not effective in improving wellbeing . Trial registration Current Controlled Trials IS RCT N08130075 Background Family caregivers of dementia patients are at increased risk of developing depression or anxiety . A multi-component program design ed to mobilize support of family networks demonstrated effectiveness in decreasing depressive symptoms in caregivers . However , the impact of an intervention consisting solely of family meetings on depression and anxiety has not yet been evaluated . This study examines the preventive effects of family meetings for primary caregivers of community-dwelling dementia patients . Methods A r and omized multicenter trial was conducted among 192 primary caregivers of community dwelling dementia patients . Caregivers did not meet the diagnostic criteria for depressive or anxiety disorder at baseline . Participants were r and omized to the family meetings intervention ( n = 96 ) or usual care ( n = 96 ) condition . The intervention consisted of two individual sessions and four family meetings which occurred once every 2 to 3 months for a year . Outcome measures after 12 months were the incidence of a clinical depressive or anxiety disorder and change in depressive and anxiety symptoms ( primary outcomes ) , caregiver burden and quality of life ( secondary outcomes ) . Intention-to-treat as well as per protocol analyses were performed . Results A substantial number of caregivers ( 72/192 ) developed a depressive or anxiety disorder within 12 months . The intervention was not superior to usual care either in reducing the risk of disorder onset ( adjusted IRR 0.98 ; 95 % CI 0.69 to 1.38 ) or in reducing depressive ( r and omization-by-time interaction coefficient = −1.40 ; 95 % CI −3.91 to 1.10 ) or anxiety symptoms ( r and omization-by-time interaction coefficient = −0.55 ; 95 % CI −1.59 to 0.49 ) . The intervention did not reduce caregiver burden or their health related quality of life . Conclusion This study did not demonstrate preventive effects of family meetings on the mental health of family caregivers . Further research should determine whether this intervention might be more beneficial if provided in a more concentrated dose , when applied for therapeutic purpose s or targeted towards subgroups of caregivers . Trial Registration Controlled-Trials.com IS RCT Abstract When caring for an older relative with dementia , family members experience considerable distress and burden . Literature review s show that supportive group interventions for these caregivers have significant positive effects on improving their distress and quality of life , but not consistent and conclusive . Limited research is found in Asian population s. This study tested the effectiveness of a 12-session bi-weekly mutual support group program for Chinese family caregivers of a relative with dementia in Hong Kong , when compared with st and ard family support service . An experimental study with pre- and post-test , parallel groups design was conducted . A r and omized sample of 78 family caregivers , 39 in each of the experimental and control groups , from one regional dementia care center participated in the study . A protocol was specifically design ed by an advanced practice nurse to guide the mutual support group process and the facilitator and peer leader training , based on evidence from the literature on family support group intervention in Western countries . The results of ANOVA tests indicated that the mutual support group participants had significantly greater improvements in distress levels and quality of life than the control group . There were only mild changes in the dem and s for mental health services in both groups at post-test . These findings support the effectiveness of mutual support groups to offer psychosocial support to Chinese family caregivers in dementia care beyond routine community mental health care 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 OBJECTIVE This study evaluated the effectiveness of a  technology-based psychoeducational intervention for family caregivers of dementia patients . An additional objective was to determine if the intervention could be implemented by a community-based social service agency . METHODS Forty-six caregivers were r and omly assigned to either a technology-based intervention or an information-only control condition . RESULTS Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidence d high depression at baseline experienced a significant decline in depression . CONCLUSION This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers OBJECTIVES To test the efficacy of a psychoeducative group program for informal caregivers of persons with dementia . METHODS The study was a multicenter r and omized controlled trial . R and omization was stratified according to sex and kinship . Participants r and omized to the control group were referred to the traditional support groups . Participants in the study group had fifteen 2-hr weekly sessions focusing on stress appraisal and coping .  Eligible participants ( primary caregivers of community-dwelling persons with dementia ) were blindly assessed before the r and omization and after 16 weeks on the following measures : frequency and reactions to behavioral problems ( primary outcome ) , burden , psychological distress , anxiety , perceived social support , and personal efficacy . RESULTS A total of 158 participants were r and omized to the study ( n = 79 ) and control ( n = 79 ) groups in 12 successive waves . Results show that study participants presented a 14 % decrease in their reactions to the behavioral problems of the care-receivers as opposed to a 5 % decrease in the control group ( p = .04 ) . The frequency of behavior problems also decreased ( p = .06 ) , as did the cross-product frequency/reaction ( p = .02 ) . There was no significant effect on the secondary outcome variables . DISCUSSION This is one of the first studies showing a significant effect of this type of support group program on the caregivers of participants with dementia PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers ' expectations and patients ' actual functional abilities and by teaching supportive skills . Although a group of 49 caregiver-patient dyads were recruited , the outcome measures of only those dyads ( 47 ) that completed the week seven session were used for analysis . Half of the dyads were r and omized to an intervention group and the other half to a waiting list . The intervention group ( N = 24 ) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved . Comparisons were made between baseline scores , scores at seven weeks , and scores at the end of 17 weeks on the congruence between caregiver estimates and patients ' actual performance on the Independent Living Scale and measures of cognition , function , preillness quality of relationship , caregiver mood , feeling of self-efficacy , and several other measures . We were not able to increase the congruence between caregiver estimates and patients ' actual performance and found no change in any other measure . We did find the expected relationship between depression and caregiver sense of self-efficacy To evaluate nonpharmacologic interventions , caregivers ( 65 women , 38 men ) and their dementia-diagnosed spouses ( patients ) were r and omized to one of four treatment programs ( cognitive stimulation , dyadic counseling , dual supportive seminar , and early-stage day care ) or to a wait-list control group . Assessment s occurred initially and at postintervention ( 3 months ) . Patients were evaluated on memory , verbal fluency , and problem-solving ability , and caregivers were assessed on marital interaction , emotional status , and physical health , along with stress , coping , and social support .  Caregivers also completed a program evaluation . Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes , and caregivers decreased in depressive symptoms . Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies , respectively . Although qualitatively derived benefits differed across groups , similarities in program content reduced the potential for quantitative differentiation among the groups OBJECTIVE The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer 's disease . METHOD The participants were 406 spouse-caregivers of Alzheimer 's disease patients who lived at home at baseline . The caregivers were r and omly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care ( control group ) . Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling , agreed to join support groups 4 months after enrollment , and received ongoing ad hoc counseling . The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study . RESULTS After baseline differences were controlled for , caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects . These effects were sustained for 3.1 years after baseline , similar across gender and patient severity level , and sustained after nursing home placement or death of the patient . CONCLUSIONS Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer 's disease patients and should be widely available to provide effective , evidence -based intervention for family caregivers PURPOSE We investigated whether community consultants could be trained to teach family caregivers a systematic behavioral approach for reducing mood and behavior problems in persons with Alzheimer 's disease . DESIGN AND METHODS This study consisted of a r and omized controlled trial ; we r and omly assigned 95 family caregivers and care recipients with Alzheimer 's disease to STAR-caregivers ( STAR-C ) or control groups . Masked interviewers conducted assessment s at baseline , after treatment , and after 6 months . Consultants were master's-level health care professionals who were currently practicing in community setting s serving older adults . We assessed the extent to which consultants were able to learn and adhere to the treatment protocol , and the relationship between adherence and measures of caregiver mood , burden , and care recipient mood and behavior . RESULTS Community consultants were able to learn and adhere to the behavioral treatment protocol . Caregivers receiving STAR-C training showed significant improvements in depression , burden , and reactivity to behavior problems in the care recipient . There were also significant reductions in the frequency and severity of care recipient behavior problems , and improved quality of life . Results were maintained at 6-month follow-up . IMPLICATION S Community-based consultants successfully implemented a behavioral intervention with family caregivers of persons with Alzheimer 's disease . Consequently , STAR-C seems to be a practicable and reasonable evidence d-based approach to caregiver training in actual clinical setting Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs PURPOSE The neuropsychiatric symptoms associated with Alzheimer 's disease are a major contributor to caregiver  distress and burden . Despite recent efforts to teach caregivers skills to manage neuropsychiatric symptoms and reduce burden , there continues to be limited evidence that these strategies have helped caregivers of individuals with Alzheimer 's disease to effectively manage neuropsychiatric symptoms . We report here on Project CARE , a r and omized controlled trial design ed to test the effectiveness of a caregiver-based multicomponent behavioral intervention aim ed to reduce caregiver distress related to neuropsychiatric symptoms , as well as general caregiver burden , and to decrease neuropsychiatric symptom severity among individuals with Alzheimer 's disease . DESIGN AND METHODS The behavioral intervention involved five weekly sessions design ed to teach caregivers specific techniques for managing patient neuropsychiatric symptoms in the home environment . Through the use of a r and omized control trial , 80 caregivers were assigned to either the behavioral intervention group or a psychoeducational control group and were assessed both before and after the intervention . RESULTS Compared with caregivers in the control group , caregivers in the behavioral intervention group displayed significantly greater reductions in caregiver distress related to neuropsychiatric symptoms ( p=.005 ) . Global caregiver burden , however , did not decrease significantly for caregivers in either group ( p>.05 ) . Although it was not statistically significant , there was a trend toward greater reductions in care recipients ' neuropsychiatric symptom severity in the intervention group ( p=.10 ) . IMPLICATION S The current findings suggest that targeted , group-based behavioral interventions are effective for reducing distress related to neuropsychiatric symptoms among caregivers of individuals with Alzheimer 's disease and for reducing care recipients ' neuropsychiatric symptoms This article is about the trial of a transportable psychoeducation program for family caregivers of older adults with Alzheimer 's disease and other dementias that was based on a program developed and previously tested in an academic setting . Family caregivers were recruited by agencies in three states and invited to participate in a r and omized trial of this six-session program . Question naires were administered prior to r and omization and again 5 to 6 months later to assess program effect . A total of 52 caregivers completed both question naires ( 22 were in the wait-list control group ) . Experimental participants ' scores on measures of mastery and distress were significantly better than control participants ' scores at follow-up ( Time 2 Results for this transported program showed benefits to caregivers com parable to those in the previous trials . The program demonstrated that it could be offered in a variety of setting s and that it had benefit for caregivers The spouse caregivers of 406 patients with Alzheimer 's disease were r and omly assigned to an enhanced counseling and support intervention or to a usual care control condition . Structured interviews were conducted to assess changes in social support and psychosocial outcomes for the 312 caregivers who provided care in the home for at least 1 year . The number of support persons , satisfaction with the support network , and support persons ' assistance with caregiving all increased significantly as a function of the intervention . Structural equation models indicated increased satisfaction with the social support network mediated a significant proportion of the intervention 's impact on caregiver depression . A portion of this mediated effect was further mediated by changes in caregiver stress appraisal s. Implication s for strengthening intervention programs for spouse caregivers of individuals with Alzheimer 's disease are discussed The objective of this study was to examine the preliminary efficacy of Family Intervention : Telephone Tracking — Dementia ( FITT-D ) , a multi-component intervention that is delivered in 23 telephone contacts over 12 months . Thirty-three dementia caregivers were r and omly assigned to receive either FITT-D ( n = 16 ) or st and ard care ( n = 17 ) using urn r and omization to balance the groups on dementia severity , caregiver gender and relationship type ( spouse versus other ) . Inclusion criteria included formal dementia diagnosis , caregiving for at least six months , residing with the care recipient , and providing at least four hours of direct supervision per day . Master's-level therapists contacted caregivers by telephone over 12 months . Each contact followed a st and ardized treatment manual , involving assessment and individualized application of interventions to address mood , family functioning , social support and health . Outcomes included Zarit Burden Interview , Revised Memory and Behavior Problem Checklist , and the Geriatric Depression Scale at baseline and 12 months ( end of treatment ) . Caregivers receiving  FITT-D exhibited significantly lower burden scores and less severe reactions to memory and behavior problems than caregivers in the st and ard care condition . Findings provide preliminary evidence for the efficacy of FITT-D , a potentially highly accessible , low-cost intervention for dementia caregivers OBJECTIVES Family caregiving is an integral part of the care system for persons with dementing disorders , such as Alzheimer 's disease . This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving . DESIGN Training effectiveness was tested in a trial in which family care receiver dyads were r and omly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months , following completion of data collection . SETTING A community-based 14-hour training program provided in seven weekly 2-hour sessions . The training program curriculum was built on a stress and coping theory base . Recruitment and r and omization were ongoing . Programs were begun every 2 months over a two and one half-year period for a total of 16 programs . PARTICIPANTS Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate . MEASUREMENTS Data reported in this paper were gathered from each participating family at entry to the study and 5 months later . St and ard measures of beliefs about caregiving , burden , depression , and reaction to care receiver behavior were administered to caregivers . A st and ard measure of mental status was administered to the person with dementia and st and ardized instruments were used to gather information from caregivers concerning care receivers ' behavior and abilities to perform activities of daily living ( ADLs ) . RESULTS Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data . Treatment and control caregivers and care receivers were similar at baseline , and care receivers in both groups declined similarly over the 5-month period . Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving ( P = .044 ) and reaction to behavior ( P = .001 ) . When outcomes were compared , treatment group caregivers were significantly different ( in the expected direction ) from those in the control group on measures of the stress mediator , beliefs ( P = .025 ) , and key outcomes , response to behavior ( P = .019 ) , depression ( P = .040 ) , and burden ( P = .051 ) . There was a significant positive association between the strengthened mediator , the caregivers ' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities , and the outcome , namely improvements in burden ( P = .019 ) and depression ( P = .007 ) . CONCLUSION A caregiver training intervention focused on the work of caregiving and targeted at knowledge , skills , and beliefs benefits caregivers in important outcome dimensions . The results suggest the benefits of providing information , linkage , and role coaching to dementia family caregivers BACKGROUND The majority of patients with Alzheimer 's disease live outside institutions and there is considerable serious psychological morbidity among their carers . AIMS To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer 's disease and produces clinical benefits in the patients . METHOD A prospect i ve single-blind r and omised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups . RESULTS There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up . There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group . Based on an improvement on the General Health Question naire result ing in a carer converting from a case to a non-case , the number to treat was three immediately post-treatment and two at follow-up . CONCLUSIONS Family intervention can have significant benefits in carers of patients with Alzheimer 's disease and has a positive impact on patient behaviour 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 OBJECTIVE This pilot study evaluated the effectiveness of Coping with Caregiving ( CWC ) psychoeducational program for Chinese family caregivers of patients with Alzheimer 's disease in Hong Kong . METHOD Twenty-seven female primary caregivers were r and omized to join the  treatment group or wait-list control group . The caregivers in the treatment group participated in 13 weekly training sessions which taught specific cognitive-behavioral strategies to h and le caregiving stress . RESULTS As compared to the wait-list control group , caregivers completing the CWC program demonstrated a significant increase in their self-efficacy for controlling their up setting thoughts and h and ling disruptive behaviors of the care recipients . They also reported a significant increase in the use of both problem-focused and emotion-focused coping strategies . CONCLUSION These findings suggested that cognitive-behavioral programs can be effective in improving the re source fulness of Chinese caregivers of persons with dementia in Hong Kong . PRACTICE IMPLICATION S Future CWC programs will have to enhance participants ' ability to differentiate among various coping skills and to use situation-appropriate strategies PURPOSE This study developed and tested two 24-month primary care interventions to alleviate the psychological distress suffered by the caregivers of those with Alzheimer 's disease . The interventions , using targeted educational material s , were patient behavior management only , and patient behavior management plus caregiver stress-coping management . We hypothesized that the addition of the stress-coping component would improve caregiver outcomes . DESIGN AND METHODS A r and omized clinical trial of 167 caregiver-care recipient dyads was run , of whom 76 completed the study without bereavement or placement . RESULTS During 24 months , caregivers who received the patient behavior management component only , compared with those who also received the stress-coping component , had significantly worse outcomes for general well-being and a trend toward increased risk of depression ( i.e. , a score of > 16 on the Center for Epidemiological Studies Depression scale ) . There was a study wide improvement for bother associated with care recipient behaviors ( according to the Revised Memory and Behavior Problems Checklist ) . IMPLICATION S Our data suggest that brief primary care interventions may be effective in reducing caregiver distress and burden in the long-term management of the dementia patient . They further suggest that interventions that focus only on care recipient behavior , without addressing caregiving issues , may not be as adequate for reducing caregiver distress Despite the importance of self-care for dementia caregivers , few interventions have included a focus on health behaviors . This study reports outcomes of a telephone-based exercise intervention design ed for women caring for a spouse with dementia . Caregivers ( N = 137 ) were r and omized to intervention or control conditions . Participants with at- or below-median exercise scores at baseline had a significantly greater increase in exercise at 6-month follow-up compared with their control counterparts . At 6 months , participants had greater reductions in perceived stress relative to controls . Participants also reported significantly greater increases in exercise self-efficacy than caregivers in the control group at both follow-up points . Results indicate that spouse caregivers are able to increase their physical activity and that a focus on exercise in multicomponent interventions may be beneficial . Debate and discussion are needed to inform expectations for program effects and their maintenance and to explore the interface between enhanced self-care and caregiving perceptions The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia . 30 informal carers were allocated to the workshop sessions and 15 to the booklet . Outcome measures included awareness of communication strategies ; perceived frequency of communication breakdown at home , and the associated level of distress ; general stress ; and consumer satisfaction . At six week follow-up , the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group . Both groups reported some reduction in the frequency of communication problems at home , and a reduction in the associated level of distress . The frequency of other problem behaviours remained stable . Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner 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 With an aim to improve quality of life in caregivers of dementia patients , we examined the effect of regular exercise on caregivers ' sense of burden and their physical symptoms . Participants were 31 elderly caregivers living with older patients diagnosed with Alzheimer's-type dementia . They were r and omly assigned to either the intervention group , who were prescribed regular exercise with moderate-intensity : 3 metabolic equivalents ( 3METs ) , 3 times per week for 12 weeks , or the control group , who did not receive any prescription . In the intervention group , significant reductions in the Zarit caregiver burden interview ( ZBI ) score and in the frequency of feeling fatigued , and an improvement in quality of sleep were observed at follow-up ( p < 0.05 ) , while no such changes were observed in the control group . These results suggest that obtaining sustainable habit of moderate exercise may improve quality of life in caregivers of demented patients
PURPOSE The objective of this systematic review was to assess the effects of family support programs on caregiving burden , depression , and stress in family caregivers of people with dementia .