The PREP system of nursing interventions: a pilot test with families caring for older members. Preparedness (PR), enrichment (E) and predictability (P). Worksite-based internet multimedia program for family caregivers of persons with dementia. The Buffering Effect of a Computer Support Network on Caregiver Strain E-care: a telecommunications technology intervention for family caregivers of dementia patients. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Nutrition and health risks in the elderly: the nutrition screening initiative. Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study Comparative Outcomes of Two Distance-Based Interventions for Male Caregivers of Family Members With Dementia The effect of a family therapy and technology-based intervention on caregiver depression. Caring for others: Internet video-conferencing group intervention for family caregivers of older adults with neurodegenerative disease. Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. User evaluation of the DEMentia-specific Digital Interactive Social Chart (DEM-DISC). A pilot study among informal carers on its impact, user friendliness and, usefulness
The PREP system of nursing interventions , design ed to increase preparedness ( PR ) , enrichment ( E ) , and predictability ( P ) in families providing care to older people , was pilot tested for acceptability and preliminary effectiveness . Eleven family units were assigned to the PREP group and 11 to a st and ard home health control group .  The PREP group scored approximately one SD higher than the control group ( p < .05 ) on the Care Effectiveness Scale , indicating greater preparedness , enrichment , and predictability . Further , on a rating of overall usefulness , the PREP group rated their assistance from PREP nurses ( M = 9.75 ) as significantly higher ( p < .01 ) than the control group rated assistance from the home health nurse or physical therapist ( M = 6.57 ) . Although not statistically significant , mean hospital costs for the PREP group ( $ 2,775 ) were lower than for the control group ( $ 6,929 ) . Results provided support for a full intervention trial PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being ComputerLink was a computer support network for family caregivers of people with Alzheimer 's disease . In a 12-month experiment , 102 caregivers were r and omly assigned to an experimental group that had access to ComputerLink or to a  control group  that did not . This investigation examined whether caregivers in the experimental group had greater reductions in four types of care-related strain by the end of the 1-year study . ComputerLink reduced certain types of strain if caregivers also had larger informal support networks , were spouses , or did not live alone with their care receivers . More frequent use of the communication function was related to significantly reduced strain for caregivers who were initially more stressed and for non-spouse caregivers . Greater use of the information function was related to significantly lower strain among caregivers who lived alone with care receivers . Overall , ComputerLink appeared to be an effective tool for reducing strain for some caregivers 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 PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons . METHODS A 14-item checklist of characteristics associated with nutritional status was administered to a r and om sample of Medicare beneficiaries , aged 70 years and older , in New Engl and . Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status . Sensitivity and specificity values were review ed to define low , moderate , and high nutritional risk scores . RESULTS A revised checklist containing 10 yes/no items was adopted . Scores of 6 or more points defined persons at high nutritional risk . Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist . Among those in the high-risk group , 56 % perceived their health to be " fair " or " poor " and 38 % had dietary intakes below 75 % of the recommended dietary allowances for three or more nutrients . CONCLUSIONS The Nutrition Screening Initiative Checklist is a brief , easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems 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 Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions ( N = 32 ) for male family dementia caregivers . Male caregivers were r and omly assigned to either a basic education intervention ( ie , educational booklet and biweekly check-in telephone calls ) or a video intervention ( ie , set of 10 videos , an accompanying workbook , and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations ) . Results did not support the greater efficacy of the video condition in reducing psychosocial distress ( eg , negative affect , upset and annoyance following behavior problems ) or increasing positive affect or caregiving self-efficacy . There was , however , a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions . Potential reasons for the lack of differential treatment effects are discussed , along with implication s for recruitment of male dementia caregivers PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship PURPOSE The aim of this pilot feasibility study was to evaluate the effects of an innovative , Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease . DESIGN AND METHODS After receiving signed informed consent from each participant , we r and omly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group .  The intervention group received computers and training in order to access a password-protected Web site with links to information , e-mail , and threaded discussion . Unique to the Web site was a video-conferencing link that supported caregivers ' participation in a 10-session , manual-guided psychosocial support group , followed by 12 additional online sessions facilitated by a group member . Participants completed health-status and stress-response measures at baseline and 6-month follow-up . RESULTS Content analysis of archived video sessions showed ( a ) reliable adherence to the manual-guided support-group intervention and ( b ) online group discussion themes similar to those in face-to-face caregiver support groups . Analyses of stress-response outcome data showed significant between-group differences , with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group . IMPLICATION S Despite the limitations of this pilot study in terms of limited sample size and 54 % dropout of control participants at 6-month follow-up , the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease 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 There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity . Research ers have also suggested that the combination of loss , prolonged distress , the physical dem and s of caregiving , and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems , leading to increased mortality . OBJECTIVE To examine the relationship between caregiving dem and s among older spousal caregivers and 4-year all-cause mortality , controlling for sociodemographic factors , prevalent clinical disease , and sub clinical disease at baseline . DESIGN Prospect i ve population -based cohort study , from 1993 through 1998 with an average of 4.5 years of follow-up . SETTING Four US communities . PARTICIPANTS A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses . MAIN OUTCOME MEASURE Four-year mortality , based on level of caregiving : ( 1 ) spouse not disabled ; ( 2 ) spouse disabled and not helping ; ( 3 ) spouse disabled and helping with no strain reported ; or(4 ) spouse disabled and helping with mental or emotional strain  reported . RESULTS After 4 years of follow-up , 103 participants ( 12.6 % ) died . After adjusting for sociodemographic factors , prevalent disease , and sub clinical cardiovascular disease , participants who were providing care and experiencing caregiver strain had mortality risks that were 63 % higher than noncaregiving controls ( relative risk [ RR ] , 1.63 ; 95 % confidence interval [ CI ] , 1.00 - 2.65 ) . Participants who were providing care but not experiencing strain ( RR , 1.08 ; 95 % CI , 0.61 - 1.90 ) and those with a disabled spouse who were not providing care ( RR , 1.37 ; 95 % CI , 0.73 - 2.58 ) did not have elevated adjusted mortality rates relative to the noncaregiving controls . CONCLUSIONS Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality  among elderly spousal caregivers . Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls Objective : The need for information about the disease and coping with the consequences , as well as on available care and welfare services , is frequently unmet in people with dementia and their carers . To provide carers of community-dwelling people with dementia with tailored information , the DEMentia-specific dynamic interactive social chart ( DEM-DISC ) was developed . The impact on the daily life of people with dementia and their carers , the user friendliness and usefulness of a first prototype of DEM-DISC was evaluated . Method : DEM-DISC was tested among informal carers in a pretest – posttest control group design . Fourteen informal carers could access DEM-DISC at home during a two month period . Fourteen controls did not have access to DEM-DISC .  Data were collected by separate interviews with people with dementia and carers at pretest and posttest , by means of digital logging , short telephone interviews , and a bottleneck checklist during the intervention period . Results : People with dementia and informal carers reported more met and less unmet needs after DEM-DISC use and carers in the experimental group reported higher levels of competence than controls . Although they were not explicitly satisfied with this first prototype of DEM-DISC , carers found DEM-DISC easy to learn and relatively user friendly . Carers acknowledged the system 's benefits . Conclusion : The positive effects might be caused by the systematic and tailored individual way of information provisioning by DEM-DISC . It would be worthwhile to continue to develop DEM-DISC and to conduct r and omized trials on the impact on patients and carers as well as the impact on nursing home admission and healthcare expenditure
Background : Caring for a friend or relative with dementia can be burdensome and stressful , and puts carers at increased risk of physical and psychological problems .
A number of psychosocial interventions , some delivered by computer , have been developed to support carers .
This review evaluates the outcomes of computer-mediated interventions .