A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial Exploring the effectiveness of an Internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program Worksite-based internet multimedia program for family caregivers of persons with dementia. Psychosocial group intervention to enhance self-management skills of people with dementia and their caregivers: study protocol for a randomized controlled trial Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs 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 Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. The use of Internet technology for psychoeducation and support with dementia caregivers.
Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being Background After diagnosis of a dementing illness , patients and their spouses have many concerns related to the disease and their future . This often leads to poor psychological well-being and reduced health-related quality of life ( HRQoL ) of the family . Support for self-management skills has been proven to be an effective method to improve prognosis of asthma , heart failure and osteoarthritis . However , self-management interventions have not been studied in dementia . Therefore , our aim was to examine , in an objective -oriented group intervention , the efficacy of self-management support program ( SMP ) on the HRQoL of dementia patients and their spousal caregivers as well as on the sense of competence and psychological well-being of caregivers . Methods During the years 2011 to 12 , 160 dementia patients and their spouses will be recruited from memory clinics and r and omized into two arms : 80 patients for group-based SMP sessions  including topics selected by the participants , 80 patients will serve as controls in usual community care . Sessions may include topics on dementia , community services , active lifestyle and prevention for cognitive decline , spousal relationship , future planning and emotional well-being . The patients and spouses will have their separate group sessions ( ten participants per group ) once a week for eight weeks . Main outcome measures will be patients ’ HRQoL ( 15D ) and spousal caregivers ’ HRQoL ( R AND -36 ) , and sense of competence ( SCQ ) . Secondary measures will be caregivers ’ psychological well-being ( GHQ-12 ) and coping re sources , patients ’ depression , cognition and signs of frailty . Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two-year follow-up . Discussion This is a ‘ proof-of-concept ’ study to explore the efficacy of group support for self-management skills among dementia families . It will also provide data on cost-effectiveness of the intervention . Trial registration Background The number of people with dementia is rising rapidly as a consequence of the greying of the world population . There is an urgent need to develop cost effective approaches that meet the needs of people with dementia and their family caregivers . Depression , feelings of burden and caregiver stress are common and serious health problems in these family caregivers . Different kinds of interventions are developed to prevent or reduce the negative psychological consequences of caregiving . The use of internet interventions is still very limited , although they may be a cost effective way to support family caregivers in an earlier stage and diminish their psychological distress in the short and longer run . Methods / design A pragmatic r and omized controlled trial is design ed to evaluate the effectiveness and cost-effectiveness of  ‘ Mastery over Dementia ’ , an internet intervention for caregivers of people with dementia . The intervention aims at prevention and decrease of psychological distress , in particular depressive symptoms . The experimental condition consists of an internet course with 8 sessions and a booster session over a maximum period of 6 months guided by a psychologist . Caregivers in the comparison condition receive a minimal intervention . In addition to a pre and post measurement , an intermediate measurement will be conducted . In addition , there will be two follow-up measurements 3 and 6 months after post-treatment in the experimental group only . To study the effectiveness of the intervention , depressive symptoms are used as the primary outcome , whereas symptoms of anxiety , role overload and caregiver perceived stress are used as secondary outcomes . To study which caregivers profit most of the internet intervention , several variables that may modify the impact of the intervention are taken into account . Regarding the cost-effectiveness , an economic evaluation will be conducted from a societal perspective . Discussion This study will provide evidence about the effectiveness and cost-effectiveness of an internet intervention for caregivers . If both can be shown , this might set the stage for the development of a range of internet interventions in the field of caregiving for people with dementia . This is even more important because future generations of caregivers will be more familiar with the use of internet . Trial registration NTR-2051/ RCT 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 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 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 A large r and omized trial evaluated the benefits of online education , support , and self-care promotion  for caregivers of persons with dementia . Anecdotal reports from participants indicated enjoyment of the material s , convenient access from home , and support from professionals and other caregivers . A substantial number of screened caregivers experienced obstacles of access , cost , and time regarding use of technology . Telephone options are being explored , and future caregiving generations are expected to have increased exposure and willingness to use computer technology , such as the program described here
INTRODUCTION The elderly population is growing driven by the increase in life expectancy , which in turn entails an increase in the number of people with chronic diseases such as dementia .
The vast majority of people suffering from this illness is assisted by informal caregivers , who play a key role in fulfilling the patients ’ needs , promoting the possibility for people with dementia to live in their home environment .
The Internet as a support tool in psychoeducational programs can significantly improve accessibility of them , becoming a currently consoli date d interactive re source for the training of patients with acute and chronic diseases , and their caregivers .