A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. Association between low functional health literacy and mortality in older adults: longitudinal cohort study Worksite-based internet multimedia program for family caregivers of persons with dementia. Helping carers to care--the 10/66 dementia research group's randomized control trial of a caregiver intervention in Russia. Predictors of complicated grief among dementia caregivers: a prospective study of bereavement. The effects of family education program on the caregiver burden of families of elderly with dementia disorders Caregivers’ understanding of dementia predicts patients’ comfort at death: a prospective observational study A quasi-experimental design trial exploring the effect of a partnership intervention on family and staff well-being in long-term dementia care Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study. "Learning to become a family caregiver" efficacy of an intervention program for caregivers following diagnosis of dementia in a relative. Preparedness for the death of a loved one and mental health in bereaved caregivers of patients with dementia: findings from the REACH study. Caregiver attribution and resentment in dementia care Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru. Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. Effectiveness of Cognitive/Behavioral Small Group Intervention for Reduction of Depression and Stress in Non-Hispanic White and Hispanic/Latino Women Dementia Family Caregivers: Outcomes and Mediators of Change
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 ) 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 Objective To investigate the association between low functional health literacy ( ability to read and underst and basic health related information ) and mortality  in older adults . Design Population based longitudinal cohort study based on a stratified r and om sample of households . Setting Engl and . Participants 7857 adults aged 52 or more who participated in the second wave ( 2004 - 5 ) of the English Longitudinal Study of Ageing and survived more than 12 months after interview . Participants completed a brief four item test of functional health literacy  , which assessed underst and ing of written instructions for taking an aspirin tablet . Main outcome measure Time to death , based on all cause mortality through October 2009 . Results Health literacy was categorised as high ( maximum score , 67.2 % ) , medium ( one error , 20.3 % ) , or low ( more than one error , 12.5 % ) . During follow-up ( mean 5.3 years ) 621 deaths occurred : 321 ( 6.1 % ) in the high health literacy category , 143 ( 9.0 % ) in the medium category , and 157 ( 16.0 % ) in the low category . After adjusting for personal characteristics , socioeconomic position , baseline health , and health behaviours , the hazard ratio for all cause mortality for participants with low health literacy was 1.40 ( 95 % confidence interval 1.15 to 1.72 ) and with medium health literacy was 1.15 ( 0.94 to 1.41 ) compared with participants with high health literacy . Further adjustment for cognitive ability reduced the hazard ratio for low health literacy to 1.26 ( 1.02 to 1.55 ) . Conclusions A third of older adults in Engl and have difficulties reading and underst and ing basic health related written information . Poorer underst and ing is associated with higher mortality . The limited health literacy capabilities within this population have implication s for the design and delivery of health related services for older adults in Engl and 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 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 OBJECTIVE Most family caregivers adapt well to the death of their care recipient relative ; however , a sizable minority continues to experience postdeath psychiatric morbidity . The purpose of this study was to better underst and why some caregivers manifest clinical levels of complicated grief postdeath . This is the first study to prospect ively assess predictors of complicated grief among family caregivers of patients with dementia who experience the death of their care recipient . METHOD The sample of bereaved caregivers is drawn from a larger study of 1,222 family caregivers providing in-home care to their relative with dementia . In-home assessment s of caregivers and patients were carried out at baseline and six-month intervals for a total of 18 months . This article is based on the 217 caregivers who experienced the death of their care recipient in the course of the study . Three logistic regression models are tested to identify pre- and postbereavement predictors of complicated grief , including sociodemographic factors , characteristics of the caregiving experience , including participation in a caregiver intervention , other psychiatric morbidities , and medication use . RESULTS Twenty percent of dementia caregivers evidence d complicated grief along with high levels of depressive symptomatology postdeath . Controlling for sociodemographic factors , caregivers who had high levels of preloss depressive symptoms and burden , reported positive features of the caregiving experience , and were caring for a more cognitively impaired patient were more likely to report clinical levels of complicated grief postloss . In addition , caregivers who were enrolled in a psychosocial caregiver intervention design ed to reduce depression and burden reported lower levels of complicated grief . CONCLUSION This study identifies predictors of complicated grief for which interventions could be developed to not only ease caregiver distress , but also serve as preventive interventions for bereavement . Reducing the burden of active caregiving , treating depression before the death of the loved one and providing supportive psychosocial and skills training caregiver interventions can prevent the emergence of postdeath psychiatric morbidity BACKGROUND : Family caregivers are an essential part of health care services for elderly with dementia disorders , because of providing care for such patients is a big burden for their families . This study aim ed to assess the effects of family education program in reducing the burden of families of elderly with dementia . METHODS : This was a clinical trial , in which 50 family caregivers of the elderly patients with dementia who had referred to two referral centers for dementia in the city of Isfahan were selected with convenient sampling method and were r and omized to experimental and control groups . The experimental group participated in a family education program but the control group did not . Data were collected by Zarit ’s caregiver burden scale completed by caregivers of both groups before , right after , and one month after family education program . Also , Mini-Mental Status Examination was conducted for elderly before the program . Finally , data were analyzed in SPSS software . RESULTS : Caregivers ’ burden was gradually increased in the controls , but decreased in the experimental group during the study . The means of caregivers ’ burden before , right after , and one month after family education program were 42 , 35.44 , and 33.56 in the experimental group , respectively , while they were 43.28 , 46.8 and 50.64 in the control group , respectively . Also , there was a significant difference between caregivers ’ burden of the two groups immediately after intervention , but one month after intervention no significant difference was seen between the two groups . CONCLUSIONS : Since conducting this program could reduce caregivers ’ burden of families of elderly with dementia , developing such programs and evaluating them within research projects are recommended Background Patients with dementia frequently do not receive adequate palliative care which may relate to poor underst and ing of the natural course of dementia . We hypothesized that underst and ing that dementia is a progressive and terminal disease is fundamental to a focus on comfort in dementia , and examined how family and professional caregivers ’ underst and ing of the nature of the disease was associated with patients ’ comfort during the dying process . Methods We enrolled 372 nursing home patients from 28 facilities in The Netherl and s in a prospect i ve observational study ( 2007 to 2010 ) . We studied both the families and the physicians ( 73 ) of 161 patients . Underst and ing referred to families ’ comprehension of complications , prognosis , having been counseled on these , and perception of dementia as “ a disease you can die from ” ( 5-point agreement scale ) at baseline . Physicians reported on this perception , prognosis and having counseled on this . Staff-assessed comfort with the End-of-Life in Dementia - Comfort Assessment in Dying ( EOLD-CAD ) scale . Associations between underst and ing and comfort were assessed with generalized estimating equations , structural equation modeling , and mediator analyses . Results A family ’s perception of dementia as “ a disease you can die from ” predicted higher patient comfort during the dying process ( adjusted coefficient −0.8 , 95 % confidence interval ( CI ) : −1.5 ; -0.06 point increment disagreement ) . Family and physician combined perceptions ( −0.9 , CI : −1.5 ; -0.2 ; 9-point scale ) were also predictive , including in less advanced dementia . Forty-three percent of the families perceived dementia as a disease you can die from ( agreed completely , partly ) ; 94 % of physicians did . The association between combined perception and higher comfort was mediated by the families ’ reporting of a good relationship with the patient and physicians ’ perception that good care was provided in the last week . Conclusions Awareness of the terminal nature of dementia may improve patient comfort at the end of life . Educating families on the nature of dementia may be an important part of advance care planning Objectives : This study sought to explore the effect of the family involvement in care ( FIC ) intervention on  family and staff well-being over a nine-month period in a long-term care ( LTC ) facility providing dementia care . Method : A quasi-experimental design with r and omised allocation of two LTC sites but not the participants was employed . Family caregivers ( n = 57 ) of residents with dementia and staff ( n = 59 ) from two LTC facilities in Queensl and , Australia , were recruited . Participants were assessed once pre-intervention and three times post-intervention for knowledge , stress and satisfaction outcomes . Between-group and within-group effects were analysed using ANOVAs at < 0.05 level of significance . Pre- and post-intervention interviews from a purposive sample of family caregivers were also conducted to enhance underst and ing of FIC benefits . Results : Beneficial intervention effects associated with family caregivers ’ knowledge of dementia were found ( p < 0.001 ) . Negative intervention effects were also found for family satisfaction outcomes in relation to staff consideration of their relatives and management effectiveness ( p < 0.05 ) . In addition , staff well-being and job satisfaction were found to be negatively affected by their perceived inappropriate behaviour of residents with dementia ( p < 0.05 ) . Conclusion : Participation in the FIC intervention improved family caregiver knowledge . The major barrier to the success of the partnership intervention in achieving beneficial long-term psychosocial effects for family and staff caregivers was lack of re sources and leadership required to support collaboration between family and staff , mainly due to environment and structural changes . This study contributes to our underst and ing of the importance of partnerships in promoting family involvement in dementia care OBJECTIVE Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress . However , few studies evaluate treatments for them . This study evaluated the efficacy of in-home intervention , based on cognitive behavior therapy principles , to relieve stress and depression in female Chinese American caregivers ( CGs ) . METHODS Fifty-five CGs who met inclusion criteria were r and omly assigned to a telephone support condition ( TSC ) or to an in-home behavioral management program ( IHBMP ) for 4 months . In the TSC , biweekly calls were made and relevant material was mailed . In the IHBMP , specific psychological skills were taught to deal with caregiving stress . CGs were assessed before and after treatment . Outcome measures evaluated overall perceived stress , caregiving-specific stress , and depressive symptoms . RESULTS CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC . There was no difference in overall stress . CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP , but showed little improvement in the TSC . CGs with higher self-efficacy benefited from both treatments . CONCLUSION This intervention is promising and warrants replication in future studies . Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement PURPOSE The purpose of this experimental study was to test the efficacy of a psychoeducational individual program conceived to facilitate transition to the caregiver role following diagnosis of Alzheimer disease in a relative . DESIGN AND METHODS Caregivers were recruited in memory clinics and r and omized to an experimental group ( n = 62 ) or a control group ( n = 49 ) receiving usual care .  Eligible participants - primary caregivers of a relative diagnosed with Alzheimer in the past 9 months-were assessed blindly before r and omization , at the end of the program ( post-test ) , and 3 months later ( follow-up ) on different outcomes associated with healthy role transition . RESULTS The analyses indicated that at post-test and follow-up , caregivers in the experimental group were more confident in dealing with caregiving situations , perceived themselves to be better prepared to provide care and more efficacious in their caregiver role , were better able to plan for the future care needs of their relative , had better knowledge of available services , and made more frequent use of the coping strategies of problem solving and reframing . The program had no significant effect on use of stress-management strategies , perceived informal support and family conflicts . IMPLICATION S This program underscores that a proactive intervention approach from the onset of the care trajectory is key to fostering caregiver adaptation to the new challenges they must meet BACKGROUND Although it has been suggested that family and friends who are prepared for the death of a loved one have less distress , the relationship between preparedness and bereavement mental health is inconclusive . OBJECTIVES To determine the relationship between preparedness for the death and mental health in bereaved caregivers of dementia patients and explore predictors of preparedness . DESIGN A prospect i ve study of family caregivers of persons with dementia . St and ardized assessment instruments and structured questions were used to collect data at study entry and at 6 , 12 , and 18 months . Multiple caregiving-related variables were collected . Bereaved caregivers reported whether they were " not at all " prepared or prepared for the death of their loved one . SUBJECTS Two hundred twenty-two bereaved caregivers RESULTS Twenty-three percent of caregivers were not prepared for the death . These caregivers had more depression , anxiety , and complicated grief symptoms .  Black caregivers , caregivers with less education , those with less income , and those with more depressive symptoms prior to the death were more likely to perceive themselves as " not at all " prepared . In contrast , the amount of pain the care recipient was in prior to death was positively associated with preparedness . CONCLUSIONS Despite providing high-intensity care , often for years , many bereaved caregivers perceived themselves as unprepared for the death . These caregivers had more depression , anxiety , and complicated grief symptoms . Future work should be directed to confirming these findings and determining how best to intervene with high-risk caregivers The caregivers of 37 patients with a dementing illness completed rating scales regarding the frequency and severity of their care recipient 's general behavioral disturbance and manipulative behaviors , as well as their own resentment and depression . Caregivers were r and omized to a four-week psychoeducational group intervention or control group to investigate the effect of dementia caregiving education on the caregiving experience . Findings indicated that , while care recipient behavioral disturbance was correlated with caregiver resentment and depression , the primary relationship was between behaviors perceived by the caregiver as manipulative or willful and caregiver resentment and depression . We found no significant differences in caregiver attribution , resentment , or depression between the caregivers who participated in the group session and those in the control group . The study supports the existence of resentment among dementia caregivers , and an important relationship between caregiving outcomes and attributions made by caregivers regarding their care recipients ' actions . These results are discussed in relation to existing research on  caregiver distress and intervention OBJECTIVE There is a need , in the absence of formal services , to design interventions aim ed at improving the lives of people with dementia and their families . This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima , Peru . METHOD DESIGN / PARTICIPANTS a r and omized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial ( n = 29 ) or six months later ( n = 29 ) . The intervention consisted of three modules : 1 ) assessment ( one session ) ; 2 ) basic education about dementia ( two sessions ) ; and 3 ) training regarding specific problem behaviors ( two sessions ) . MAIN OUTCOME MEASURES Caregivers and patients with dementia were assessed at baseline and after six months . For caregivers , the measures included strain ( Zarit Burden Interview ) , psychological distress ( SRQ-20 ) , and quality of life ( WHOQOL-BREF ) . Dementia patients completed scales assessing behavioral and psychological symptoms ( NPI-Q ) and quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls . No group differences were found in respect to the caregivers ' psychological distress and to quality of life in both caregivers and patients . CONCLUSION The 10/66 intervention seems to be as effective as similar interventions used in more developed countries 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 This study enrolled 184 middle-aged and older women ( 95 Non-Hispanic White and 89 Hispanic/Latino ) who provided in-home h and s-on care to an elderly relative with Alzheimer ’s disease or another form of dementia . Within ethnic group they were r and omly assigned to either a CBT-based small group intervention program called “ Coping with Caregiving ” ( CWC ) that taught a variety of cognitive and behavioral skills to reduce stress and depression , or to a minimal telephone based control condition ( TSC ) . Intervention lasted about 4 months ; one post-treatment assessment was completed 6 months after baseline by interviewers blind to the intervention condition . Interviews and interventions were conducted in English or Spanish by trained staff . Results indicated that those in the CWC ( regardless of ethnicity ) showed greater improvement from pre to post intervention than those in the TSC on measures of depressive symptoms , overall life stress , and caregiving-specific stress . In order to investigate if these changes may have been related to one proposed mechanism of change in CBT ( skill utilization ) , a new measure was constructed . Change in frequency of use and perceived helpfulness of adaptive coping skills were assessed in all caregivers . Results indicated that caregivers in CWC reported greater frequency of use , and greater perceived helpfulness , of these skills at post intervention compared to caregivers in the TSC . Improvement measured by dependent measures was correlated with an increase in these indices for those in the CWC . Tests for mediation suggest that effective skill utilization may mediate the effect of treatment on outcome . Implication s of these findings are discussed and recommendations provided for future research
BACKGROUND AND AIM The European Association of Palliative Care recommends that family carers need education on the progression of dementia .
This systematic review aim ed to explore whether interventions incorporating education regarding the progressive nature of dementia increased carers ' underst and ing of dementia and improved mental health and burden .