Aim To investigate the effects of the practice of yoga in combination with compassion meditation on the quality of life, attention, vitality and self-compassion of family caregivers of patients with Alzheimer's disease. Methods A total of 46 volunteers were randomly allocated to two groups, the yoga and compassion meditation program group ( n = 25), and the control group ( CG) that received no treatment ( n = 21). The program lasted 8 weeks, and comprised three yoga and meditation practices per week, with each session lasting 1 h and 15 min. Quality of life, attention, vitality, and self-compassion scores were measured pre- and postintervention. Results The yoga and compassion meditation program group showed statistically significant improvements ( P < 0.05) on quality of life, attention, vitality and self-compassion scores as compared with the control group, which showed no statistical significant differences at the postintervention time-point. Conclusions The findings of the present study suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of family caregivers of Alzheimer's disease patients. Geriatr Gerontol Int 2017; 17: 85-91.
BACKGROUND: Family members caring for persons with dementia are subject to multiple types of stress. Psychosocial help is recommended to lighten the emotional burden of care and can be of use in stabilizing the home-care situation. In this study conducted in rural areas in Germany, we tested whether volunteers with a special qualification for the assistance of families caring for dementia patients can support family members more effectively than conventional care companions.
METHODS: In a randomized, controlled trial, 63 family members caring for persons with dementia were aided by specially qualified family companions (experimental intervention) or by conventional care companions (control intervention). The family members' quality of life was the primary endpoint and was evaluated at the end of the study in an intention-to-treat (ITT) analysis with t-tests. In an additional per-protocol (PP) analysis, differences that arose between groups at the outset of the study were accounted for. Secondary endpoints included reduced stress and better integration into the support system.
RESULTS: The ITT analysis revealed no differences between groups in healthrelated quality of life on either the emotional or the somatic scale. The PP analysis, however, showed that the experimental intervention improved the emotional health-related quality of life of the patients' family members compared to the control group. The effect strength was intermediate (d = 0.57; p = 0.047).
CONCLUSION: The difference between the findings of the PP and ITT analyses may be explained in part by the different distribution of severity of dementia in the two groups (experimental and control).
<b>OBJECTIVES: </b>Early diagnosis, initiation of Alzheimer's disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health-related quality of life (HRQoL) in persons with AD and caregivers.<b>METHODS: </b>Kuopio ALSOVA study, a prospective, randomized intervention study with a 3-year follow-up, was carried out at memory clinics. Home-dwelling persons with very mild or mild AD (n = 236) and AD-targeted therapy and their family caregivers (n = 236) were randomized to the intervention or control group (1:2). Psychosocial intervention including education, counseling, and social support was given during the first 2 years (16 days). The primary outcome was the cumulative risk (controlled for death) of institutionalization over 36 months. Secondary outcomes were adjusted mean changes from baseline in disease severity, cognition, daily activities, behavior, and HRQoL for persons with AD; and change in psychological distress, depression, and HRQoL for caregivers.<b>RESULTS: </b>No differences were found in nursing home placement after the 36-month follow-up between intervention and control groups. No beneficial effects of the intervention were found on the secondary outcomes.<b>CONCLUSIONS: </b>The psychosocial intervention did not delay nursing home placement in persons with AD and had no effect on patient well-being, disease progression, or AD-related symptoms or caregiver well-being. Instead of automatically providing psychosocial intervention courses, individualized support programs may be more effective.
The use of telemedicine is becoming increasingly popular in assisting with the home management of People with Dementia (PwD) by offering services to the carers that may enhance their ability to care for their relative for longer. A computerized platform, ALADDIN, was evaluated in its usefulness to reduce carer burden and distress and to improve their quality of life, in an attempt to delay institutionalization of PwD. ALADDIN offers educational material about dementia to carers and provides the opportunity to contact other carers and clinicians. ALADDIN also facilitates remote monitoring of the PwD and their carers by the clinicians to enable speedy delivery of appropriate intervention. The ALADDIN platform was piloted at three European sites, and used by thirty carers of PwD living in the community (platform group). The platform group and a control group of thirty PwD and their carers were assessed at baseline, 3 months, and 6 months. The results showed a significant improvement in the quality of life of the carers in the platform group, with some reduction in carer burden and distress. The platform was useful in monitoring the patients and facilitating contact with other professionals. Access to and use of the ALADDIN platform was rated positively by carers and clinicians. The ALADDIN platform's usefulness and applicability for prolonging the home management of PwD are discussed.
There is increasing need for early, pro-active programs that can delay dementia diagnosis and enhance well-being of individuals with mild cognitive impairment (MCI) and their care-partners (i.e., care-dyads). This randomized controlled trial evaluated the efficacy of a combined cognitive rehabilitation and multi-family group treatment (CR-MFG) that was designed to facilitate adoption of newly learned cognitive strategies into the care-dyads everyday lives. Analyzed data included 23 care-dyads who participated in CR-MFG treatment and 23 care-dyads in standard care (SC). The 3-month intervention consisted of individual joining sessions, an educational workshop, and 20/twice weekly multifamily memory strategy training and problem-solving sessions. Everyday functioning, memory, and psychological functioning (i.e., quality-of-life, depression, coping) were assessed. The CR-MFG intervention was associated with significant post-test group differences and improved post-test performances by the MCI participants on performance-based measures of everyday functioning and neuropsychological tests of memory. There was also some suggestion that CR-MFG care-partners perceived positive change in the everyday functioning of the MCI participants. In contrast, no post-test group differences were found for either care-dyad member on the self-report psychological measures; care-partners in the treatment group did self-report improved coping behaviors at post-test. These 3-month results are preliminary but suggestive that CR-MFG may produce modest, practical everyday functional benefits for persons with MCI.
OBJECTIVES: To determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone. Also to document direct and indirect costs, and establish incremental cost-effectiveness.
DESIGN: The Befriending and Costs of Caring (BECCA) trial was a cost-effectiveness randomised controlled trial. Data on well-being and resource use were collected through interviews with participants at baseline and at 6, 15 and 24 months.
SETTING: This research was carried out in the English counties of Norfolk and Suffolk, and the London Borough of Havering. It was a community-based study.
PARTICIPANTS: Participants were family carers who were cohabiting with, or providing at least 20 hours' care per week for, a community-dwelling relative with a primary progressive dementia.
INTERVENTIONS: The intervention was 'access to a befriender facilitator' (BF). BFs, based with charitable/voluntary-sector organisations, were responsible for local befriending schemes, including recruitment, screening, training and ongoing support of befriending volunteers, and for matching carers with befrienders. The role of befrienders was to provide emotional support for carers. The target duration for befriending relationships was 6 months or more.
MAIN OUTCOME MEASURES: Depression was measured by the Hospital Anxiety and Depression Scale (HADS) at 15 months postrandomisation. The health-related quality of life scale EQ-5D (EuroQol 5 Dimensions) was used to derive utilities for the calculation of quality-adjusted life-years (QALYs).
RESULTS: A total of 236 carers were randomised into the trial (116 intervention; 120 control). At final follow-up, 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds, with only a 42.2% probability of being below 30,000 pounds per QALY gained. Where care-recipient QALYs were included, mean incremental cost per incremental QALY gained was 26,848 pounds, with a 51.4% probability of being below 30,000 pounds per QALY gained. Only 60 carers (52%) took up the offer of being matched with a trained lay befriender, and of these only 37 (32%) were befriended for 6 months or more. A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance (95% CI -0.09 to 2.84).
CONCLUSIONS: 'Access to a befriender facilitator' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia, although there is a suggestion of cost-effectiveness for the care dyad (carer and care recipient). In common with many services for carers of people with dementia, uptake of befriending services was not high. However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls (95% CI -0.09 to 2.84). While providing only weak evidence of any beneficial effect, further research into befriending interventions for carers is warranted.
<b>BACKGROUND: </b>Cure of dementia is not possible, but quality of life of patients and caregivers can be improved. Our aim is to investigate effects of community occupational therapy on dementia patients' and caregivers' quality of life, mood, and health status and caregivers' sense of control over life.<b>METHODS: </b>Community-dwelling patients aged 65 years or older, with mild-to-moderate dementia, and their informal caregivers (n = 135 couples of patients with their caregivers) were randomly assigned to 10 sessions of occupational therapy over 5 weeks or no intervention. Cognitive and behavioral interventions were used to train patients in the use of aids to compensate for cognitive decline and caregivers in coping behaviors and supervision. Outcomes, measured at baseline, 6 weeks, and 12 weeks, were patients' and caregivers' quality of life (Dementia Quality of Life Instrument, Dqol), patients' mood (Cornell Scale for Depression, CSD), caregivers' mood (Center for Epidemiologic Studies Depression Scale, CES-D), patients' and caregivers' health status (General Health Questionnaire, GHQ-12), and caregivers' sense of control over life (Mastery Scale).<b>RESULTS: </b>Improvement on patients' Dqol overall (0.8; 95% confidence interval [CI], 0.6-.1, effect size 1.3) and caregivers' Dqol overall (0.7; 95% CI, 0.5-.9, effect size 1.2) was significantly better in the intervention group as compared to controls. Scores on other outcome measures also improved significantly. This improvement was still significant at 12 weeks.<b>CONCLUSION: </b>Community occupational therapy should be advocated both for dementia patients and their caregivers, because it improves their mood, quality of life, and health status and caregivers' sense of control over life. Effects were still present at follow-up.
The use of telemedicine is becoming increasingly popular in assisting with the home management of People with Dementia (PwD) by offering services to the carers that may enhance their ability to care for their relative for longer. A computerized platform, ALADDIN, was evaluated in its usefulness to reduce carer burden and distress and to improve their quality of life, in an attempt to delay institutionalization of PwD. ALADDIN offers educational material about dementia to carers and provides the opportunity to contact other carers and clinicians. ALADDIN also facilitates remote monitoring of the PwD and their carers by the clinicians to enable speedy delivery of appropriate intervention. The ALADDIN platform was piloted at three European sites, and used by thirty carers of PwD living in the community (platform group). The platform group and a control group of thirty PwD and their carers were assessed at baseline, 3 months, and 6 months. The results showed a significant improvement in the quality of life of the carers in the platform group, with some reduction in carer burden and distress. The platform was useful in monitoring the patients and facilitating contact with other professionals. Access to and use of the ALADDIN platform was rated positively by carers and clinicians. The ALADDIN platform's usefulness and applicability for prolonging the home management of PwD are discussed.
BACKGROUND: Family caregivers of dementia patients are at increased risk of developing depression or anxiety. A multi-component program designed 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 randomized 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 randomized 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 (randomization-by-time interaction coefficient = -1.40; 95% CI -3.91 to 1.10) or anxiety symptoms (randomization-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 purposes or targeted towards subgroups of caregivers.
TRIAL REGISTRATION: Controlled-Trials.com ISRCTN90163486.
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 randomly 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 materials 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.
<b>BACKGROUND: </b>Adherence to dementia guidelines is poor despite evidence that some guideline recommendations can improve symptoms and delay institutionalization of patients.<b>OBJECTIVE: </b>To test the effectiveness of a dementia guideline-based disease management program on quality of care and outcomes for patients with dementia.<b>DESIGN: </b>Clinic-level, cluster randomized, controlled trial.<b>SETTING: </b>3 health care organizations collaborating with 3 community agencies in southern California.<b>Participants: </b>18 primary care clinics and 408 patients with dementia age 65 years or older paired with 408 informal caregivers.<b>Intervention: </b>Disease management program led by care managers and provided to 238 patient-caregiver pairs at 9 intervention clinics for more than 12 months.<b>Measurements: </b>Adherence to 23 guideline recommendations (primary outcome) and receipt of community resources and patient and caregiver health and quality-of-care measures (secondary outcomes).<b>RESULTS: </b>The mean percentage of per-patient guideline recommendations to which care was adherent was significantly higher in the intervention group than in the usual care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI, 25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher care quality on 21 of 23 guidelines (P < or = 0.013 for all), and higher proportions received community agency assistance (P < or = 0.03) than those who received usual care. Patient health-related quality of life, overall quality of patient care, caregiving quality, social support, and level of unmet caregiving assistance needs were better for participants in the intervention group than for those in the usual care group (P < 0.05 for all). Caregiver health-related quality of life did not differ between the 2 groups.<b>Limitations: </b>Participants were well-educated, were predominantly white, had a usual source of care, and were not institutionalized. Generalizability to other patients and geographic regions is unknown. Also, costs of a care management program under fee-for-service reimbursement may impede adoption.<b>CONCLUSIONS: </b>A dementia guideline-based disease management program led to substantial improvements in quality of care for patients with dementia. Current Controlled Trials identifier: ISRCTN72577751.
PURPOSE: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and METHODS: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying oneself as principal CG of a dependent relative with dementia or any other disability, and having performed this task for at least 6 months. CGs were randomized to an intervention group (cognitive-behavioral treatment for managing dysfunctional thoughts about caregiving and training in self-help techniques) or to a control group (care as usual). CG mental health (General Health Questionnaire [GHQ-12]), dysfunctional thoughts about caregiving, quality of life, and burden were measured. RESULTS: The intervention group showed improvement in mental health: A mean reduction in GHQ-12 score of −3.33 points was recorded in the intervention group vs. the control group (95% CI: −5.95 to −0.70; p = .01; Cohen d = 0.55). Improvement was also recorded in dysfunctional thoughts about caregiving: (−5.84; 95% CI: −10.60 to −1.09; p = .01; Cohen d = 0.62). Among the CGs that completed the initial and final assessments, a mean of 4.77 (SD 2.68) attended a maximum of 8 sessions. Men attended more often (5.00 sessions with SD 2.68) than women (4.70 sessions with SD 2.45; p < .001). Implications: Psychological group intervention in the context of PHC, aimed at the CGs of dependent persons with dementia and other disabilities, has improved mental health condition in CGs.
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 populations. Methods. A randomized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong. They were randomly selected from a dementia client list and then randomly 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 socioeconomic backgrounds and across cultures.
BACKGROUND: Family members caring for persons with dementia are subject to multiple types of stress. Psychosocial help is recommended to lighten the emotional burden of care and can be of use in stabilizing the home-care situation. In this study conducted in rural areas in Germany, we tested whether volunteers with a special qualification for the assistance of families caring for dementia patients can support family members more effectively than conventional care companions.
METHODS: In a randomized, controlled trial, 63 family members caring for persons with dementia were aided by specially qualified family companions (experimental intervention) or by conventional care companions (control intervention). The family members' quality of life was the primary endpoint and was evaluated at the end of the study in an intention-to-treat (ITT) analysis with t-tests. In an additional per-protocol (PP) analysis, differences that arose between groups at the outset of the study were accounted for. Secondary endpoints included reduced stress and better integration into the support system.
RESULTS: The ITT analysis revealed no differences between groups in healthrelated quality of life on either the emotional or the somatic scale. The PP analysis, however, showed that the experimental intervention improved the emotional health-related quality of life of the patients' family members compared to the control group. The effect strength was intermediate (d = 0.57; p = 0.047).
CONCLUSION: The difference between the findings of the PP and ITT analyses may be explained in part by the different distribution of severity of dementia in the two groups (experimental and control).
