Systematic reviews included in this broad synthesis

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Systematic review

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Best practices interventions to improve quality of care of people with dementia living at home.

Journal Patient education and counseling
Year 2014
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This article is included in 1 Broad synthesis 22 Broad syntheses (1 reference)

This article includes 22 Primary studies 22 Primary studies (22 references)

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OBJECTIVE: To identify effective interventions which improve quality of care for people with dementia (PwD) living at home. METHODS: MEDLINE-(via PubMed), CINAHL, PsycINFO and ISI Web of Science databases were searched. INCLUSION CRITERIA: (1) randomized controlled trials; (2) published in English-language, peer-reviewed journals between 1990 and 2012; (3) evaluated strategies to improve quality of care for PwD cared at home; and (4) participants older than 65. RESULTS: 23 studies met inclusion criteria. All the studies aimed to improve PwD quality of care and most of them focused on PwD caregivers. Psychoeducational programs are the most frequently assessed interventions and multicomponent interventions produced the most promising results. CONCLUSION: Due to the great variety of interventions describing specific samples and contexts, comparison of practice effectiveness is difficult. However, cognitive rehabilitation in PwD is effective when applied at an early stage of the disease. Case managers have demonstrated to reduce PwD institutionalization and the use of other community services. The studies were limited by sample heterogeneity, short follow-up or insufficiently detailed description. PRACTICE IMPLICATIONS: To improve PwD homecare, health professionals should educate and support caregivers. Before specific interventional recommendations can be made, further research addressing the limitations of current studies is needed.

Systematic review

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Multivariate models of subjective caregiver burden in dementia; a systematic review.

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Journal Ageing research reviews
Year 2014
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BACKGROUND: Burden in dementia caregivers is a complex and multidimensional construct. Several models of burden and other representations of burden like depression or mental health are described in literature. To clarify the state of science, we systematically reviewed complex models that include both patient and caregiver determinants of caregiver burden. OBJECTIVE: A review of determinant models of caregiver burden. DESIGN: Systematic review DATA SOURCES: Electronic databases PubMed, PsycInfo and EMbase were searched in December 2013. STUDY SELECTION AND ANALYSIS: Research studies with quantitative outcome measures of caregiver burden or burden-related concepts, including both patient and caregiver functional characteristics as determinants. We categorized the determinant variables in the models and calculated the percentages of proven determinants within each category. RESULTS: We found 32 studies with burden models and 24 depression and mental health models. Patient behavioral problems, caregiver coping and personality traits and competence are most consistent determinants of caregiver burden, depression and mental health. Behavioral problems are more significant than cognitive disorders or lack of self-care. Of all measured caregiver personality traits, neuroticism has the strongest impact on caregiver burden. Regarding caregiver competences, feeling competent or enjoying higher self-efficacy in general diminish caregiver burden and promote caregiver mental health.

Systematic review

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Do changes in coping style explain the effectiveness of interventions for psychological morbidity in family carers of people with dementia? A systematic review and meta-analysis.

Authors Li R , Cooper C , Austin A , Livingston G
Journal International psychogeriatrics / IPA
Year 2013
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This article is included in 1 Structured summary of systematic reviews 0 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 0 Broad syntheses (1 reference)

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BACKGROUND: Observational studies find that family carers of people with dementia who use more emotional support and acceptance-based coping, and less dysfunctional coping, are less depressed and anxious. We hypothesized that interventions effective in reducing psychological symptoms would increase emotional support and acceptance-based coping, or decrease dysfunctional coping. METHODS: We systematically reviewed randomized controlled trials published up to July 2011, of interventions for carers of people with dementia measuring coping and psychological morbidity. We rated study validity and reported findings. We conducted fixed-effect meta-analyses for interventions where possible. RESULTS: Eight of 433 papers identified by the search met inclusion criteria. All measured coping immediately after intervention. Two interventions significantly decreased depressive or anxiety symptoms: the smaller study found no change in dysfunctional coping. Neither measured emotional support and acceptance-based coping. Meta-analysis found that both group coping skills interventions alone (SMD = -0.39, 95% CI = -0.75 to -0.03, p = 0.04) and with behavioral activation (SMD = -0.26, 95% CI = -0.48 to -0.04, p = 0.02) significantly increased dysfunctional coping, while significantly reducing depressive symptoms. Positive coping (a mix of emotional and solution-focused strategies) increased (SMD = 0.28, 95% CI = 0.05-0.51, p = 0.02) with group coping skills interventions and behavioral activation. CONCLUSIONS: Contrary to our hypothesis, dysfunctional coping increased when carer depressive symptoms improved. There was preliminary evidence that emotional support and acceptance-based coping increased, as positive coping increased although solution-focused coping alone did not. More research is needed to elucidate whether successful interventions work through changing coping strategies immediately and in the longer term.

Systematic review

Unclassified

Psychological interventions for carers of people with dementia: A systematic review of quantitative and qualitative evidence.

Journal Counselling & Psychotherapy Research
Year 2013
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Rationale: Carers of people with dementia experience significant levels of stress in their everyday role. TheNational Dementia Strategyin England identifies the key role that carers play in supporting people with dementia living at home, often to the detriment of their social, emotional and physical health.Aims: To add to the substantive knowledge-base by combining search criteria used by Pinquart and Sörensen (2006) and Gallagher-Thompson and Coon (2007) to update the literature on psychological interventions for carers of people with dementia published between 2005 and 2011.Method: Following the study inclusion criteria, comprehensive searches were conducted using the electronic databases Medline, PsycINFO, ERIC, and PubMed. Twenty studies were identified, graded and synthesised into the reported systematic review with both quantitative and qualitative studies included to maximise practice application.Results: Consistent with previous findings, three categories of psychological intervention were identified: (i) psychoeducational-skill building (n=8); (ii) psychotherapy-counselling (n=1); (iii) multicomponent (n=6). Our review also identified a fourth intervention category, (iv) technology-based (n=5). The majority of studies in the updated review examine the constructs of depression, burden, social support and well-being. The development of focused interventions for carers, whether individually tailored interventions or group interventions around a common issue, was significant for developing practice. Future studies across all categories should continue to embed supervision arrangements within their psychological intervention protocols.

Systematic review

Unclassified

Coping strategies and psychological morbidity in family carers of people with dementia: a systematic review and meta-analysis.

Journal Journal of affective disorders
Year 2012
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BACKGROUND: Carers for people with dementia experience high levels of anxiety and depression. Coping style has been associated with carer anxiety and depression. METHOD: We systematically reviewed studies examining the relationships between coping and anxiety or depression among carers of people with dementia. We rated study validity using standardised checklists. We calculated weighted mean correlations (WMC) for the relationships between coping and psychological morbidity, using random effects meta-analyses. RESULTS: We included 35 studies. Dysfunctional coping correlated with higher levels of anxiety (WMC=0.39, 95% CI 0.28-0.50; N=688) and depression (0.46, 0.36-0.56; N=1428) cross-sectionally, and with depression 6 and 12months later (0.32, 0.10-0.54; N=143). Emotional support and acceptance-based coping correlated with less anxiety (-0.22, 95% CI -0.26 to -0.18; N=628) and depression (-0.20, -0.28 to -0.11; N=848) cross-sectionally; and predicted anxiety and depression a year later in the only study to measure this. Solution-focused coping did not correlate significantly with psychological morbidity. LIMITATIONS: Just over a quarter of the identified studies provided extractable data for meta-analysis, including only two longitudinal studies. CONCLUSIONS: There is good evidence that using more dysfunctional, and less emotional support and acceptance-based coping styles are associated with more anxiety and depression cross-sectionally, and there is preliminary evidence from longitudinal studies that they predict this morbidity. Our findings would support the development of psychological interventions for carers that aim to modify coping style.

Systematic review

Unclassified

Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia.

Authors Brodaty H , Arasaratnam C
Journal The American journal of psychiatry
Year 2012
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This article is included in 2 Structured summaries of systematic reviews 0 Structured summaries of systematic reviews (2 references) 1 Broad synthesis 0 Broad syntheses (1 reference)

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OBJECTIVE: Behavioral and psychological symptoms are common in dementia, and they are especially stressful for family caregivers. Nonpharmacological (or psychosocial) interventions have been shown to be effective in managing behavioral and psychological symptoms, but mainly in institutional settings. The authors reviewed the effectiveness of community-based nonpharmacological interventions delivered through family caregivers. METHOD: Of 1,665 articles identified in a literature search, 23 included unique randomized or pseudorandomized nonpharmacological interventions with family caregivers and outcomes related to the frequency or severity of behavioral and psychological symptoms of dementia, caregiver reactions to these symptoms, or caregiver distress attributed to these symptoms. Studies were rated according to an evidence hierarchy for intervention research. RESULTS: Nonpharmacological interventions were effective in reducing behavioral and psychological symptoms, with an overall effect size of 0.34 (95% CI=0.20-0.48; z=4.87; p<0.01), as well as in ameliorating caregiver reactions to these behaviors, with an overall effect size of 0.15 (95% CI=0.04-0.26; z=2.76; p=0.006). CONCLUSIONS: Nonpharmacological interventions delivered by family caregivers have the potential to reduce the frequency and severity of behavioral and psychological symptoms of dementia, with effect sizes at least equaling those of pharmacotherapy, as well as to reduce caregivers' adverse reactions. The successful interventions identified included approximately nine to 12 sessions tailored to the needs of the person with dementia and the caregiver and were delivered individually in the home using multiple components over 3-6 months with periodic follow-up.

Systematic review

Unclassified

Systematic review of the effectiveness of non-pharmacological interventions to improve quality of life of people with dementia.

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Journal International psychogeriatrics / IPA
Year 2012
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This article is included in 1 Structured summary of systematic reviews 20 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 20 Broad syntheses (1 reference)

This article includes 20 Primary studies 20 Primary studies (20 references)

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BACKGROUND: People with dementia report lower quality of life, but we know little about what interventions might improve it. METHODS: We systematically reviewed 20 randomized controlled trials reporting the effectiveness of non-pharmacological interventions in improving quality of life or well-being of people with dementia meeting predetermined criteria. We rated study validity with a checklist. We contacted authors for additional data. We calculated standardized mean differences (SMD) and, for studies reporting similar interventions, pooled standardized effect sizes (SES). RESULTS: Pooled analyses found that family carer coping strategy-based interventions (four studies, which did not individually achieve significance; n = 420; SES 0.24 (range 0.03-0.45)) and combined patient activity and family carer coping interventions (two studies, not individually significant; n = 191; SES 0.84 (range 0.54-1.14)) might improve quality of life. In one high-quality study, a care management system improved quality of life of people with dementia living at home. Group Cognitive Stimulation Therapy (GCST) improved quality of life of people with dementia in care homes. CONCLUSION: Preliminary evidence indicated that coping strategy-based family carer therapy with or without a patient activity intervention improved quality of life of people with dementia living at home. GCST was the only effective intervention in a higher quality trial for those in care homes, but we did not find such evidence in the community. Few studies explored whether effects continued after the intervention stopped. Future research should explore the longer-term impact of interventions on, and devise strategies to increase, life quality of people with dementia living in care homes or at home without a family carer.

Systematic review

Unclassified

The problem with "problem behaviors": a systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad.

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Authors Ornstein K , Gaugler JE
Journal International psychogeriatrics / IPA
Year 2012
Links Pubmed DOI PubMed Central

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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BACKGROUND: Behavioral and psychological symptoms of dementia (BPSDs) are routinely cited as important predictors of caregiver burden and depression. Although BPSDs include a wide variety of patient behaviors, they are routinely grouped together as one construct to differentiate them from cognitive symptoms of dementia. Determining the specific BPSDs that result in increased depression and burden for caregivers may elucidate the stress process for caregivers and facilitate the development of effective interventions for caregivers. METHODS: We conducted a systematic review of English-language articles published from 1990 to 2010 to determine whether there are known symptoms or symptom clusters which exert undue negative impact on caregiver depression and burden. Additionally, we review systems used for classifying BSPD symptom clusters and determine whether there have been any mechanisms studied by which individual BPSD symptoms negatively affect caregivers. Finally, we examine how the role of timing of symptoms has been examined within the literature. RESULTS: Thirty-five original research articles examined the impact of an individual behavior symptom on caregiver burden or depression/depressive symptoms. The studies had no consistent system for categorizing symptoms. Although depression, aggression, and sleep disturbances were the most frequently identified patient symptoms to impact negatively on caregivers, a wide range of symptoms was associated with caregiver burden and depression. CONCLUSIONS: The evidence is not conclusive as to whether some symptoms are more important than others. The studies reviewed were largely exploratory relative to the differential impact of individual BPSDs and did not focus on testing causal mechanisms by which specific symptoms exert more impact on caregiver mental health than others. Future research may benefit from the re-conceptualization of BPSDs from the perspective of their impact on the caregiver to examine hypothesis-driven differences among BPSD symptom clusters.

Systematic review

Unclassified

Effect of Educational and Supportive Strategies on the Ability of Caregivers of People With Dementia to Maintain Participation in That Role.

Authors Thinnes A , Padilla R
Journal The American journal of occupational therapy : official publication of the American Occupational Therapy Association
Year 2011
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A systematic review of evidence of the effectiveness of educational and supportive strategies for enabling caregivers of people with Alzheimer's disease (AD) or related dementias to maintain participation in that role was conducted as part of the American Occupational Therapy Association's Evidence-Based Literature Review Project. Forty-three articles met inclusion criteria. Results suggest that interventions that jointly engage people with AD and their caregivers in education and training in the home setting are more successful than strategies that focus solely on people with AD. Greater carryover is noted when education and training are implemented at the time that the caregiver identifies concerns. Interventions should provide caregivers with problem solving, technical skills, support, simple home modification strategies, and referral to community resources. Interventions mediated by technology have a positive effect on the caregiver and are especially important for those who live in rural areas.

Systematic review

Unclassified

Coping and subjective burden in caregivers of older relatives: a quantitative systematic review.

Journal Journal of advanced nursing
Year 2011
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Aim. This article is a report on a review of the effect of coping strategies on subjective burden in informal caregivers of older adults. Background. Informal care has negative effects on caregivers' health, and subjective burden is one of these. It has been linked with other effects (e.g. anxiety and depression). Thus, greater prevention of subjective burden will mean increased prevention of these effects. To achieve this, identification of factors related to subjective burden is essential. Data sources. Electronic databases and manual searches of scientific journals. Review methods. A quantitative systematic review was conducted including: (a) original studies (b) that related caregiver subjective burden to coping strategies compatible with the classifications of Lazarus & Folkman or Moos et al. (c) in informal caregivers of older relatives. The searches ranged from the first year included in each database until January 2010. After quality appraisal, ten studies were included; these, care-recipients living at home and having cognitive impairment. Results. Four coping categories have been related to subjective burden: problem-focused, emotion-focused, approach and avoidance. Interesting results were only found for avoidance coping (positive association). In other categories, results were heterogeneous (problem-focused and approach) or we found few valid studies (emotion-focused). Conclusion. We found some evidence for a positive association between avoidance coping and subjective burden in home caregivers of older relatives with cognitive impairment. It is probable that avoidance coping either mediates or moderates the relationship between subjective burden and its outcomes, or that avoidance coping precedes subjective burden, which in turn leads to the coping outcomes. In both situations, avoidance coping is an ineffective coping.