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Evaluation of the Reitman Centre CARERS program for supporting dementia family caregivers: a pre–post intervention study

Published online by Cambridge University Press:  18 January 2021

Joel Sadavoy*
Affiliation:
Department of Psychiatry, Sinai Health, University of Toronto, Toronto, Canada
Sima Sajedinejad
Affiliation:
Department of Psychiatry, Sinai Health, University of Toronto, Toronto, Canada
Mary Chiu
Affiliation:
Department of Research & Academics, Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
*
Correspondence should be addressed to: Joel Sadavoy, 60 Murray St, Suite L1-012, Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 3L9 Canada. Phone: +416 258 7054; Assistant: 416 586 4800, ext: 5192; Fax: +416 586 3231. Email: Joel.Sadavoy@sinaihealth.ca.

Abstract

Objectives:

While family caregivers (CGs) of persons with dementia are cost-effective for the health system, this form of caregiving leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among CGs. The study goal was to determine the effect of the Reitman Centre CARERS program on key outcomes in family CGs of people with dementia. The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills training intervention based on integrated problem-solving techniques (PST), simulation learning, and group psychotherapy designed to address each CGs’ unique situation.

Design:

A quasi-experimental, non-randomized, pre–post evaluation, multiple groups, multisite trial.

Setting:

Multisite group intervention provided in community agencies and hospital-based locations.

Participants:

Spousal or adult child family CGs (n = 264) living in the community and providing care to community-dwelling family members with dementia.

Measurement:

CGs were assessed for depression (CES-D); stress (PSS); burden (12-item SZBI); role overload, mastery, caregiving competence, and role captivity (Perlin scales), coping (CISS – Coping Inventory for Stressful Situations), CG reactions to CR’s memory and behavioral symptoms (RMBPC). Care recipients (CRs) were assessed on basic and complex activities of daily living (Katz and Lawton). Paired t-tests and Wilcoxon signed-rank test were used for statistical analysis of both the whole group and a more compromised subgroup of CGs.

Results:

For the group as a whole, CGs showed significant positive change on post-intervention outcome measures of stress, depression, burden, competence, role captivity, overload, mastery, coping, and reaction to memory issues. The intervention showed especially robust effect sizes (ES) in more compromised CGs. These positive outcomes emerged despite a significant measured deterioration in CRs’ function.

Conclusion:

The CARERS program may be an effective multicomponent intervention to improve the well-being, functioning, and coping skills of dementia CGs.

Type
Original Research Article
Copyright
© International Psychogeriatric Association 2021

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References

Alzheimer’s Association. (2008). 2008 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 4(2), 110133.CrossRefGoogle Scholar
Bangerter, L. R., Griffin, J. M., Zarit, S. H. and Havyer, R (2017). Measuring the needs of family caregivers of people with dementia: An assessment of current methodological strategies and key recommendations. Journal of Applied Gerontology, 38(9), 13041318. https://doi.org/10.1177/0733464817705959 CrossRefGoogle ScholarPubMed
Bauer, J. M. and Sousa-Poza, A. (2015). Impacts of informal caregiving on caregiver employment, health, and family. Journal of Population Ageing, 8(3), 113145.CrossRefGoogle Scholar
Bédard, M., Molloy, W., Squire, L., Dubois, S., Lever, J.A. O’Donnell, M. (2001). The Zarit Burden Interview: A New Short Version and Screening Version. The Gerontologist 41(5), 652657.CrossRefGoogle ScholarPubMed
Benjamini, Y. and Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological), 57(1), 289300.Google Scholar
Blank, K., Gruman, C. and Robison, J. T. (2004). Case-finding for depression in elderly people: balancing ease of administration with validity in varied treatment settings. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(4), M378M384.CrossRefGoogle ScholarPubMed
Blom, M. M., Zarit, S. H., Zwaaftink, R. B. G., Cuijpers, P. and Pot, A. M. (2015). Effectiveness of an Internet intervention for family caregivers of people with dementia: results of a randomized controlled trial. PLoS One, 10(2), e0116622.CrossRefGoogle ScholarPubMed
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), 217228.CrossRefGoogle ScholarPubMed
Cant, R. P. and Cooper, S. J. (2010). Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing, 66(1), 315.CrossRefGoogle ScholarPubMed
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, 73.CrossRefGoogle ScholarPubMed
Cheema, J. R. (2014). Some general guidelines for choosing missing data handling methods in educational research. Journal of Modern Applied Statistical Methods, 13(2), 3.CrossRefGoogle Scholar
Cheng, S. et al. (2020). The effectiveness of nonpharmacological interventions for informal dementia caregivers: an updated systematic review and meta-analysis. Psychology and Aging, 35(1), 55.CrossRefGoogle ScholarPubMed
Chiu, M., Pauley, T., Wesson, V., Pushpakumar, D., Sadavoy, J. (2015). Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care. International Psychogeriatrics, 27(6), 937948.CrossRefGoogle ScholarPubMed
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385396.CrossRefGoogle ScholarPubMed
Cooke, D., Mcnally, L., Mulligan, K., Harrison, M. and Newman, S. P. (2001). Psychosocial interventions for caregivers of people with dementia: a systematic review. Aging & Mental Health, 5(2), 120135.CrossRefGoogle ScholarPubMed
Dhand, N. K. and Khatkar, M. S. (2014). Statulator: an online statistical calculator. Sample Size Calculator for Comparing Two Paired Means. Available at: http://statulator.com/SampleSize/ss2M.html; last accessed 11 December 2020.Google Scholar
Dong, Y. and Peng, C. J. (2013). Principled missing data methods for researchers. SpringerPlus, 2(1), 222.CrossRefGoogle ScholarPubMed
Eaton, W. W., Smith, C., Ybarra, M., Muntaner, C. and Tien, A. (2004). Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). In: M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults (pp. 363–377). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
Endler, N. S. and Parker, J. D. (1990). Multidimensional assessment of coping: a critical evaluation. Journal of Personality and Social Psychology, 58(5), 844.CrossRefGoogle ScholarPubMed
Etters, L., Goodall, D. and Harrison, B. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20(8), 423428.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D., Coon, D. W., Solano, N., Ambler, C., Rabinowitz, Y. and Thompson, L. W. (2003). Change in indices of distress among Latino and Anglo female caregivers of elderly relatives with dementia: site-specific results from the REACH national collaborative study. The Gerontologist, 43(4), 580591.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Jarrott, S. E., Zarit, S. E. and Stephens, M. P. (2003). Select respite for dementia caregivers: the effects of adult day service use on caregiving hours and care demands. International Psychogeriatrics, 15(1), 3758.CrossRefGoogle Scholar
Gitlin, L. N., Marx, K., Stanley, I. H., and Hodgson, N. (2015). Translating Evidence-Based Dementia Caregiving Interventions into Practice: State-of-the-Science and Next Steps. The Gerontologist, 55(2), 210226. https://doi.org/10.1093/geront/gnu123 CrossRefGoogle Scholar
Gresham, M., Heffernan, M. and Brodaty, H. (2018). The going to stay at home program: combining dementia caregiver training and residential respite care. International Psychogeriatrics, 30, 16971706. https://doi.org/10.1017/S1041610218000686 CrossRefGoogle ScholarPubMed
Hébert, R., Bravo, G. and Préville, M. (2000). Reliability, validity and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 19(4), 494507.CrossRefGoogle Scholar
Hendriks, I., Meiland, F. J. M., Gerritsen, D. L. and Droes, R. M. (2019). Implementation and impact of unforgettable: an interactive art program for people with dementia and their caregivers. International Psychogeriatrics, 31, 351362. https://doi.org/10.1017/S1041610218000959.CrossRefGoogle ScholarPubMed
Hepburn, K. W., Tornatore, J., Center, B. and Ostwald, S. W. (2001). Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. Journal of the American Geriatrics Society, 49(4), 450457.CrossRefGoogle ScholarPubMed
Hopkinson, M. D., Reavell, J., Lane, D. A. and Mallikarjun, P. (2019). Cognitive behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: a systematic review and meta-analysis. The Gerontologist, 59(4), e343e362.CrossRefGoogle ScholarPubMed
IBM. (2020). Does SPSS Statistics offer multiple comparisons using the Benjamini & Hochberg method to control the false discovery rate? Available at: https://www.ibm.com/support/pages/does-spss-statistics-offer-multiple-comparisons-using-benjamini-hochberg-method-control-false-discovery-rate; last accessed 11 December 2020.Google Scholar
Kamkhagi, D. et al. (2015). Benefits of psychodynamic group therapy on depression, burden and quality of life of family caregivers to Alzheimer’s disease patients. Archives of Clinical Psychiatry (São Paulo), 42(6), 157160.CrossRefGoogle Scholar
Katz, S., Downs, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in development of the index of ADL. The Gerontologist, 10(1_Part_1), 2030.CrossRefGoogle ScholarPubMed
Kwon, O., Ahn, H. S., Kim, H. J. and Park, K. (2017). Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. Journal of Clinical Neurology, 13(4), 394404.CrossRefGoogle ScholarPubMed
Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863.CrossRefGoogle ScholarPubMed
Laver, K., Milte, R., Dyer, S. and Crotty, M. 2017). A systematic review and meta-analysis comparing carer focused and dyadic multicomponent interventions for carers of people with dementia. Journal of Aging and Health, 29(8), 13081349.CrossRefGoogle ScholarPubMed
Lawton, M. P. and Brody, E. M. 1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3_Part_1), 179186.CrossRefGoogle ScholarPubMed
Lee, M., Ryoo, J. H., Chung, M., Anderson, J. G., Rose, K. and Williams, I. C. (2019). Effective interventions for depressive symptoms among caregivers of people with dementia: a systematic review and meta-analysis. Dementia (London). Epub ahead of print. https://doi.org/10.1177/1471301218822640 Google ScholarPubMed
Livingston, G. et al. (2017). Dementia prevention, intervention, and care. Lancet (London, England), 390(10113), 26732734.CrossRefGoogle ScholarPubMed
Madruga, M., Gozalo, M., Prieto, J., Rohlfs Domínguez, P. and Gusi, N. (2020). Effects of a home-based exercise program on mental health for caregivers of relatives with dementia: a randomized controlled trial. International Psychogeriatrics, 114. https://doi.org/10.1017/S104161022000157X Google ScholarPubMed
Mccabe, M., You, E. and Tatangelo, G. (2016). Hearing their voice: a systematic review of dementia family caregivers’ needs. The Gerontologist, 56(5), e70e88.CrossRefGoogle ScholarPubMed
Mcnaughton, N., Ravitz, P., Wadell, A. and Hodges, B. D. (2008). Psychiatric education and simulation: a review of the literature. The Canadian Journal of Psychiatry, 53(2), 8593.CrossRefGoogle ScholarPubMed
Mittelman, M. S. (2000). Effect of support and counseling on caregivers of patients with Alzheimer’s Disease. International Psychogeriatrics, 12(S1), 341346.CrossRefGoogle Scholar
Mittelman, M. S., Brodaty, H., Wallen, A. S. and Burns, A. (2008). A three-country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: effects on caregiver depression. The American Journal of Geriatric Psychiatry, 16(11), 893904.CrossRefGoogle ScholarPubMed
Olsen, I., Kvien, T. and Uhlig, T. (2012). Consequences of handling missing data for treatment response in osteoarthritis: a simulation study. Osteoarthritis and Cartilage, 20(8), 822828.CrossRefGoogle ScholarPubMed
Park, S. and Park, M. (2015). Effects of family support programs for caregivers of people with dementia-caregiving burden, depression, and stress: systematic review and meta-analysis. Journal of Korean Academy of Nursing, 45(5), 627640.CrossRefGoogle ScholarPubMed
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist, 30(5), 583594.CrossRefGoogle ScholarPubMed
Piersol, C. V., Canton, K., Connor, S. E., Giller, I., Lipman, S. and Sager, S. (2017). Effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders: a systematic review. American Journal of Occupational Therapy, 71(5), 110.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(2), P112P128.CrossRefGoogle ScholarPubMed
Pleasant, M. L., Molinari, V., Hobday, J. V., Fazio, S., Cullen, N. and Hyer, K. (2017). An evaluation of the CARES® Dementia Basics Program among caregivers. International Psychogeriatrics, 29(1), 4556. https://doi.org/10.1017/S1041610216001526 CrossRefGoogle ScholarPubMed
Quinn, C. and Toms, G (2019). Influence of positive aspects of dementia caregiving on caregivers’ well-being: a systematic review. The Gerontologist, 59(5), e584e596.Google ScholarPubMed
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385401.CrossRefGoogle Scholar
Reinhard, S., Given, B., Petlick, N. and Bemis, A. (2008). Supporting family caregivers in providing. In: R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality (US).Google Scholar
Schoenmakers, B., Buntinx, F. and Delepeleire, J. (2010a). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66(2), 191200.CrossRefGoogle ScholarPubMed
Schoenmakers, B., Buntinx, F. and Delepeleire, J. (2010b). Supporting the dementia family caregiver: the effect of home care intervention on general well-being. Aging and Mental Health, 14(1), 4456.CrossRefGoogle ScholarPubMed
Schulmann, K., Llinca, S. and Leichsenring, K. (2017). Community Care for people with Dementia: A Handbook for Policymakers. European Centre for Social Welfare Policy and Research.Google Scholar
Schulz, R. and Martire, L.M. (2004). Family caregiving of persons with dementia: prevalence, health effects, and support strategies. The American Journal of Geriatric Psychiatry, 12(3), 240249.CrossRefGoogle ScholarPubMed
Statistics Canada. (2017). Education in Canada: Key results from 2016 Census. Available at: https://www150.statcan.gc.ca/n1/daily-quotidien/171129/dq171129a-eng.htm; last accessed 3 March 2020.Google Scholar
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology and Aging, 7(4), 622.CrossRefGoogle ScholarPubMed
Tomar, R., Jha, A., Gale, T. and Huzzey, L. (2019). Benefits of attending a ‘Dementia First Aid’course for family caregivers of people with early dementia: findings of a pilot evaluation. British Journal of Medical Practitioners, 12(1).a008Google Scholar
Vaingankar, J.A. et al. (2016). Care participation and burden among informal caregivers of older adults with care needs and associations with dementia. International Psychogeriatrics, 28(2), 221231.CrossRefGoogle ScholarPubMed
Van Belle, G. (2011). Statistical Rules of Thumb (pp. 2751). Seattle, WA: John Wiley & Sons.Google Scholar
Watson, B., Tatangelo, G. and Mccabe, M. (2019). Depression and anxiety among partner and offspring carers of people with dementia: a systematic review. The Gerontologist, 59(5), e597e610.Google ScholarPubMed
World Health Organization. (2017). Global action plan on the public health response to dementia 2017–2025. Printed by the WHO Document Production Services. Geneva, Switzerland: World Health Organization.Google Scholar
Yalom, I. D. and Leszcz, M. (2005). The Theory and Practice of Group Psychotherapy. New York: Basic Books.Google Scholar
Yu, J., Yap, P. and Liew, T.M. (2019). The optimal short version of the Zarit Burden Interview for dementia caregivers: diagnostic utility and externally validated cutoffs. Aging & Mental Health, 23(6), 706710.CrossRefGoogle ScholarPubMed
Zarit, S. H., Gaugler, J. E. and Jarrott, S. E. (1999). Useful services for families: research findings and directions. International Journal of Geriatric Psychiatry, 14(3), 165178.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
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