Dr Shaji et al raise an important point in relation to the interpretation of trials of interventions with carers of people with dementia. In relation to our own study, information was provided in three 45-minute sessions by an experienced clinician, and supplemented by four written information booklets entitled “What are dementia and Alzheimer's disease”, “Stress and the person with Alzheimer's disease”, “ Coping with caring” and “Advice about services”. The control group did not receive the information and education sessions. We carried out an analysis after the three sessions of information, which occurred at the beginning of the intervention, and there was no difference between the intervention and control groups at that time on any outcome variable. This finding has also been reported in trials of family intervention with the carers of patients with serious mental illness (Reference Tarrier, Barrowclough and VaughnTarrier et al, 1988). This is perhaps not surprising, as providing information and advice is notoriously poor at changing people's behaviour.

With regard to the method of the intervention, we utilised an integrated model described previously in relation to schizophrenia (Reference Barrowclough and TarrierBarrowclough & Tarrier, 1992). This takes an individualised approach and includes an assessment of the carer's own model of coping. It is recognised that there are significant individual differences in the impact of education on carers managing older people with dementia. It may be that the information provided will enable those in the intervention group to utilise the later sessions more effectively.

We agree entirely with Dr Shaji et al that simple, straightforward strategies should be evaluated in carers of people with dementia, and that costly interventions should not be adopted unless they have been shown to be effective.