Literature review of Technology Group Interventions for Informal Dementia Caregivers
Dementia is a growing concern of the society and with the limited availability of healthcare professionals and the associated economic costs, the caregivers are subjected to excessive pressure. The challenges associated with dementia care poses a serious burden on the informal caregivers with respect to physical and emotional health issues. Caregiver support interventions generally help to provide quality care to the individuals with dementia, thereby improving the quality of life and other social engagements. To delineate the determinants of the caregiver burden and to determine the interventions, the following PICO question of problem, intervention, comparison and outcome were used. The search engines used were PubMed and Google Scholar. The keywords used were dementia, caregivers, technology group interventions, home healthcare. The search strategy showed 68 results consisting of both primary research (randomized control trials) as well as secondary systematic reviews. In USA, 15.7 million family caregivers were found to care for dementia patients of which, 88% reported anxiety and stress ad 77% stated sleep deprivation (Caregiver.org, 2016).
This essay is a literature review on the effectiveness of technology group interventions for informal dementia care-givers.
Care giving can have a significant impact on the health of the caregiver. The study carried out by Ducharme, (2014), is a review of 3 programs that are designed to provide psychoeducational support to the family caregivers of patients with dementia. The 3 programs that have been found to have significant effects on the health of the care givers include “the learning to become a caregiver”, which helps in the smooth transition to the role of a family caregiver following diagnosis of dementia, the “learning how to manage stress” program intended to provide educational training either through individualized sessions or through web based coaching. The third program that has been evaluated in this review is the “taking care of myself” program provides information about the intervention strategies that help to facilitate the awareness, confidence and coping techniques among the caregivers. However, the study also revealed that in order to make this program available to the caregivers residing in isolated locations, they redesigned the program with the aim to deliver it to the caregivers through online or web modes. The effects of the e-learning services were found to be statistically significant with respect to the quality of life of the caregivers. Such an intervention as described in the study is of importance as it provides both asynchronism and accessibility to the caregivers.
Studies Examining Psychoeducational Support Programs for Dementia Caregivers
The study by Lopez-Hartmann et al., (2012), determines the effect of various interventions on improving the quality of life of the dementia caregivers. In order to do so, they used the information and communication technology support. The study involved a literature search using various databases. The study revealed that information technologies like computer or telephone services can reduce the rate of anxiety, burden and depression among the informal dementia caregivers.
The study by Beinart et al., (2012), is a review that carries out a literature search to determine the effectiveness of the various technological interventions in reducing dementia caregiver burden. The interventions that were identified were computer support, interactive voice response services, tele-support, among others. They were found to increase the confidence levels of the caregivers with respect to decision-making, but there were no significant improvements with respect to social isolation or kills required for effective decision-making.
The work by Tao & McRoy, (2015), is an expert discussion on the various care services provided to various dementia caregivers. The article carries out a discussion on the importance of technology support for home caregivers. These technological support interventions not only helps the caregivers to deliver appropriate care to the dementia patients thereby improving patient outcomes but these interventions were also found to be cost-effective. The various interventions that have been described are telehealth, telephone services, among others.
Dementia related caregivers while looking after the needs of dementia patients face aggressive or challenging behaviors. The lack of sufficient online training programs is a key concern for the caregivers. The CARES dementia related behaviour online training program was found to be effective in educating the caregivers about the dementia related behaviors and how to communicate with individuals suffering from dementia (Gaugler et al., 2016).
The study by Torkamani et al., (2014), determines the usefulness of ALADDIN, a computerized platform in reducing caregiver stress and burden. A randomized control study was carried out and informed consent was obtained from participants. Ten participants were randomly allocated to both control and experimental groups, respectively. Various assessments were carried out like the Zarit, NPI, BDI, Zung, EQ5D, QOLS, MMSE, DRS2, BDRS, CDRS, MBPC, GDS, BI, LADL, CCI, among others were used. Statistical analysis were carried out using the ANCOVA, t-tests and SPSS software. The results revealed that ALADDIN platform significantly reduced the caregiver stress and burden.
The study by Fänge et al., (2017), involved evaluation of an information and communication technology called [email protected], to reduce caregiver burden. The randomized controlled trial recruited 320 dementia patients and their caregivers. The intervention group were provided with a home monitoring kit and following this, questionnaires were used to determine the effectiveness of the monitoring kit to reduce caregiver burden and improve the quality of life. The data were analyzed using statistical procedures like the t-test, Mann-Witney test, ANOVA. This intervention helped to reduce the caregiver stress by the use of various sensors and alert systems that enable them to determine patient problems and provide adequate treatment in a timely manner.
Information and Communication Technology Support
The study by Vandepitte et al., (2016), involves a literature search that determines the various supportive strategies that positively impact the lives of the informal caregivers. They used the Downs and Black checklist to assess the methodological quality of the various articles reviewed. The technological interventions that were found to provide caregiver benefits were telephone based intervention and DVD training.
The work of Godwin et al., (2013), is a literature review that involved the search of articles that described the role of various technology driven interventions in order to reduce caregiver stress. The interventions studied were REACH telephone linked care, REACH structural ecosystem therapy and computer telephone integrated system. These interventions were found to reduce caregiver depression, improve social support, confidence and ability to provide effective care.
The study by Kajiyama et al., (2013), involved determining the ability of an online program called the iCare Stress Management e-training Program in reducing caregiver depression and stress. Randomized controlled trials were carried out and statistical tests like ANOVA was carried out to determine the significance of the tests. Informed consent was obtained from participants. Significant changes in stress levels were observed for the participants with respect to the e-training program.
Caregivers of dementia patients are subjected to feelings of loneliness, face various burdens and also suffer from social isolation. The study carried out by Dam et al., (2016), determines the effectiveness of a social support tool in providing support to dementia care givers. A mixed method randomized control trial was carried to determine the effectiveness of Inlife in providing effective support to the dementia caregivers. This online social support tool is expected to enhance the social support and improve the feelings of competence and reduce feelings of social isolation and loneliness among dementia caregivers.
The study by Baker et al., (2015), involves determination of the effectiveness of a web based mindfulness stress reduction course in reducing the stress of dementia caregivers. A mixed methods stepped wedge cluster randomized trial was used. Consent was obtained and questionnaires were used following the implementation of the intervention to determine its effectiveness. Statistical analysis was carried out and the results revealed that such mindfulness based training helped to reduce caregiver stress and thereby paved the way for its application in the future.
The TALKING TIME project is a randomized clinical trial that was carried out to determine the effectiveness of telephone based support groups for informal caregivers caring for dementia patients. The caregivers find it highly stressful as they do not find any time for themselves as they always have to be with the patient due to the lack of extra support. Such a project will help to determine the effectiveness of telephone based interventions with respect to providing support to the caregivers (Berwig et al., 2017).
Effectiveness of Technological Interventions in Reducing Dementia Caregiver Burden
Stress associated with caregiver burden can give rise to distress and hospital admissions. However, the UP-TECH project carried out by Chiatti et al., (2013), in order to provide support to the caregivers by reducing the burden and also to prevent the patient admissions to hospitals. This project integrates case management, education, counseling, new technologies and nurse home visits in order to support the caregivers.
The study of Kales et al., (2017), involves the designing of a web based program called the WeCareAdvisor and evaluating its ability to enable the caregivers to identify the behavioral ad psychological symptoms of dementia (BPSD). Focus groups, semi-structured interviews and technology surveys were used to assess the effectiveness of the program. The web-based tool was found to reduce caregiver burden and improve outcomes with respect to severity and frequency of BPSD.
Conclusion
Thus, it can be concluded that dementia caregivers are subjected to daily challenges and are highly burdened due to lack of education, training and support. The literature review summarizes the various determinants of caregiver stress as well as outlines various interventions to overcome the stress. Thus, the evidences is a clear rationale for carrying out the DNP project.
Reference List
Baker, C., Huxley, P., Dennis, M., Islam, S., & Russell, I. (2015). Alleviating staff stress in care homes for people with dementia: protocol for stepped-wedge cluster randomised trial to evaluate a web-based Mindfulness-Stress Reduction course. BMC psychiatry, 15(1), 317.
Beinart, N., Weinman, J., Wade, D., & Brady, R. (2012). Caregiver burden and psychoeducational interventions in Alzheimer’s disease: a review. Dementia and geriatric cognitive disorders extra, 2(1), 638-648.
Berwig, M., Dichter, M. N., Albers, B., Wermke, K., Trutschel, D., Seismann-Petersen, S., & Halek, M. (2017). Feasibility and effectiveness of a telephone-based social support intervention for informal caregivers of people with dementia: Study protocol of the TALKING TIME project. BMC health services research, 17(1), 280.
Caregiver.org. (2016). Caregiver Statistics: Demographics | Family Caregiver Alliance. Caregiver.org. Retrieved 8 February 2018, from https://www.caregiver.org/caregiver-statistics-demographics
Chiatti, C., Masera, F., Rimland, J. M., Cherubini, A., Scarpino, O., Spazzafumo, L., & Lattanzio, F. (2013). The UP-TECH project, an intervention to support caregivers of Alzheimer’s disease patients in Italy: study protocol for a randomized controlled trial. Trials, 14(1), 155.
Dam, A. E., de Vugt, M. E., van Boxtel, M. P., & Verhey, F. R. (2017). Effectiveness of an online social support intervention for caregivers of people with dementia: the study protocol of a randomised controlled trial. Trials, 18(1), 395.
Ducharme, F. (2014). Psychoeducational interventions for family caregivers of seniors across their life trajectory: an evidence-based research program to inform clinical practice. Advances in Geriatrics, 2014.
Fänge, A. M., Schmidt, S. M., Nilsson, M. H., Carlsson, G., Liwander, A., Bergström, C. D., & Chiatti, C. (2017). The [email protected] HOME study, a technological intervention to reduce caregiver burden for informal caregivers of people with dementia: study protocol for a randomized controlled trial. Trials, 18(1), 63.
Gaugler, J. E., Hobday, J. V., Robbins, J. C., & Barclay, M. P. (2016). Direct Care Worker Training to Respond to the Behavior of Individuals With Dementia: The CARES® Dementia-Related Behavior™ Online Program. Gerontology and geriatric medicine, 2, 2333721415626888.
Godwin, K. M., Mills, W. L., Anderson, J. A., & Kunik, M. E. (2013). Technology-driven interventions for caregivers of persons with dementia: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias®, 28(3), 216-222.
Kajiyama, B., Thompson, L. W., Eto-Iwase, T., Yamashita, M., Di Mario, J., Marian Tzuang, Y., & Gallagher-Thompson, D. (2013). Exploring the effectiveness of an internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program. Aging & mental health, 17(5), 544-554.
Kales, H. C., Gitlin, L. N., Stanislawski, B., Marx, K., Turnwald, M., Watkins, D. C., & Lyketsos, C. G. (2017). WeCareAdvisor™: The development of a caregiver-focused, web-based program to assess and manage behavioral and psychological symptoms of dementia. Alzheimer Disease & Associated Disorders, 31(3), 263-270.
Lopez-Hartmann, M., Wens, J., Verhoeven, V., & Remmen, R. (2012). The effect of caregiver support interventions for informal caregivers of community-dwelling frail elderly: a systematic review. International journal of integrated care, 12.
Tao, H., & McRoy, S. (2015). Caring for and keeping the elderly in their homes. Chinese Nursing Research, 2(2-3), 31-34.
Torkamani, M., McDonald, L., Aguayo, I. S., Kanios, C., Katsanou, M. N., Madeley, L., & Jahanshahi, M. (2014). A randomized controlled pilot study to evaluate a technology platform for the assisted living of people with dementia and their carers. Journal of Alzheimer’s Disease, 41(2), 515-523.
Vandepitte, S., Van den Noortgate, N., Putman, K., Verhaeghe, S., Faes, K., & Annemans, L. (2016). Effectiveness of supporting informal caregivers of people with dementia: a systematic review of randomized and non-randomized controlled trials. Journal of Alzheimer’s Disease, 52(3), 929-965.
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