Nathalie Paolino, DO; Patrick G. O’Malley, MD, MPH, FACP
Do nonpharmacologic interventions involving family caregivers of community-dwelling patients with dementia reduce neuropsychiatric symptoms and caregivers' adverse reactions to neuropsychiatric symptoms?
Included studies compared nonpharmacologic interventions involving caregivers (live-in family member) of patients with dementia with control. Studies of respite care, drug therapy, or patients with schizophrenia or bipolar disorder were excluded. Outcomes were neuropsychiatric (behavioral and psychological) dementia symptoms in patients and caregivers' adverse reactions to patients' neuropsychiatric symptoms.
MEDLINE, EMBASE/Excerpta Medica, PsycINFO, and Scopus (all 1985 to Jul 2010) were searched for experimental and clinical trials and single-case studies with > 5 patients published in English. 23 studies (n = 3279 patient–caregiver dyads) met the selection criteria: 16 were randomized controlled trials (RCTs), and 7 reported randomization but did not clearly meet the criteria to be classified as RCTs. 14 studies had ≥ 80 caregivers or dyads. Intervention types included skills training for caregivers (18 studies), education for caregivers (21 studies), activity planning and environmental redesign (5 studies), enhancing support for caregivers (5 studies), self-care techniques for caregivers (12 studies), and miscellaneous strategies (e.g., collaborative care with health professionals, exercise for patient) (3 studies), often given in combination; and were delivered individually to caregivers or dyads in 20 studies. Intervention duration ranged from 6 weeks to 24 months.
Meta-analyses showed that caregiver interventions reduced neuropsychiatric symptoms in patients and reduced related adverse reactions in caregivers (Table).
Nonpharmacologic interventions involving family caregivers reduce neuropsychiatric symptoms in community-dwelling persons with dementia and caregivers' adverse reactions to neuropsychiatric symptoms.
Nonpharmacologic caregiver interventions vs control in patients with dementia and their live-in family caregivers*
*CI defined in Glossary. Number of comparisons exceeds number of studies because some studies had multiple comparisons.
†7 of 23 studies were classified as pseudorandomized.
‡Positive effect size indicates positive overall effect of caregiver interventions on outcomes. Effect sizes (difference between treatment and control groups or between pre-and posttreatment assessments) were standardized mean differences (Cohen d) calculated using a random-effects model.
Paolino N, O’Malley PG. Review: Nonpharmacologic caregiver interventions improve dementia symptoms and caregiver reactions. Ann Intern Med. ;158:JC4. doi: 10.7326/0003-4819-158-4-201302190-02004
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Published: Ann Intern Med. 2013;158(4):JC4.
Dementia, Geriatric Medicine, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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