A meta-review of stress, coping and interventions in dementia and dementia caregiving.

K J Gilhooly,A Mcintyre,M L M Gilhooly,R Woodbridge,M P Sullivan,S Crutch,E Harding,L Wilson

doi:10.1186/s12877-016-0280-8

Abstract

BackgroundThere has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This paper provides a meta-review of this literature 1988-2014.MethodA meta-review was carried out of systematic reviews of stress, coping and interventions for people with dementia and their caregivers, using SCOPUS, Google Scholar and CINAHL Plus databases and manual searches.ResultsThe meta-review identified 45 systematic reviews, of which 15 were meta-analyses. Thirty one reviews addressed the effects of interventions and 14 addressed the results of correlational studies of factors associated with stress and coping. Of the 31 systematic reviews dealing with intervention studies, 22 focused on caregivers, 6 focused on people with dementia and 3 addressed both groups. Overall, benefits in terms of psychological measures of mental health and depression were generally found for the use of problem focused coping strategies and acceptance and social-emotional support coping strategies. Poor outcomes were associated with wishful thinking, denial, and avoidance coping strategies. The interventions addressed in the systematic reviews were extremely varied and encompassed Psychosocial, Psychoeducational, Technical, Therapy, Support Groups and Multicomponent interventions. Specific outcome measures used in the primary sources covered by the systematic reviews were also extremely varied but could be grouped into three dimensions, viz., a broad dimension of “Psychological Well-Being v. Psychological Morbidity” and two narrower dimensions of “Knowledge and Coping” and of “Institutionalisation Delay”.ConclusionsThis meta-review supports the conclusion that being a caregiver for people with dementia is associated with psychological stress and physical ill-health. Benefits in terms of mental health and depression were generally found for caregiver coping strategies involving problem focus, acceptance and social-emotional support. Negative outcomes for caregivers were associated with wishful thinking, denial and avoidance coping strategies. Psychosocial and Psychoeducational interventions were beneficial for caregivers and for people with dementia. Support groups, Multicomponent interventions and Joint Engagements by both caregivers and people with dementia were generally found to be beneficial. It was notable that virtually all reviews addressed very general coping strategies for stress broadly considered, rather than in terms of specific remedies for specific sources of stress. Investigation of specific stressors and remedies would seem to be a useful area for future research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0280-8) contains supplementary material, which is available to authorized users.

Highlights

There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers
The 46 relevant systematic reviews identified by our search procedure were given a quality rating using the Assessment of Multiple Systematic Reviews (AMSTAR) scoring scheme developed by Shea et al [6] to assess the methodological quality of systematic reviews
The 45 systematic review papers included in our analysis are summarised in Additional file 2, which shows AMSTAR quality rating, authorship, year of publication, the focus of each paper, the search strategy used by each review, whether or not a meta-analysis was conducted, the number of papers included or excluded in each review, and the conclusions drawn from each review

Summary

Introduction

There has been a substantial number of systematic reviews of stress, coping and interventions for people with dementia and their caregivers. This research has explored the levels of stress experienced by CGs and PWD, the correlates of stress, coping strategies, and the benefits of a range of interventions. As an indication of the volume of primary research in the area, it may be noted that an initial search of SCOPUS in September 2014, with terms (Alz* AND stress*) since 1988, produced 3537 titles. Excluding those primarily neurological, biochemical, pharmaceutical and medical, left 124 studies associated with caregiver stress. As part of a wider study on caregivers of people with dementia, we set out to examine the knowledge base in relation to factors affecting stress and coping in CGs and PWD and in relation to nonpharmacological interventions that have been found to be beneficial, in terms of reducing stress, increasing coping and improving the quality of life, for both CGs and PWD

Methods

Results

Discussion

Conclusion