Abstract
BackgroundDay-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment.MethodsIn a two-arm cluster-randomized trial involving multicomponent therapy for cognitively impaired persons in day-care centers and telephone counseling for their caregivers versus treatment as usual (TAU), we investigated long-term effects on caregivers’ burden and depressiveness. Person-caregiver dyads involving home-dwelling persons with MCI, mild dementia, or moderate dementia were eligible. Day-care centers were randomized into an intervention group (IG) or a control group (CG). Outcome assessors were blinded. Out of 359 caregivers who had completed a 6-month intervention phase (nIG = 205, nCG = 154), a total of 304 of them were available at the 12-month follow-up (nIG = 173, nCG = 131). Instruments for assessing were the Burden Scale for Family Caregivers – short version (BSFC-s) (caregiver burden) and the Well-Being Index Score (WHO-5) (depressiveness). Mixed ANOVAs were used for the main analyses; descriptive statistics and subgroup analyses were additionally performed; secondary analyses involved multiple linear regressions for the main outcomes that were significant in the unadjusted main analysis.ResultsAt follow-up, crude mean differences showed a nonsignificant advantage for the IG in caregiver burden [IG: −.20 (SD = 5.39) vs. CG: .76 (SD = 5.49), p = .126, d = .177] and depressiveness (reverse scored) [IG: −.05 (SD = 5.17) vs. CG: −.98 (SD = 5.65), p = .136, d = .173]. For caregiver burden, a mixed ANOVA resulted in significant main effects of group (F (1, 302) = 4.40; p = .037) and time (F (1.88, 568.96) = 3.56; p = .032) but not a significant interaction. The largest effects were found for the “mild dementia” subgroup (d = .443 for caregiver burden and d = .520 for depressiveness).DiscussionPositive long-term effects of a combined intervention involving telephone counseling for caregivers and multicomponent activation for patients were observed especially for mild dementia. However, the treatment effects washed out after the intervention ended.Trial registrationISRCTN16412551 (date: 30 July 2014, retrospectively).
Highlights
Day-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment
While descriptive statistics depicted a worsening of caregiver burden from t0 to t2 in the control group (Mean Delta = +.76 (SD = 5.49)) versus a small improvement in the intervention group (Mean Delta = −.20 (SD = 5.39)), the difference was not significant (p = .126)
Main analysis A mixed ANOVA with the dependent variable caregiver burden, the within-subject variable “time” (3-fold: therapy start, therapy end, 12-month follow-up) and the between-subject factor “group” (2-fold: intervention group, control group) yielded a significant main effect of time (Greenhouse-Geisser-corrected): F (1.88, 568.96) = 3.56; p = .032; partial η2 = .01, indicating that caregiver burden changed in the total sample over time
Summary
Day-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment. An estimated 35.6 million people worldwide were affected by dementia in 2009. This number is anticipated to increase to 66 million by 2030 and 115 million by 2050 [1]. Demographic change along with increases in life expectancy have led to the challenge that cognitive impairment and society’s handling of it are becoming a substantial issue for health care systems and for the affected people and their caregivers [1,2,3,4]. There are multiple effective offers of support for people with cognitive impairment and their caregivers [5,6,7,8]. Attending day-care seems to be associated with a higher quality of life for the persons with cognitive impairment (PCIs) [11]
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