Individualized support for informal caregivers of people with dementia \u2013 effectiveness of the German adaptation of REACH II

Martin Berwig,Jenny Spahlholz,Elmar Brähler,Hermann-Josef Gertz,Nina Hallensleben,Stephanie Heinrich

doi:10.1186/s12877-017-0678-y

Abstract

BackgroundIndividualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia. In this study, we adapted and evaluated a multicomponent intervention (Resources for Enhancing Alzheimer’s Caregiver Health II, REACH II), which was developed in the USA, to the German health-care system. Therefore the project is called the German adaptation of REACH II (in German: Deutsche Adaptation der REACH II, DE-REACH).MethodsThe effectiveness of DE-REACH was examined in a randomized, controlled trial on 92 informal caregivers of people with dementia. The intervention comprised 12 individual two-weekly sessions (9 at home with the informal caregiver and 3 via telephone) and combined five modules. The reduction of the burden of the informal caregivers was chosen as the primary outcome.ResultsThe results showed a great stabilizing effect of the intervention on caregiver burden (effect size d = 0.91), that is, comparing pre- and post-measurements the burden decreased very slightly in the intervention group whereas it increased very strongly in the control group. After a three-month follow-up period this effect decreased from a great to a moderate effect. There were also improvements as a result of the intervention in somatization, health-related psychological quality of life and the reaction of the informal caregivers in response to challenging behaviors of the relative with dementia. Moreover, the frequency of challenging behaviors of the affected person itself was reduced in favor of the intervention.ConclusionThe findings of this study provide further evidence for the impact of multicomponent support interventions for informal caregivers of people with dementia.Clinical trial registrationNCT01690117. Registered September 17, 2012.

Highlights

Individualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia
The patients’ cognitive ability was recorded at baseline to confirm the presence of a clinical dementia syndrome in addition to the medical dementia diagnosis
Conclusion and in summary, it should be noted that our results fundamentally confirm the arguments of critics of the concept of caregiver burden

Summary

Introduction

Individualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia. Caring for a person with dementia is timeconsuming and associated with significant personal engagement and day-to-day management Due to these high demands and high level of burden there is a higher risk of falling physically and mentally ill for informal caregivers of people with dementia [5]. A meta-analysis on the REACH I (Resources for Enhancing Alzheimer’s Caregiver Health I) project concludes that in terms of burden and depression, individualized, outreach and structured multicomponent interventions are the most effective [10]. This conclusion is confirmed by the results of two actual meta-reviews or analyses, respectively [11, 12]

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Results

Discussion

Conclusion