Research on Alzheimer's caregiving in Canada: Current status and future directions
The following is an excerpt from:
Research on
Alzheimer's caregiving in Canada: Current status and future directions
There are three approaches to designing and evaluating interventions.37 The first involves developing multi-component interventions that are offered to all caregivers. This approach is relatively easy to implement and evaluate but may not be flexible to individual needs. The second approach involves designing targeted or tailored interventions that attempt to reach types of caregivers, types of care recipients, and stages of caregiving. Targeted and tailored interventions can be complex, expensive to implement and should be grounded in theory. They do, however, allow interventions to be matched with caregivers and care recipients. A third approach is to develop local community interventions involving local Alzheimer's disease society branches and other interest groups that would volunteer their time to assist informal caregivers. Interventions should be developed in collaboration with caregivers, who can identify the most effective strategies. Present and former caregivers of individuals with Alzheimer's disease should be interviewed to learn what information, training, and support they wish they had had.
Our search for Canadian studies discovered eleven Alzheimer's caregiver intervention studies published since 1990. Pilot studies were excluded from the review. Studies that examined the impact of dementia management medications for care recipients on caregiver costs were also excluded. However, several recent studies have examined this issue,38-40 and further work is needed to determine the effects that prescription and non-prescription medications used for dementia management have on those caring for seniors with dementia.
In response to criticisms that traditional support groups for unpaid caregivers of people with dementia were ineffective,41 recent Canadian studies of interventions targeted at individual Alzheimer's caregivers have emphasized theoretically based cognitive and behavioural group interventions. These programs are typically designed to increase caregivers' self-efficacy42 and to provide individual caregivers with tools for coping with psychological distress associated with caring for the cognitively impaired, such as problem-solving skills, assertiveness training, and cognitive restructuring.42-44
The interventions for caregivers of people with Alzheimer's disease vary. One approach is to facilitate problem-solving skills in caregivers. Roberts and colleagues44 developed an individualized problem-solving intervention. Their 'therapy' sessions consisted of the following steps: problem orientation, problem definition and formulation, generation of alternatives, decision-making, and solution implementation and verification.
Another type of intervention is the provision of respite care.45 This may involve attendants coming to the house to look after the care recipient while the caregiver leaves the home or stays in the home but tends to non-caregiver tasks; adult daycare or day hospital programs; or respite beds in a facility where the care receiver stays for days or weeks. Usually respite care is promoted to help care recipients avoid leaving their homes and being placed in a long-term care facility and to decrease caregiver burden.
Other interventions have employed a combination of approaches.46-47 For instance, Mohide and colleagues48 designed an intervention with a combination of caregiver-focussed health care, education about Alzheimer's disease and caregiving, assistance with problem solving, regularly scheduled in-home respite, and access to a self-help family caregiver support group. A similar randomized controlled trial employed a combination of information, social support, skills training, and behaviour modification.46 Hébert and colleagues47 designed a multifaceted support group program with information on Alzheimer's disease, techniques for solving behavioural and emotional problems, and relaxation techniques. Hébert and colleagues49,50 also developed a psycho-educative group intervention aimed at improving caregivers' ability to deal with stressful demands encountered in caring for individuals with Alzheimer's disease. Their 15-week program was designed to help participants with their cognitive appraisals of stressful situations and to provide mechanisms for coping with them.
