How effective are dementia caregiver interventions? An updated comprehensive meta-analysis

Study Aim/Purpose: The purpose of this paper was to update a 2006 meta-analysis of interventions for caregivers of persons with dementia that was conducted by Pinquart and Sorensen. The analysis sought to determine the average effects of interventions for caregivers of individuals with dementia on caregivers and their care recipients, how these effects differ between intervention types, and the impact of study characteristics, caregiver characteristics, and the relationship between the caregiver and care recipient on these effects. 

Summary of Methods: The authors conducted a systematic review of literature published In English, German, or a language for which they could obtain translation, published after the 2006 meta-analysis. The search was performed using PubMed, PsychINFO, and PSCYNDEX, using the search terms: 1) “dementia” or “Alzheimer’s disease” and 2) “caregiver” or “carer” or “caregiving” and 3) “intervention” or “trial” or “support” or “training”, and 4) “control” or “controlled” or “RCT” or “experiment” or “experimental.” The inclusion criteria for studies were: care receiver has dementia, participants are informal caregivers (relatives or friends), the intervention is psychosocial, there is a treatment and control group with assignment implemented in a way that should not lead to systematic differences between groups, and at least one of the desired outcomes was reported to allow for computation of effect size. After review by the authors, 280 studies were included. The intervention types were categorized according to their dominant component in 7 categories: psychoeducational, cognitive-behavioral therapy, counseling/case management, general support, respite, training of the care receiver (e.g. memory training), and multicomponent interventions. The outcome measures that we included in the analysis were: caregiver burden, depression, subjective well-being, ability and knowledge, anxiety, and symptoms of the care receiver with dementia. 

Summary of Results: Caregiver interventions had, on average, significant small-to-moderate effects on improvement of the caregiver’s ability/knowledge, subjective well-being, burden, depression, and anxiety as well as on symptoms of the care recipient. Younger male and non-spouse caregivers appear to be more likely to have reduced burden and depression, whereas women are more likely to have gains in ability/knowledge. Examining the outcomes by intervention type demonstrated that multi-component skill-building psychoeducational and cognitive-behavior therapy interventions affected most outcomes; whereas the effects of other intervention types were limited to specific outcomes. Only multicomponent interventions were found to be effective in reducing the risk of institutionalization at post-test. 

Study Limitations (as cited by authors): The authors noted several limitations of the meta-analysis. First, despite the relatively large number of studies included, the test power was limited for testing the mostly small intervention effects. They also explained that the classification of interventions was ambiguous at times because an intervention that is primarily of one type may also use principles from another type or have a small component of another type. This overlap in intervention type may explain why there was similar mean effect size on burden and depression for skill-building, psycho-educational, cognitive-behavioral therapy, and counseling/case management interventions. 

Authors’ Discussion/Conclusions: With regard to programmatic application of the study findings, the authors recommend that practitioners of programs serving caregivers choose interventions based on whether broad or specific outcomes are desired. Because interventions that were purely informational had no effect on most outcomes, they also recommend that interventions include some form of active participation or training. With regard to future research, the authors conclude that more primary research is needed on the effects of respite and support interventions as well as on training of the care recipient and the long-term effects of caregiver interventions. Additionally, they suggest that future quantitative syntheses of studies examine the effects of individual components or different combinations of components among multi-component interventions. Finally, they recommend that, as with other therapy research, more research is needed to understand the processes and change mechanisms by which dementia caregiver interventions realize their effects.