Past is prologue: How to advance caregiver interventions

Study Aim/Purpose: This article is a retrospective overview of research on caregiver interventions to highlight strengths and weaknesses and identify conceptual and methodological issues that could lead to better treatment outcomes. 

Summary of Methods: The author provided a critical review of the literature of caregiver interventions, drawing examples from studies of psychosocial interventions for caregivers of persons with dementia; however, the issues raised are considered relevant to interventions for caregivers of persons with other types of health issues. The paper also briefly addresses research on respite care. 

Summary of Results: The paper critiques the literature on caregiver treatment interventions and explains the limited positive outcomes as a result of the lack of consideration of differences in symptoms and needs among caregivers in the pre/post analysis of change in outcomes. For example, in most caregiver intervention studies the main outcome is depressive symptoms and studies have typically found only modest changes in this outcome. Researchers, the author notes, have partly addressed this issue by including measures of other outcomes, such as subjective burden, stress, and aspects of health and quality of life; however, treatment effects on these outcomes have also been limited. The author also found that the potential measurable impact of interventions are diluted because they generally use a “one-size fits all” treatment approach that may not address the problems that individual caregivers have or the outcomes they are looking for. He goes on to suggest that focusing on problems that caregivers do not have could also not only dilute positive outcomes but “could under some conditions lead to adverse outcomes.” 

Authors’ Discussion/Conclusions: The author’s major recommendations were the following: (1) Engage caregivers in discussions of what they need, including using qualitative research methods; (2) Design interventions with adaptive approaches that consider the heterogeneity of the caregiving population and allow tailoring and sequencing of intervention components based on individualized assessment of caregivers’ needs; (3) Use process measures to determine fidelity of intervention implementation; (4) Design evaluations with a sample size adequately powered to detect differences in subgroup effects (e.g., variation based on caregivers’ baseline stress levels); and (5) Test the mechanisms by which treatment leads to improved outcomes (e.g., determining if individual treatment components have their intended short term effects; the links between intermediate outcomes like coping and longer-term outcomes such as reduced distress post-treatment and beyond).