Evaluation of technology-based interventions for informal caregivers of patients with dementia – A meta-analysis of randomized controlled trials

OBJECTIVE The aim of this study was to estimate the efficacy of technology-based interventions for informal caregivers of people with dementia (PWD). METHODS PubMed, PsycINFO, and Cochrane Library databases were searched in August 2018, with no restrictions in language or publication date. Two independent reviewers identified 33 eligible randomized controlled trials (RCTs) conducting a technology-based intervention for informal carers of PWD. Meta-analyses for the outcome measures caregiver depression and caregiver burden were conducted with subgroup analyses according to mode of delivery (telephone, computer/web-based, combined interventions). To assess methodologic quality, the Cochrane risk-of-bias assessment was rated. RESULTS Meta-analyses revealed a small but significant postintervention effect of technology-based interventions for caregiver depression and caregiver burden. Combined interventions showed the strongest effects. CONCLUSION Technology-based interventions have the potential to support informal caregivers of PWD. Because of advantages such as high flexibility and availability, technology-based interventions provide a promising alternative compared with "traditional services," e.g., those for people living in rural areas. More high-quality RCTs for specific caregiver groups are needed.

[1]  C. Lyketsos,et al.  Effect of the WeCareAdvisor™ on family caregiver outcomes in dementia: a pilot randomized controlled trial , 2018, BMC Geriatrics.

[2]  M. Reder,et al.  The Tele.TAnDem Intervention: Telephone-based CBT for Family Caregivers of People With Dementia , 2018, The Gerontologist.

[3]  R. Sanson-Fisher,et al.  Computer and telephone delivered interventions to support caregivers of people with dementia: a systematic review of research output and quality , 2017, BMC Geriatrics.

[4]  Sheung-Tak Cheng.  Dementia Caregiver Burden: a Research Update and Critical Analysis , 2017, Current Psychiatry Reports.

[5]  Candice M. Daniel,et al.  Supporting Caregivers of Rural Veterans Electronically (SCORE) , 2017, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[6]  D. Oslin,et al.  A Randomized Pilot Trial of a Telephone-Based Collaborative Care Management Program for Caregivers of Individuals With Dementia , 2017, Psychological services.

[7]  J. Millán-Calenti,et al.  UnderstAID, an ICT Platform to Help Informal Caregivers of People with Dementia: A Pilot Randomized Controlled Study , 2016, BioMed research international.

[8]  C. Doyle,et al.  A systematic review of the effect of telephone, internet or combined support for carers of people living with Alzheimer's, vascular or mixed dementia in the community. , 2016, Archives of gerontology and geriatrics.

[9]  K. Sanderson,et al.  Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers , 2016, Aging & mental health.

[10]  S. Crutch,et al.  A meta-review of stress, coping and interventions in dementia and dementia caregiving , 2016, BMC Geriatrics.

[11]  Shelia R. Cotten,et al.  What do they like? Communication preferences and patterns of older adults in the United States: The role of technology , 2016 .

[12]  E. Park,et al.  Depression in the Family of Patients With Dementia in Korea , 2016, American journal of Alzheimer's disease and other dementias.

[13]  A. Steffen,et al.  A telehealth behavioral coaching intervention for neurocognitive disorder family carers , 2015, International journal of geriatric psychiatry.

[14]  R. Ho,et al.  Prevalence of Mental Health Disorders Among Caregivers of Patients With Alzheimer Disease. , 2015, Journal of the American Medical Directors Association.

[15]  C. Nugent,et al.  Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom , 2015, Journal of medical Internet research.

[16]  I. Hallberg,et al.  Dementia care in European countries, from the perspective of people with dementia and their caregivers. , 2015, Journal of advanced nursing.

[17]  Jennifer D. Davis,et al.  Psychosocial telephone intervention for dementia caregivers: A randomized, controlled trial , 2015, Alzheimer's & Dementia.

[18]  Anne-Sophie Rigaud,et al.  A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial , 2015, Journal of medical Internet research.

[19]  A. Au.  Developing Volunteer-Assisted Behavioral Activation Teleprograms to Meet the Needs of Chinese Dementia Caregivers , 2015 .

[20]  Pim Cuijpers,et al.  Effectiveness of an Internet Intervention for Family Caregivers of People with Dementia: Results of a Randomized Controlled Trial , 2015, PloS one.

[21]  C. Becker,et al.  Dementia Caregiver Interventions: A Systematic Review of CaregiverOutcomes and Instruments in Randomized Controlled Trials , 2015 .

[22]  G. Rücker,et al.  Efficacy and experiences of telephone counselling for informal carers of people with dementia. , 2014, The Cochrane database of systematic reviews.

[23]  L. Leung,et al.  Telephone-assisted pleasant-event scheduling to enhance well-being of caregivers of people with dementia: a randomised controlled trial. , 2014, Hong Kong medical journal = Xianggang yi xue za zhi.

[24]  F. Verhey,et al.  A systematic review of Internet‐based supportive interventions for caregivers of patients with dementia , 2014, International journal of geriatric psychiatry.

[25]  Aaron C. T. Smith.  Older adults and technology use , 2014 .

[26]  M. Jahanshahi,et al.  A randomized controlled pilot study to evaluate a technology platform for the assisted living of people with dementia and their carers. , 2014, Journal of Alzheimer's disease : JAD.

[27]  L. Nichols,et al.  A trial of dementia caregiver telephone support. , 2013, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[28]  Rolf Holle,et al.  Predictors of Institutionalization of Dementia Patients in Mild and Moderate Stages: A 4-Year Prospective Analysis , 2013, Dementia and Geriatric Cognitive Disorders Extra.

[29]  Richard Schulz,et al.  A videophone psychosocial intervention for dementia caregivers. , 2013, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[30]  D. Young,et al.  Telephone-delivered psychoeducational intervention for Hong Kong Chinese dementia caregivers: a single-blinded randomized controlled trial , 2013, Clinical Interventions in Aging.

[31]  D. gallagher-Thompson,et al.  Exploring the effectiveness of an Internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program , 2013, Aging & mental health.

[32]  Whitney L. Mills,et al.  Technology-Driven Interventions for Caregivers of Persons With Dementia , 2013, American journal of Alzheimer's disease and other dementias.

[33]  C. Lai,et al.  Online and onsite training for family caregivers of people with dementia: results from a pilot study , 2013, International journal of geriatric psychiatry.

[34]  Michelle M. Kazmer,et al.  Telephone-based, cognitive-behavioral therapy for African American dementia caregivers with depression: initial findings. , 2012, Rehabilitation psychology.

[35]  Marita A. O'Brien,et al.  Diffusion of Technology: Frequency of use for Younger and Older Adults , 2011, Ageing international.

[36]  Kathleen C. Buckwalter,et al.  Elder Caregiving in Rural Communities , 2011 .

[37]  N. Luo,et al.  Validity and reliability of the Zarit Burden Interview in assessing caregiving burden. , 2010, Annals of the Academy of Medicine, Singapore.

[38]  Karen Z. Naufel,et al.  Rural mental health and psychological treatment: a review for practitioners. , 2010, Journal of clinical psychology.

[39]  D. gallagher-Thompson,et al.  Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study , 2010, Aging & mental health.

[40]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[41]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[42]  C. Connell,et al.  Effects of a Telephone-Based Exercise Intervention for Dementia Caregiving Wives , 2008, Journal of applied gerontology : the official journal of the Southern Gerontological Society.

[43]  R. Fortinsky,et al.  Telephone-delivered psychosocial intervention reduces burden in dementia caregivers , 2008, Dementia.

[44]  S. Elmståhl,et al.  The relationship between caregiver burden, caregivers' perceived health and their sense of coherence in caring for elders with dementia. , 2008, Journal of clinical nursing.

[45]  S. Zarit,et al.  A future for family care and dementia intervention research? Challenges and strategies , 2008, Aging & mental health.

[46]  C. Stine,et al.  Telephone-Based Cognitive-Behavioral Intervention for Distressed Rural Dementia Caregivers , 2007 .

[47]  Richard Schulz,et al.  E-care: a telecommunications technology intervention for family caregivers of dementia patients. , 2007, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[48]  S. Lauderdale,et al.  Comparative Outcomes of Two Distance-Based Interventions for Male Caregivers of Family Members With Dementia , 2007, American journal of Alzheimer's disease and other dementias.

[49]  Joan Wood,et al.  Patient and caregiver characteristics associated with depression in caregivers of patients with dementia , 2003, Journal of General Internal Medicine.

[50]  L. Gitlin,et al.  Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals With Dementia , 2007, American journal of Alzheimer's disease and other dementias.

[51]  N. Charness,et al.  Factors Predicting the Use of Technology: Findings From the Center for Research and Education on Aging and Technology Enhancement (CREATE) , 2006 .

[52]  Martin Pinquart,et al.  Helping caregivers of persons with dementia: which interventions work and how large are their effects? , 2006, International Psychogeriatrics.

[53]  J. Seeley,et al.  Worksite-based internet multimedia program for family caregivers of persons with dementia. , 2005, The Gerontologist.

[54]  Jan Colvin,et al.  Caregivers of Older Adults: Advantages and Disadvantages of Internet‐based Social Support* , 2004 .

[55]  Richard Schulz,et al.  Effect of multicomponent interventions on caregiver burden and depression: the REACH multisite initiative at 6-month follow-up. , 2003, Psychology and aging.

[56]  S. Wisniewski,et al.  Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH). , 2003, Psychology and aging.

[57]  S. Czaja,et al.  The effect of a family therapy and technology-based intervention on caregiver depression. , 2003, The Gerontologist.

[58]  Richard N. Jones,et al.  Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. , 2003, The Gerontologist.

[59]  R. Spitzer,et al.  The PHQ-9: A new depression diagnostic and severity measure , 2002 .

[60]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[61]  G J Acton,et al.  Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis. , 2001, Research in nursing & health.

[62]  A. Steffen.  Anger management for dementia caregivers: A preliminary study using video and telephone interventions , 2000 .

[63]  R. Schulz,et al.  Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. , 1999, JAMA.

[64]  M. Irwin,et al.  Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D) , 1999, Archives of internal medicine.

[65]  B. Chang.  Cognitive-behavioral intervention for homebound caregivers of persons with dementia. , 1999, Nursing research.

[66]  R Goeree,et al.  Relation between severity of Alzheimer's disease and costs of caring. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[67]  Patricia Flatley Brennan,et al.  The Buffering Effect of a Computer Support Network on Caregiver Strain , 1998, Journal of aging and health.

[68]  S. Moore,et al.  The Effects of a Special Computer Network on Caregivers of Persons with Alzheimer's Disease , 1995, Nursing research.

[69]  P. Truax,et al.  Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. , 1992, Psychology and aging.

[70]  J. Pynoos,et al.  A model telephone information and support program for caregivers of Alzheimer's patients. , 1990, The Gerontologist.

[71]  S. W. Poulshock,et al.  Families caring for elders in residence: issues in the measurement of burden. , 1984, Journal of gerontology.

[72]  M P Lawton,et al.  A research and service oriented multilevel assessment instrument. , 1982, Journal of gerontology.

[73]  V. Leirer,et al.  Development and validation of a geriatric depression screening scale: a preliminary report. , 1982, Journal of psychiatric research.

[74]  S. Zarit,et al.  Relatives of the impaired elderly: correlates of feelings of burden. , 1980, The Gerontologist.

[75]  L. Radloff.  The CES-D Scale , 1977 .