||Thompson, C. A., Spilsbury, K., Hall, J., Birks, Y., Barnes, C., & Adamson, J. (2007). Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatrics, 7(1), 18.
||Background: Dementia is an important health and social care problem and is one of the main causes of disability in later life. The number of families affected by dementia will dramatically increase over the next five decades. Despite the implications for health and social care services in the future, the overwhelming majority of care for people with dementia takes place away from health care settings. Providing informal care for someone with dementia can be psychologically, physically and financially expensive and a range of health service interventions aimed at supporting and providing information to these carers has developed to help carers meet these demands.
Objective: To review research on information and support interventions designed to improve the quality of life of people caring for individuals with dementia.
Search strategy: Trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group during November 2003 and October 2005 using the terms: computer*, telephon*, training*, education*, information, "care-planning", carer*, caregiv*. Databases included in the Specialized Register were Cochrane Central Register of Controlled Trial, Current Controlled trials, ClinicalTrials.gov, MEDLINE, EMBASE, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SIGLE (Grey Literature in Europe), ISTP (Index to Scientific and Technical Proceedings), INSIDE (BL database of Conference Proceedings and Journals), Aslib Index to Theses (UK and Ireland theses), Dissertation Abstract (USA), ADEAR (Alzheimer's Disease Clinical Trials Database), Alzheimer Society, South Australian Network for Research on Ageing, US Dept of Veterans Affairs Cooperative Studies, National Institutes of Health (NIH), GlaxoSmithKline, Schering Health Care Ltd, Hong Kong Health Services Research Fund, Medical Research Council (MRC), National Research Register, NHS R&D Health Technology Assessment Programme, and LILACS: Latin American and Carribbean Health Science Literature. No language restrictions were imposed. Citation searches for key papers, reference checking and contact with authors to obtain further details (where necessary) were all undertaken.
Selection criteria: Studies were included that 1) were randomized control trials, 2) involved principal caregiver and care recipient dyads, 3) involved an information and/or support intervention, and 4) measured patient outcomes, caregiver outcomes, economic outcomes, and/or health service utilization outcomes.
Data collection and analysis: A total of 141 relevant titles and abstracts were identified. Each of the authors independently reviewed and rated each study using a quality assessment rubric. Any disagreements were resolved with a third party.
Results: Forty-four studies were included in the review. Controlling for the quality of the evidence, the authors found statistically significant evidence that group-based supportive interventions impact positively on psychological morbidity. However, whilst the improvement was unlikely to be due to chance, the clinical significance of this finding should be interpreted tentatively, due to the difficulties in interpreting the standardized mean difference as a measure of effect and the complex etiology of depression. No evidence was found for the effectiveness of any other form of intervention on a range of physical and psychological health outcomes.
Conclusions: There is little evidence that interventions aimed at supporting and/or providing information to carers of people with dementia are uniformly effective. There is a pressing need to ensure that supportive interventions at the development stage are accompanied by good quality randomized evaluations in which outcomes that are important to clinicians and carers are measured.