BMC geriatrics
Par Conradsson M, Olofsson B, Holmberg H et 4 autres.
Contenu en anglais
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To improve the situation of informal caregivers, both supportive efforts for caregiver and rehabilitation for the person with dementia, may be needed. This randomized controlled pilot trial evaluated, among caregivers, the feasibility of a person-centred multidimensional interdisciplinary rehabilitation program for community-dwelling people with dementia that incorporated an education and support intervention for informal caregivers.
Informal caregivers were randomized alongside the person with dementia to an intervention group (n=36) or usual care (n=31). Multiprofessional team rehabilitation for individuals with dementia and support for caregivers, were offered for one 20-week and two 4-week follow-up periods after 5 and 14 months. Caregivers were offered assessments, participation in group sessions, and individual support. After the last group session, scheduled during the last four weeks of the 20-week period, a survey was distributed. Attendance at group sessions and uptake of individual support were recorded. Blinded assessments of caregiver burden (Caregiver Burden Scale, CBS), depressive symptoms (Geriatric Depression Scale 15-item version, GDS) and health-related quality of life (Short Form 36-Health Survey, SF-36), were performed at baseline and after 5, 12, 24, and 36 months.
Thirty-seven participants (56%) were spouses and 26 (39%) were adult children. Participation rate in assessments of outcomes at 36 months was 100% and 87% for intervention and control group in GDS and SF-36, respectively, and 69% and 61% for CBS, respectively. Missing data were primarily due to mortality. All caregivers in the intervention group (n=36) were assessed, and all received individual interventions by team staff. Twenty-three caregivers attended group sessions, and 21 completed a survey after the last session. Twenty (95%) caregivers reported increased knowledge about supporting the person with dementia, and 19 (90%) improved coping strategies. No significant differences were observed between groups in depressive symptoms or caregiver burden, yet differences in favour of the control group were seen in subscales of health-related quality of life at 24 and 36 months.
The program, combining rehabilitation for the person with dementia with caregiver support, seems feasible regarding caregivers' participation in the intervention and study evaluation, and thus further evaluation in an adequately powered randomized controlled trial seems relevant. A future definitive trial should evaluate continuous support over a longer period adapted to the caregiver and refine assessment procedures, including conducting assessments during ongoing interventions to provide greater insights into rehabilitation and caregiver-support effects.
The study protocol is published online 04/11/2015 at http://www.isrctn.com/ISRCTN59155421.
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