Supporting Family Carers of Community-Dwelling Elder with Cognitive Decline: A Randomized Controlled Trial

Objective. Caring for a patient with cognitive decline has an important impact on the general well-being of family caregivers. Although highly appreciated, interventions in dementia home care remain mainly ineffective in terms of well-being. Consequently, in spite of an extensive support system, abrupt ending of home care remains more rule than exception. Method. The hypothesis was that the intervention of a care counselor, coordinating care in quasi-unstructured way during one year, will alleviate caregivers' feelings of depression. The study population was composed of community-dwelling patients with cognitive decline. A care counselor was at the exclusive disposal of the intervention group. Primary outcome measure was caregiver depression. Results. Finally, depression was 6.25 times less frequent in the intervention group. The actual intervention appeared minimal with only ten applications for more support followed by only three interventions effectively carried out. Although caregivers felt burdened and depressed, formal support remained stable. On the other hand, the availability of the care counselor made caregivers feel less depressed with the same amount of support. Conclusion. Carers do not always need to be surrounded with more professionals, but they want to feel more supported. In terms of policy, this could have some important implications

Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review

Dementia caregivers suffer a considerable care burden. More than in comparable groups of caregivers or peers, they are confronted with feelings of depression and decreased physical health. Although many studies are set up to determine the link between the stressors in dementia care-giving and the impact on the family caregiver, the results remained inconclusive. Others, depression in caregivers remains the main cause of a premature or acute ending of home care.The aim of this systematic literature review was to analyse what factors determine the development of depression in caregivers of elderly patients with dementia. Depression was taken as primary outcome as it is shown to be the main reason for caregivers to abandon home care.Depression occurs in one in three of caregivers and it occurs more frequently in those who care for patients with dementia than in caregivers of patients with other chronic illnesses.Caregiver characteristics rather than objective care needs of the patients tend to be responsible for the onset of depression. Future research should concentrate on demonstrating links between negative feelings in caregivers and the way the care situation evolves. This can have important implications in home care support

Supporting the dementia family caregiver: The effect of home care intervention on general well-being

Although high volumes of literature have been written on interventions in dementia home care, only a poor efficiency has been proved. Nevertheless, caregivers often express strong feelings of satisfaction about the proposed support. In this meta-analytic review, a quantitative analysis of the effect of the different types of professional dementia home care interventions was made.A systematic literature search, covering the years 1980 until 2007, was performed using Medline, Embase, Cochrane DSR, Dare, CCTR, and ACP Journal Club). Limitations on publication type were determined as randomized controlled trial and controlled trial.Psychosocial intervention in dementia home care was found to be beneficial in a non-significant way on caregivers' burden. An almost negligible decrease in depression was found in the psychosocial intervention arm while multidisciplinary case management contributed to a larger though insignificant decrease of depression in caregivers. Respite care was responsible for an increase in burden.This review demonstrated, in accordance with other qualitative reviews, the weak evidence that supporting family caregivers could be beneficial. Although the rather small benefits of formal support, supporting family caregivers is an indispensable issue in dementia home care. Professional caregivers should keep in mind that family caregivers highly appreciate the intervention and that they feel less burdened or depressed in the short time follow up but that premature home care remains more rule than exception

Relation entre les troubles psychologiques et comportementaux de la démence et le stade évolutif

Qualide

Evaluation des troubles psychologiques et comportementaux chez des personnes âgées démentes et non démentes

Qualide

Persistance des troubles psychologiques et comportementaux de la démence

est considérable. Actuellement, la sélection d’un traitement dépend de la nature du trouble et de son intensité. La connaissance de leur persistance s’avère importante pour la sélection et l’organisation du traitement. Objectifs: Evaluer la persistance des troubles psychologiques et comportementaux dans une population de sujets déments suivis longitudinalement. Méthodes: Nous avons sélectionné 104 sujets déments issus de l’étude Qualidem (Paquay et al., 2004). Tous les sujets sont institutionnalisés et présentent des perturbations cognitives (score MMSE<20). Les troubles psychologiques et comportementaux ont été évalués à 12 mois d’intervalle avec le Neuropsychiatric Inventory (Cummings et al., 1997). Résultats: Les perturbations les plus persistantes sont les idées délirantes (62%), et l’agitation (67%). Le risque de rechute est moins important pour la dépression (54%), les hallucinations (44%), l’exaltation de l’humeur (43%), l’apathie (48%), l’irritabilité (52%), et le comportement moteur aberrant (52%). L’anxiété (38%), la désinhibition (39%), les troubles du sommeil (39%) et de l’appétit (38%) sont les moins persistants. Conclusion: La nature persistante de l’agitation et des idées délirantes suggère que le traitement de ces perturbations doit être prolongé. La nature ponctuelle de l’anxiété, la désinhibition et des troubles de l’appétit et du sommeil suggère qu’un traitement à court terme est plus approprié pour ces perturbations. Ces résultats sont à interpréter par rapport à la définition des troubles induite par le NPI.Qualide

Impact des troubles psychologiques et comportementaux sur la qualité de vie des personnes démentes

Qualide