Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T07:13:25.040Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care

Published online by Cambridge University Press:  23 January 2015

Mary Chiu ,
Tim Pauley ,
Virginia Wesson ,
Dunstan Pushpakumar  and
Joel Sadavoy
Mary Chiu*
Affiliation:
The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer's Support and Training, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Geriatric and General Psychiatry, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 3L9, Canada
Tim Pauley
Affiliation:
Department of Research and Evaluation, Toronto Central Community Care Access Centre, Toronto, Ontario, M5T 2Z5, Canada Department of Research and Evaluation, West Park Healthcare Centre, Toronto, Ontario, M6M 2J5, Canada
Virginia Wesson
Affiliation:
The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer's Support and Training, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Geriatric and General Psychiatry, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 3L9, Canada
Dunstan Pushpakumar
Affiliation:
The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer's Support and Training, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
Joel Sadavoy
Affiliation:
The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer's Support and Training, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Geriatric and General Psychiatry, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 3L9, Canada
*
Correspondence should be addressed to: Mary Chiu, Department of Psychiatry, The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer's Support and Training, Mount Sinai Hospital, 60 Murray Street, Room L1-012, Toronto, Ontario, M5G 1X5, Canada. Phone: +1-416-586-4800 x4104; Fax: +1-416-586-3231. Email: mchiu@mtsinai.on.ca.
Get access

Abstract

Background:

The value of care provided by informal carers in Canada is estimated at $26 billion annually (Hollander et al., 2009). However, carers’ needs are often overlooked, limiting their capacity to provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional distress and improve carers’ competence (Chiu et al., 2013). This study evaluated the effectiveness of problem-solving techniques-based intervention based on adapted PST methods, in enhancing carers’ physical and emotional capacity to care for relatives with dementia living in the community.

Methods:

56 carers were equally allocated to a problem-solving techniques-based intervention group or a control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC) who had been given advanced training in PS techniques-based intervention. Coping, mastery, competence, burden, and perceived stress of the carers were evaluated at baseline and post-intervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA was performed on the data.

Results:

Post-intervention measures completion rate was 82% and 92% for the intervention and control groups, respectively. Carers in the intervention group showed significantly improved task-oriented coping, mastery, and competence and significantly reduced emotion-oriented coping, burden and stress (p < 0.01–0.001). Control carers showed no change.

Conclusion:

PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-to-day caregiving, improves carers’ caregiving competence, coping, burden, and perceived stress. This may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence that establishing effective partnerships between inter-professional clinicians in academic clinical health science centers, and community agencies can extend the reach of the expertise of specialized health care institutions.

Keywords

carersbehavioral and psychological symptoms of dementiacommunity caretrainingcognitive behavioral therapy
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 6 , June 2015 , pp. 937 - 948
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S. et al. (2010). Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of General Psychiatry, 68, 33–41.CrossRefGoogle Scholar
Aneshensel, C., Pearlin, L., Mullan, J., Zarit, S. and Whitlatch, C. (1995). Profiles in Caregiving: the Unexpected Career, New York: Academic Press.Google Scholar
Bédard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A. and O’Donnell, M. (2001). The Zarit Burden interview: a new short version and screening version. The Gerontologist, 41, 652–657.CrossRefGoogle ScholarPubMed
Berry, J. W., Elliott, T. R., Grant, J. S., Edwards, G. and Fine, P. R. (2012). Does problem-solving training for family carers benefit their care recipients with severe disabilities? A latent growth model of the project CLUES randomized clinical trial. Rehabilitation Psychology, 57, 98–112.CrossRefGoogle Scholar
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217–228.Google Scholar
Canadian Institute for Health Information. (2010). Caring for seniors with Alzheimer's Disease and other forms of Dementia. Available at: http://www.cihi.ca.Google Scholar
Chiu, M., Wesson, V. and Sadavoy, J. (2013). Improving caregiving competence, stress coping, and mental well-being in family carers of individuals with dementia: piloting the reitman centre carers program. World Journal of Psychiatry, 3, 65–75.Google Scholar
Cohen, C. A., Colantonio, A. and Vernich, L. (2002). Positive aspects of caregiving: rounding out the caregiver experience. International Journal of Geriatric Psychiatry, 17, 184–188.Google Scholar
Donaldson, C. and Burns, A. (1999). Burden of Alzheimer's disease: helping the patient and caregiver. Journal of Geriatric Psychiatry and Neurology, 12, 21–28.CrossRefGoogle ScholarPubMed
Endler, N. S., Parker, J. D. and Butcher, J. N. (1993). A factor analytic study of coping styles and the MMPI-2 content scales. Journal of Clinical Psychology, 49, 523–527.Google Scholar
Gellis, Z. and Kenaley, B. (2008). Problem-solving therapy for depression in adults: a systematic review.Research on Social Work Practice, 18, 117–131.Google Scholar
George, L. and Gwyther, L. (1986). Caregiver well-being: a multidimensional examination of family caregivers of demented adults. The Gerontologist, 26, 253–259.CrossRefGoogle ScholarPubMed
Hirdes, J., Poss, J. and Curtin-Telegdi, N. (2008). The method for assigning priority levels (MAPLe): a new decision-support system for allocating home care resources. BioMedical Central Medicine, 6, 9.Google Scholar
Hollander, M., Liu, G. and Chappell, N. (2009). Who cares and how much? the imputed economic contribution to the Canadian healthcare system of middle-aged and older unpaid carers providing care to the elderly. Healthcare Quarterly, 12, 42–49.Google Scholar
Kramer, B. J. (1997). Gain in the caregiving experience: where are we? What next? The Gerontologist, 37, 218–232.Google Scholar
Malouff, J., Thorsteinsson, E. and Schutte, N. (2007). The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clinical Psychology Review, 27, 46–57.Google Scholar
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130–135.Google Scholar
Mynors-Wallis, L., Davies, I., Gray, A., Barbour, F. and Gath, D. (1997). A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care. British Journal of Psychiatry, 170, 113–119.Google Scholar
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist, 30, 583–594.Google Scholar
Prince, M., Prina, M. and Guerehet, M. (2013). World Alzheimer Report 2013: Journey of Caring—An Analysis of Long Term Care for Dementia. London, UK: Alzheimer's Disease International. Available at: http://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf.Google Scholar
Rivera, P., Elliott, T., Berry, J. and Grant, J. (2008). Problem-solving training for family carers of persons with traumatic brain injuries: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89, 931–941.Google Scholar
Sadavoy, J. and Wesson, V. (2012). Refining dementia intervention: the caregiver-patient dyad as the unit of care. Canadian Geriatrics Society Journal of Canadian Medical Education, 2, 5–10.Google Scholar
Sadavoy, J., Wesson, V. and Nelles, L. J. (2012). The Reitman Centre CARERS Program: A Training Manual for Health Professionals, Toronto, Ontario: Mount Sinai Hospital.Google Scholar
Schulz, R., O’Brien, A. T., Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. The Gerontologist, 35, 771–791.Google Scholar
Wimo, A. and Prince, M. (2010). World Alzheimer Report 2010: The Global Economic Impact of Dementia. London, UK: Alzheimer's Disease International. Available at: http://www.alz.co.uk/research/files/WorldAlzheimerReport2010.pdf.Google Scholar