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Spiers G, Tan MMC, Astbury JL, Hall A, Ahmed N, Lanyi K, Williams O, Beyer F, Craig D, Hanratty B. What works to support carers of older people and older carers? an international evidence map of interventions and outcomes. BMC Geriatr 2024; 24:301. [PMID: 38553679 PMCID: PMC10979610 DOI: 10.1186/s12877-024-04897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence. METHODS Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years). FINDINGS 205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers' mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers' physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes. CONCLUSION Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers' physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.
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Affiliation(s)
- Gemma Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michelle M C Tan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jayne L Astbury
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Nisar Ahmed
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kate Lanyi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oleta Williams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Thai GH, Rivette S, Sharman J, Epps F, Masoud S. Dementia Caregiver Experiences: Insights From a Telephone-Based Support Program. J Appl Gerontol 2024:7334648241234745. [PMID: 38459827 DOI: 10.1177/07334648241234745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
Dementia caregivers face daunting challenges as both the oldest subpopulation of those providing unpaid care and the most at risk of adverse health outcomes as a result of their role, including depression, anxiety, and increased mortality. To better understand the experiences and needs of dementia caregivers, a qualitative content analysis was conducted of secondary data extracted from call logs (N = 569) recorded by a provider-initiated, telephone-based support program. Experiences identified from the call logs were coded, categorized, and ranked to determine the most prevalent dementia caregiving-related experiences. Features of the program, particularly the semi-structured call format and directionality of calls, helped to uniquely capture common experiences of family caregivers and their day-to-day concerns. Findings from this analysis reflect the high prevalence of caregiver mental and emotional health-related concerns. This analysis supports the development of interventions that align with the experiences of dementia caregivers.
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Affiliation(s)
- Glory H Thai
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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3
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Lee H, Lee H, Lim H. Sleep Quality of Family Caregivers of Children With Tracheostomies or Home Ventilators: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:368-381. [PMID: 37039276 DOI: 10.1177/10748407231157406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Family caregivers of children with tracheostomies or home ventilators are more likely to experience poor sleep quality when undertaking the full responsibility of caring for fragile children. This scoping review aimed to identify the sleep quality, related factors, and their impact on the health of family caregivers of children with tracheostomies or home ventilators. The included studies (N = 16) were retrieved through PubMed, CINAHL, Cochrane Library, Embase, PsycINFO, and Web of Science. Family caregivers' sleep were low in quality, frequently disturbed, and insufficient. Their sleep quality was related to fatigue, anxiety, depression, family functioning, and health-related quality of life. The sleep disturbing factors were classified as child, caregiver, or environment-related, which were mutually interrelated. This review emphasizes the need to develop nursing interventions to both improve the sleep quality of family caregivers and the health of children with tracheostomies or home ventilators based on an in-depth understanding of the family's context.
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Fabius CD, Millar R, Geil E, Stockwell I, Diehl C, Johnston D, Gallo JJ, Wolff JL. The Role of Dementia and Residential Service Agency Characteristics in the Care Experiences of Maryland Medicaid Home and Community-Based Service Participants and Family and Unpaid Caregivers. J Appl Gerontol 2023; 42:627-638. [PMID: 36200297 PMCID: PMC9991935 DOI: 10.1177/07334648221128286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022] Open
Abstract
In Maryland, residential service agencies deliver Medicaid Home and Community-Based Services (HCBS) to older adults with disabilities through direct care workers (e.g., personal care aides). Leveraging survey data from residential service agency administrators, linked to interRAI Home Care assessments for 1144 participants, we describe agency characteristics, and participant and family caregiver experiences by participant dementia status. Most (61.7%) participants experienced low social engagement, and roughly 10.0% experienced a hospitalization or emergency room visit within 90 days. Few (14.4%) participants were served by agencies requiring dementia-specific direct care worker training, and most were served by agencies offering supplemental services, or in which direct care workers helped with health information technology (81.2% and 72.8%, respectively). Few caregivers reported negative care experiences. Participants with dementia and those served by agencies with training and support more often reported negative care experiences. Findings lay the foundation for future longitudinal and embedded interventions within Medicaid HCBS.
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Affiliation(s)
- Chanee D Fabius
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Erick Geil
- 51575The Hilltop Institute, Baltimore, MD, USA
| | | | | | | | - Joseph J Gallo
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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5
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Jiménez S, Bueno B, Navarro AB. Do the caregiving spouses of people with dementia in Spain perceive the same barriers for taking part in interventions as caregiving offspring? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2385-e2394. [PMID: 34890481 DOI: 10.1111/hsc.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
The aim of this qualitative research is to examine the difficulties perceived by caregivers for taking part in an offered intervention, exploring whether there are differences depending on caregiver's degree of kinship. Forty-two family caregivers from Salamanca (Spain) were interviewed after declining an invitation to take part in an intervention programme. All the telephone conversations were transcribed verbatim. The transcriptions were subject to a thematic content analysis using QDA MINER software. The barriers identified were (1) difficulties adapting to the intervention's schedule due to a lack of time, or incompatibility with its dates or timetables, (2) belief among the caregivers that they do not need or are not interested in the support the intervention provides, (3) impossibility to separate from the family member to attend due to the absence of relief or a feeling of guilt, (4) caregiver's health issues, (5) difficulties with accessibility, and (6) belief that the therapies serve no useful purpose. Certain differences were identified depending on the caregiver's kinship. Understanding the difficulties caregivers face for taking part in the interventions will enable steps to be taken to remove and/or reduce such barriers, whereby more caregivers will benefit from interventions.
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Affiliation(s)
- Sara Jiménez
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
| | - Belén Bueno
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
| | - Ana B Navarro
- Departamento de Psicología Evolutiva y de la Educación, Facultad de Psicología, Universidad de Salamanca, Salamanca, Spain
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6
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Lee K, Tang W, Cassidy J, Seo CH, Zhao J, Horowitz A. The impact of formal and informal support on emotional stress among non-co-resident caregivers of persons with dementia. Aging Ment Health 2022; 26:1604-1612. [PMID: 34114901 DOI: 10.1080/13607863.2021.1935460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the prevalence of formal and informal support between non-co-resident and co-resident family caregivers of persons with dementia and to investigate the impact of receiving formal or informal assistance on family caregivers' residential status and their perceived emotional stress. METHOD We used secondary data from the 2018 National Survey of Older American Act conducted by the Administration for Community Living. We selected 751 primary family caregivers of persons with dementia and conducted regression analyses to explore our research questions. RESULTS Non-co-resident caregivers of persons with dementia were younger, racially and ethnically diverse, employed, and had higher income than co-resident caregivers. They were less likely to utilize formal support, such as caregiver training or education (p = .005) and respite care (p = .019) but more likely to rely on informal support in their social networks (p = .002), compared to co-resident caregivers. Non-co-resident caregivers who had better informal support systems showed less emotional stress than co-resident caregivers (p = .024). CONCLUSION Findings from our study suggest the importance of engaging informal networks to alleviate emotional stress of non-co-resident caregivers of persons with dementia. Furthermore, it is critical to help them utilize adequate caregiver training and education as well as respite care before their loved ones experience dramatic functional and health declines.
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Affiliation(s)
- Kathy Lee
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Weizhou Tang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Jessica Cassidy
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Chang Hyun Seo
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Joe Zhao
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, NY, USA
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7
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Caulfield M, Seddon D, Williams S, Hedd Jones C. Planning, commissioning and delivering bespoke short breaks for carers and their partner living with dementia: Challenges and opportunities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1255-e1267. [PMID: 34363262 DOI: 10.1111/hsc.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/17/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly, there is growing policy and practice interest in short breaks provision to address the diversity of carer break needs and preferences and deliver meaningful outcomes for carers and those they support. This paper reports findings from qualitative staff interviews that offered strategic and operational insights into short breaks provision. It presents a dynamic model of the short break landscape in a region of Wales, describing factors shaping local and regional decision-making. The model identifies key challenges (barriers) and opportunities (enablers) that shape the planning, commissioning and delivery of bespoke short breaks for spousal carers and their partner living with dementia. Through highlighting the interplay between complex context-specific processes and contingences, the model informs initial theory development in short breaks provision.
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Affiliation(s)
- Maria Caulfield
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Diane Seddon
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
- Centre for Ageing and Dementia Research (CADR), DSDC Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Sion Williams
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
| | - Catrin Hedd Jones
- Ageing & Dementia @ Bangor, Dementia Services Development Centre (DSDC) Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
- Centre for Ageing and Dementia Research (CADR), DSDC Wales Research Centre, School of Health Sciences, Bangor University, Gwynedd, Wales, UK
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8
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Lee Y, Choi W, Park MS. Respite Service Use Among Dementia and Nondementia Caregivers: Findings From the National Caregiving in the U.S. 2015 Survey. J Appl Gerontol 2022; 41:1557-1567. [PMID: 35303780 DOI: 10.1177/07334648221075620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined factors related to respite service use among caregivers and further tested the moderating effect of dementia caregiver status in these relationships using nationally representative U.S. data. Logistic regression analyses were conducted among 1203 caregivers (276 dementia and 927 nondementia caregivers). Caregivers' race and ethnicity as a predisposing factor, caregivers' self-rated health as an enabling factor, and care recipients' living arrangement and functional limitations as need factors were significantly related to respite service use. Moreover, dementia caregiver status moderated the association between enabling factors (i.e., household income, work status, and self-rated health) and respite service use. Our findings imply that dementia caregivers may be more in need of respite service use than nondementia caregivers when they have limited enabling factors (e.g., lower household income, nonworking status, poorer health). Policy and practice efforts that specifically support enabling factors are suggested to promote more respite service use among dementia caregivers.
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Affiliation(s)
- Yura Lee
- Department of Social Work, Helen Bader School of Social Welfare, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Wonchan Choi
- School of Information Studies, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Min Sook Park
- School of Information Studies, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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9
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Liao YH, Ku LJE, Liu LF, Li CY. The Effects of in-Home Respite Care on the Burden of Caregivers in Taiwan. J Appl Gerontol 2022; 41:1283-1292. [PMID: 35236155 DOI: 10.1177/07334648211073876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The utilization rate of respite care in Taiwan is low, and past studies that evaluated the effects of in-home respite care on caregiver burden are few. This two-wave panel study used Taiwan's long-term care plan 1.0 database and included 2342 care recipient-caregiver dyads who used home services to examine the impact of in-home respite care on caregiver burden. Propensity score matching was used to select 323 in-home respite service users matched with 646 nonusers as control groups (1:2 matching). The mixed effect model was applied to estimate the effects of receiving in-home respite care on caregiver burden. Results showed that compared with those of nonusers, caregiver burden scores of service users decreased significantly after receiving in-home respite care for more than 14 days (adjusted B = -0.14, SE = 0.05). The government should prioritize increasing the number of days of in-home respite care for those in need to reduce the caregiver burden.
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Affiliation(s)
- Yi-Han Liao
- Department of Public Health, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Li-Jung Elizabeth Ku
- Institute of Gerontology, College of Medicine, 38026National Cheng Kung University, Tainan, Taiwan
| | - Li-Fan Liu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taichung, Taiwan
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10
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Falzarano FB, Cimarolli V, Boerner K, Siedlecki KL, Horowitz A. Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers. THE GERONTOLOGIST 2022; 62:252-261. [PMID: 34166493 PMCID: PMC8827323 DOI: 10.1093/geront/gnab088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services. RESEARCH DESIGN AND METHODS The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services. RESULTS Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains. DISCUSSION AND IMPLICATIONS Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.
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Affiliation(s)
- Francesca B Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts Boston, USA
| | | | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, New York, USA
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Ha NHL, Yap Lin Kiat P, Nicholas SO, Chan I, Wee SL. Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia. Dement Geriatr Cogn Disord 2021; 49:598-603. [PMID: 33271552 DOI: 10.1159/000512290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. METHODS CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita. RESULTS CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alz-heimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0. DISCUSSION CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.
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Affiliation(s)
| | - Philip Yap Lin Kiat
- Geriatric Education and Research Institute, Singapore, Singapore, .,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore,
| | | | - Ivana Chan
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore.,Health and Social Science Cluster, Singapore Institute of Technology, Singapore, Singapore.,Program in Health Services and System Research, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Vandepitte S, Putman K, Van Den Noortgate N, Verhaeghe N, Annemans L. Cost-effectiveness of an in-home respite care program to support informal caregivers of persons with dementia: A model-based analysis. Int J Geriatr Psychiatry 2020; 35:601-609. [PMID: 32011773 DOI: 10.1002/gps.5276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/20/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate cost-effectiveness of an in-home respite care program in addition to standard community-based dementia care to support informal caregivers of persons with dementia compared with standard community-based dementia care. METHODS An age-dependent decision-analytic Markov model was applied from a third-party payer and a societal perspective projecting results of a quasi-experimental study over a time horizon of 5 years assuming a repetition of the program every 6 months. Additionally, to deal with uncertainty and to test robustness of the model scenario, one-way and probabilistic sensitivity analyses were conducted. RESULTS Implementing the program resulted in a quality-adjusted life year (QALY) gain of 0.14 in favor of the invention group compared with controls and an incremental cost of 1270€ from the third-party payer perspective and of 1220€ from the societal perspective. Next, an incremental cost-effectiveness ratio of 9042€/QALY and of 8690€/QALY was found in the base case, from the third-party payer perspective and the societal perspective, respectively. The scenario, one-way sensitivity, and probabilistic analyses demonstrated robustness of the base-case results. CONCLUSION This cost-effectiveness analysis suggests that an in-home respite care program in addition to standard community-based dementia care is a cost-effective approach compared with standard community-based dementia care only. These findings provide more insight into the value of such services for the patient, the caregiver, and for society.
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Affiliation(s)
- Sophie Vandepitte
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Koen Putman
- Faculty of Medicine and Pharmacy, Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
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Petrovic M, Gaggioli A. Digital Mental Health Tools for Caregivers of Older Adults-A Scoping Review. Front Public Health 2020; 8:128. [PMID: 32411643 PMCID: PMC7198719 DOI: 10.3389/fpubh.2020.00128] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/30/2020] [Indexed: 01/25/2023] Open
Abstract
Aim: Informal caregivers have an important role in bridging the gap between the assistance care recipients need and what can be provided by the health care systems across Europe. The burden of the caregiving role places a significant threat to caregiver health, and the vast majority of caregiver's report stress and emotional strain, depression, and increased rates of chronic diseases. In line with this, strengthening the caregiver's mental health is one of the main goals for optimal caregiving. Caregivers already struggle with the demand of their role while coping with health problems, social, family, and work obligations. The solution for the caregiver's mental health needs to be accessible, low cost, and time-effective. This scoping review investigates digital mental health tools available as a mean of supporting the mental health of caregivers. Method: Databases searched include Summon search box, the Cochrane Library, and PubMed. Three groups of keywords were combined: relating to digital mental health interventions for caregivers, digital mental health interventions and stress in elderly care, and digital mental health interventions and burden in elderly care. Results: Caregivers reported that digital mental health tools have an overall positive role in their health. Coping skills, emotion regulation, skill building, and education are found to be important aspects of digital mental health tools. There was a noted lack of digital mental health apps available specifically for the caregiver of older adults. Furthermore, the digital mental health tools, divided into three categories in this review, focused either on building skills or educating caregivers and assisting with the duties rather than the mental health of the caregiver itself. As repeatedly suggested in the reviewed studies, digital mental health interventions overall contribute to reducing the caregiver burden with a limitation of addressing one aspect of caregiver needs –i.e., specific coping skills or education regarding illnesses such as Alzheimer's disease and Dementia. The lack of all-encompassing, data and theory-driven digital mental health tools for addressing and supporting the caregiver's mental health is evident.
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Affiliation(s)
- Milica Petrovic
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy
| | - Andrea Gaggioli
- Department of Psychology, Catholic University of Sacred Heart, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano (IRCCS), Milan, Italy
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Vandepitte S, Van Wilder L, Putman K, Van Den Noortgate N, Verhaeghe S, Trybou J, Annemans L. Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study. BMC Geriatr 2020; 20:18. [PMID: 31948386 PMCID: PMC6966839 DOI: 10.1186/s12877-020-1414-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. Methods Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. Results The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 – € 2545) per person from a societal perspective and at € 968 (95% CI € 825 – € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. Conclusions Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care. Trial registration Clinicaltrials.gov NCT02630446, December 15, 2015.
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Affiliation(s)
- S Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - L Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - K Putman
- Faculty of Medicine and Pharmacy, Department of Medical Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Van Den Noortgate
- Department of Internal medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - S Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - J Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - L Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Reply to: “Informal caregiver quality of life in a palliative oncology population”. Support Care Cancer 2019; 27:4387-4388. [DOI: 10.1007/s00520-019-05032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
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