Telephone-Based Behavioral Activation for Improving Sleep Quality in Family Caregivers of People With Dementia: A Pilot Randomized Controlled Trial

Negative Consequences of Sleep Deprivation Experienced by Informal Caregivers of People With Dementia on Caregivers and Care Recipients: A Scoping Review

AIMS

This study aimed to summarise the results of research concerning the impact of sleep deprivation among informal caregivers of People with Dementia (PwD) and their care recipients.

METHODS

This was a scoping review and followed the PRISMA Scoping Review guideline. Seven electronic databases were searched, and all studies that provided information regarding any outcomes related to sleep deprivation among informal caregivers of PwD published before July 2022 were included.

RESULTS

Sixty studies were identified. Mental and physical effects caused by caregivers' sleep deprivation have been observed. Biomarkers of stress, cognitive functions, immune system functions, and mental status, including burden, depression, and distress, were most frequently mentioned in caregivers with regards to sleep deprivation. As for PwD, mental health indicators like depression and behavioural change were related to sleep deprivation of caregivers. The relationship between caregivers and PwD, as well as the family's financial situation change were also identified.

CONCLUSION

Sleep deprivation in caregivers of PwD harms both parties, underscoring the need for adequate caregiver rest and interventions targeting sleep issues. Future research should explore more care factors and standardise sleep deprivation metrics, improving support for caregivers and patient care.

Multicomponent Intervention for Distressed Informal Caregivers of People With Dementia: A Randomized Clinical Trial

Importance

Multicomponent interventions for informal caregivers of people with dementia are urgently needed, but evidence regarding which components are most effective is lacking.

Objective

To apply a multiphase optimization strategy to examine the effects of 5 psychosocial components of an intervention designed to support informal caregivers of people with dementia.

Design, Setting, and Participants

In this assessor-blinded randomized clinical trial with a fractional factorial design, Chinese community-dwelling adults (aged ≥18 years) who were informal family caregivers of people with dementia were screened between July 2 and December 28, 2022, in Hong Kong. Eligible participants with elevated depression or caregiving burden were included and randomized to 1 of 16 experimental conditions. Assessments were conducted at baseline, 6 months, and 12 months. The last 12-month follow-up assessment was conducted on February 26, 2024.

Interventions

The intervention involved a core component (dementia caregiving education) and 5 tested psychosocial components (self-care skills [SC], behavioral problem management [BPM], behavioral activation [BA], mindfulness-based intervention [MBI], and support group [SG]).

Main Outcomes and Measures

Primary outcomes for each tested psychosocial component were physical health (12-item Short-Form Health Survey), caregiver burden (12-item Zarit Burden Interview) and stress (10-item Perceived Stress Scale), psychological well-being (Ryff Psychological Well-Being Scale), anxiety (Hospital Anxiety and Depression Scale-Anxiety Subscale), depressive symptoms (9-item Patient Health Questionnaire), and social support (20-item Medical Outcomes Study Social Support Survey). Multiple linear regression models were used to analyze score changes from baseline to 6 months and from baseline to 12 months for primary and proximal outcomes across the 5 components.

Results

This trial included 250 caregivers (mean [SD] age, 48.9 [13.8] years); most (171 [68.4%]) were female. The MBI component significantly improved multiple caregiver outcomes, with reduced depressive symptoms (β = -2.13 [95% CI, -2.85 to -1.38]; P < .001) and increased mindfulness (β = 4.23 [95% CI, 2.27-6.36]; P < .001), perceived social support (β = 4.76 [95% CI, 1.28-8.15]; P = .007), and active dementia care management (β = 3.70 [95% CI, 1.80-5.66]; P < .001) at 12 months. The SG component significantly improved perceived social support (β = 4.63 [95% CI, 1.32-7.85]; P = .006) at 12 months. BPM had mixed effects; that is, it initially increased caregiver anxiety (β = 1.43 [95% CI, 0.43-2.42]; P = .005) and self-care risk (β = -1.12 [95% CI, -1.82 to -0.43]; P = .002) at 6 months but improved dementia care strategies in terms of encouragement (β = 2.49 [95% CI, 0.74-4.22]; P = .005), active management (β = 5.99 [95% CI, 4.12-7.84]; P < .001), and psychological well-being (β = 3.52 [95% CI, 0.92-6.08]; P = .008) at 12 months. Interaction effects were observed, with the MBI component enhancing the benefits of SC (β = -1.70 [95% CI, -3.05 to -0.35]; P = .01) and BPM (β = -1.40 [95% CI, -2.76 to -0.05]; P = .04) on depression; meanwhile, the MBI and SG components synergistically improved perceived social support (β = 7.58 [95% CI, 0.90-14.26]; P = .03).

Conclusions and Relevance

In this clinical trial of informal caregivers of people with dementia, synergistic interaction effects were noted for MBI, which enhanced the benefits of SC and BPM on depression. The combination of the MBI and SG components also synergistically improved social support. Integrating MBI with SC, SG, or BPM components was an effective multicomponent approach to support caregivers in this study, although ongoing support was needed to mitigate potential short-term risks. Further research is required to validate the efficacy of this optimized intervention package.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR2300071235.

Completeness of Telehealth Interventions Reporting in Randomized Controlled Trials for Caregivers of People With Dementia: Systematic Review

BACKGROUND

Telehealth interventions can effectively support caregivers of people with dementia by providing care and improving their health outcomes. However, to successfully translate research into clinical practice, the content and details of the interventions must be sufficiently reported in published papers.

OBJECTIVE

This study aims to evaluate the completeness of a telehealth intervention reporting in randomized controlled trials (RCTs) conducted for caregivers of people with dementia.

METHODS

A systematic search of relevant papers was conducted on July 26, 2023, in 9 electronic databases. RCTs of telehealth interventions for caregivers of people with dementia were included. Two independent researchers extracted the descriptive information and assessed the methodological quality (Cochrane risk of bias tool) and the completeness of reporting of the intervention by using the Template for Intervention Description and Replication (TIDieR)-Telehealth checklist, which consists of 12 items.

RESULTS

Thirty-eight eligible RCTs were included finally, and the overall quality of the studies was assessed as moderate. None of the studies completely reported all the TIDieR-Telehealth items. The most frequently reported items were the brief trial name (35/38, 92%), rationale (38/38, 100%), materials and procedures (35/38, 92%), and the modes of delivery (34/38, 90%). The least reported items were the type of location (0/38, 0%), modifications (4/38, 11%), and assessment and improvement of fidelity (9/38, 24%).

CONCLUSIONS

Many details of the telehealth interventions in RCTs are reported incompletely. Greater adherence to the TIDieR-Telehealth checklist is essential for improving the reporting quality and for facilitating replicability, which has substantial implications for translation into clinical practice.

Exploring the impact and mechanisms of behavioral activation on sleep disorders in colorectal cancer: a randomized controlled trial

BACKGROUND

Colorectal cancer (CRC) patients frequently experience sleep disturbances, significantly impacting their quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment but is often complex, costly, and requires highly trained therapists. Behavioral activation (BA), derived from cognitive behavioral therapy (CBT), offers a flexible, simple, and cost-effective alternative. BA highlights the importance of activation, a strategy that encourages active participation in positive, meaningful activities to boost positive experiences and reduce negative emotions, which may have potential benefits for individuals with sleep disorders. This study explores the effects of BA on sleep disturbances, quality of life, and psychological distress in CRC patients and investigates potential underlying mechanisms.

METHODS

The study included 101 CRC patients with sleep disturbances, who were randomly assigned to either the BA group (n = 53) or the usual care (UC) group (n = 48). Assessments of quality of life, sleep disturbances, psychological distress, activation, avoidance, and physical activity levels were conducted at baseline (T0), four weeks later (T1), and post-intervention (T2). Generalized estimating equation (GEE) analysis was used to evaluate the intervention's impact and potential mediating effects.

RESULTS

The BA group experienced significant improvements in sleep disturbances (Wald's χ2 = 7.979, P = 0.019), enhanced quality of life (Wald's χ2 = 6.435.P = 0.04), and reduced psychological distress (Wald's χ2 = 56.728, P < 0.001) compared to the UC group. Physical activity (P < 0.001) partially mediated the intervention effects of BA on sleep disturbances, while activation (P = 0.073) demonstrated marginal mediating effects.

CONCLUSION

BA is an effective psychological intervention that significantly improves sleep disturbances, enhances quality of life, and alleviates psychological distress in CRC patients. Mediator analysis indicates that physical activity partially mediates the effects of BA on sleep disturbances, with activation showing marginal significance. Future research should further investigate the underlying mechanisms and long-term effects of BA on sleep disturbances.

Behavioral activation is associated with post-disaster mental health: Secondary longitudinal analysis from a population-based study

OBJECTIVE

Interventions in post-disaster environments may be accelerated by identifying protective behavioral factors adding incremental value to models of psychopathology using longitudinal methods. One protective behavior applicable to post-disaster contexts is behavioral activation (BA). BA is defined here as a behavioral pattern involving presence of valued activity engagement. While relevant post-disaster, the incremental value of BA behaviors in predicting longitudinal post-disaster outcomes is not well understood. We hypothesized that higher baseline engagement in behaviors consistent with a BA framework would predict decreased posttraumatic stress disorder (PTSD) symptom severity, depression symptom severity, and sleep disturbance approximately 3, 6, and 12 months after hurricane survivors completed baseline measures.

METHODS

The current study is a secondary analysis from a randomized controlled trial of a disaster mental health digital intervention. Participants completed surveys at baseline and approximately 3, 6, and 12 months post-enrollment. Correlations and hierarchical regression analyses were calculated following data screening to predict PTSD symptom severity, depression symptom severity, and sleep disturbances.

RESULTS

Controlling for alcohol use, prior trauma, displacement, and intervention condition, higher baseline BA consistently predicted less PTSD symptom severity, depression symptom severity, and sleep disturbances.

CONCLUSION

Results suggest that post-disaster interventions should consider addressing BA. The study provides evidence that BA is potentially an important protective factor longitudinally predicting sleep disturbances and psychopathology after natural disasters.

The relationship between burden and caregiver's sleep disturbances in dementia: a systematic review

Caregivers of people living with dementia (PLwD) have a high burden degree that leads to health issues, including sleep.

Objective

This study aimed to analyze the impacts of the caregiving burden on caregiver's sleep disturbances.

Methods

This systematic review involved a qualitative analysis of publications on Web of Science and Pubmed/Medline databases published between February 2018 and August 2022.

Results

A total of 27 studies were identified and analyzed. Caregiver's sleep presents impairments in sleep latency, sleep fragmentation, sleep duration, subjective sleep quality, daytime dysfunction, and insomnia. Caregiver's distress and depressive symptoms have a dual relationship with sleep problems.

Conclusion

Sleep disturbances presented by caregivers are correlated with higher burden levels and lead to more vulnerability to psychiatric symptoms and health issues.

Association of leisure activity changes and reversion from mild cognitive impairment to normal cognitive function among older adults: A prospective cohort study

Background

Older adults with mild cognitive impairment (MCI) have the possibility of reverting to normal cognitive function. Leisure activity engagement (LAE) plays a critical role in the progress of the cognitive function. A better understanding of the dynamic relationship between LAE and MCI reversion would inform the implementation of preclinical dementia interventions. This study aimed to investigate the association between change patterns of LAE and MCI reversion among older adults using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database.

Study design

Longitudinal population-based study.

Methods

Older adults with MCI at the baseline were enrolled in this study. Information about cognitive function, overall, cognitively stimulating, physically active/demanding, and socially engaged LAE was collected at baseline and follow-up. Adjusted hazard ratios (HRs) for reversion and 95% confidence intervals (CIs) were calculated by Cox hazard models with time as the underlying time metric. We also assessed potential effect modifications by creating a cross-product of the stratifying variable with LAE change patterns in the fully adjusted model.

Results

The restricted cubic spline showed that the association between LAE change scores and MCI reversion rate was statistically significant and nonlinear (p<0.01). Taking participants in the low-low group as a reference, participants in the low-medium, low-high, medium-medium, medium-high, high-medium, and high-high groups had increased possibilities of MCI reversion with HRs (95% CI) of 2.19 (1.57-3.06), 2.97 (2.13-4.13), 0.87 (0.64-1.19), 2.28 (1.71-3.03), 2.78 (2.10-3.69), 1.93 (1.43-2.59), and 2.74 (2.09-3.60), respectively. Further stratified models showed that the impact of LAE change patterns on MCI reversion varied in different ages (nonagenarian, octogenarian, and younger elderly) and gender.

Conclusions

Participants who maintained the highest LAE had the greatest possibility of MCI reversion. Meanwhile, a higher level of LAE maintenance was associated with the increased possibility of MCI reversion. These results provide a practical message to older adults about how dynamic changes in LAE are associated with improved cognitive function.