Dementia caregiver interventions in Chinese people: A systematic review

Evaluating an evidence-based iSupport for Dementia programme in routine care services: study protocol for a hybrid type II trial

INTRODUCTION

Disparities in supporting carers of people with dementia exist in carer populations. The WHO developed an evidence-based iSupport for Dementia programme to address the disparities. However, evidence on how to embed the iSupport programme in routine health and aged care services to optimise support for carers remains largely unknown.

METHODS AND ANALYSIS

This study will apply a hybrid type II effectiveness-implementation trial to evaluate the embedment of two iSupport innovations: 'usual iSupport' and 'tailored iSupport' in health and aged care services in Australia and China. The RE-AIM framework informed the study design. Three aged care organisations in Australia, two public hospitals and a community health centre in China will participate in the trial by delivering the two iSupport innovations to 158 carers of people with dementia with 79 carers in each intervention group using a randomised controlled trial design. The effectiveness of the two iSupport innovations will be determined by measuring the quality of life and self-efficacy of carers, and the quality of life of people with dementia, unplanned hospital admissions, emergency department presentations and admissions to permanent nursing homes and perceived quality of care of people with dementia at baseline, 3 months and 6 months. The effectiveness of strategies used to embed the iSupport innovations in routine care services will be evaluated using qualitative data collected from focus groups or interviews with carers, staff and management involved in the study and records from the participating organisations.

ETHICS AND DISSEMINATION

Ethics approval was obtained from Flinders University (project number: 5819), Xi'an Jiaotong University (project number: 2023-1629) and Zunyi Medical University (project number: KLL-2023-245). We will obtain informed written or oral consent from participants in the trial. We will publish the results in peer-reviewed journals to disseminate the study and generate impact on policy and practice changes.

TRIAL REGISTRATION NUMBER

ACTRN12623000323628; The Australian New Zealand Clinical Trials Registry (ANZCTR); registered on 27 March 2023.

Feasibility Study of a Culturally Tailored Support Group Program for the Psychosocial Wellbeing of Caregivers of Individuals Living With Dementia

INTRODUCTION

Culturally tailored support group interventions can help family caregivers. Little is known about the impacts of integrating philosophical thoughts in the interventions on the psychosocial wellbeing of family caregivers of persons with dementia.

METHODOLOGY

A program integrating Chinese philosophies was provided to caregivers in the intervention group. A total of 33 and 30 caregivers in Hong Kong joined the intervention and control groups. They were asked to complete pre- and post-tests to assess their psychosocial health.

RESULTS

There were significant positive changes for the level of satisfaction with social support (p < .05) and general quality of life (p < .05). There were also significant improvements in the four aspects of coping (positive reframing: p < .01; planning: p < .05; humor: p < .01; religion: p < .01).

DISCUSSION

The intervention could provide insight into how culturally tailored interventions can improve the psychosocial wellbeing of family caregivers in Chinese communities.

Caregiving in Asia: Priority areas for research, policy, and practice to support family caregivers

Population aging presents a growing societal challenge and imposes a heavy burden on the healthcare system in many Asian countries. Given the limited availability of formal long-term care (LTC) facilities and personnel, family caregivers play a vital role in providing care for the increasing population of older adults. While awareness of the challenges faced by caregivers is rising, discussions often remain within academic circles, resulting in the lived experiences, well-being, and needs of family caregivers being frequently overlooked. In this review, we identify four key priority areas to advance research, practice, and policy related to family caregivers in Asia: (1) Emphasizing family caregivers as sociocultural navigators in the healthcare system; (2) addressing the mental and physical health needs of family caregivers; (3) recognizing the diverse caregiving experiences across different cultural backgrounds, socioeconomic status, and countries of residence; and (4) strengthening policy support for family caregivers. Our review also identifies deficiencies in institutional LTC and underscores the importance of providing training and empowerment to caregivers. Policymakers, practitioners, and researchers interested in supporting family caregivers should prioritize these key areas to tackle the challenge of population aging in Asian countries. Cross-country knowledge exchange and capacity development are crucial for better serving both the aging population and their caregivers.

The effectiveness of case management and nursing counselling among caregivers of patients with dementia: A pilot study

According to the data released by the Taiwan Ministry of Health and Welfare in 2021, in 2019, 235,000 patients sought medical treatment for dementia-related diseases at the National-Health-Insurance-participating hospitals and clinics for more than three outpatient visits or had been hospitalised, and the number had increased by 15,000 from the previous year (Ministry of Health and Welfare, 2021). This implies that families are affected, causing tremendous physical, psychological, and economic pressures and burdens on the caregivers and families of the patient. The estimated social cost of caring for dementia families increased from $1.3 trillion in 2019 to $2.8 trillion in 2030 (World Health Organisation, 2021). Thus, long-term care for the dementia population has become a critical issue in medical care and social services in Taiwan and worldwide. In 2017, Taiwan Ministry of Health and Welfare has been starting Dementia care policy with 10 years long-term care plan through set up dementia care centre. The purpose of this study is to investigate the effectiveness of dementia care centre for reducing the burden and improving the quality of life for caregivers of dementia patients. This pilot study adopts a quasi-experimental research design and uses purposive sampling to select in house informal caregivers of dementia patients who are part of a dementia collaborative care programme at a medical centre in the northern region and were willing to participate in this study. Upon enrolment in the study, subjects were given a pre-test, followed by a one-hour face-to-face nursing consultation and assessment after 2 weeks. Subsequently, a telephone nursing consultation was conducted once a month for 3 months. Two weeks after completing all counselling sessions, a post-test was administered to measure the caregiver burden with The Chinese version of the Caregiver Burden Inventory and the quality of life for caregivers with The 'Chinese Health Questionnaire CHQ-12'. After providing case management and nursing counselling, the total caregiver burden score significantly decreased from an average of 40.1 (SD = 21.6) at the pre-test to an average of 38.6 (SD = 21.4) at the post-test, reaching statistical significance (p < 0.01). The results of this study showed that providing dementia caregivers with case management and nursing consultation services helps improve the overall caregiver burden (particularly emotional burden and physical burden) as well as the health questionnaire scores. However, the social burden and time burden did not improve after receiving case management and counselling among caregivers; instead, post-test scores of these aspects were significantly higher.

Logotherapy-Based Interventions for Chinese Family Caregivers of Older Adults with Dementia Through Online Groups: A Mixed-Methods Study

Chinese family caregivers of people with dementia (PWD) can suffer from physical and psychological burden. This study aimed to examine the effects of logotherapy-based interventions on Chinese family caregivers of older adults with dementia to decrease caregiver burden. This mixed-methods study used a pre-experimental design with pre-posttests and semi-structured interviews. A purposive sample of 13 family caregivers from a suburban district in Shanghai was enrolled with (1) caregiver burden and (2) access and capability to use smart devices. Participants received eight online group logotherapy sessions with a focus on hope and meaning construction. Participants completed the Zarit Burden Interview, a 22-item measure of caregiver burden, before and after the intervention, and a 30-min semi-structured interview post-intervention. From the quantitative data, dementia caregivers reported severe caregiving burdens at the baseline (M = 54.77, SD = 9.33). Caregiver burden significantly decreased after the logotherapy-based intervention (M = 52.15, SD = 8.80, p < .001). Two themes pertaining to participants' experiences in intervention emerged from the qualitative data: (1) improved attitudes toward suffering, and (2) enhanced sense of meaning in life and hope. The cultural relevance of logotherapy to Chinese familism and Confucianism may further enhance its feasibility in the Chinese context.

Priorities for research promoting mental health in the south and east of Asia

Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.

Understanding the experience of family caregivers of people with dementia in a culturally tailored support group programme: A qualitative study

Studies on support group interventions for family caregivers of people with dementia have not explicitly reported on the incorporation of cultural elements. This study evaluates the impact of a culturally tailored intervention (a six-session programme called 'Cultivate Yourself: Support for Caregivers of Persons with Dementia') that integrates Chinese philosophies for psychosocial well-being among target caregivers in Hong Kong. Thirty-three family caregivers of people with dementia from two older adult centres in Hong Kong participated in the programme from October 2020 to September 2021. Multiple benefits from the programme, namely improvements in family caregivers' psychosocial well-being, caring process and supporting values, were identified during six focus group interviews with 29 participants who attended at least four of the six sessions. Our findings provide insight into strategies for developing a culturally tailored support group programme for Chinese caregivers.

Impact of additional community services provision on dementia caregiver burden: an interrupted time-series analysis of 12-year interRAI assessments in Hong Kong

OBJECTIVES

To evaluate the impact of providing additional dementia caregiver support services on caregiver burden.

DESIGN

Interrupted time-series analysis using territory-wide panel data.

SETTINGS

All public-funded district elderly community centres in Hong Kong (HK).

PARTICIPANTS

Primary caregivers for older adults (age over 65 years) living with dementia assessed through International Residential Assessment in HK between 1 October 2004 and 31 September 2016. Paid caregivers were excluded.

INTERVENTIONS

In April 2014, US$280 million was allocated to provide additional psychological support, education and respite care for dementia caregivers in HK.

MAIN OUTCOME MEASURES

Caregiver burden was measured by two age-standardised rates: (1) caregivers in emotional distress; and (2) caregivers with long care time in a week (more than 20 hours a week). We fitted the two time-series into Autoregressive Integrated Moving Average models to evaluate intervention impacts, with follow-up analyses to consider a 6-month transition period of policy implementation. Segmented linear regressions and Holt-Winter exponential smoothening models were used as sensitivity analyses.

RESULTS

36 689 dementia caregivers were included in this study, of which 14.4% caregivers were distress and 31.9% were long-hours caregivers after the policy intervention in April 2014. Providing additional caregiver service significantly reduced standardised rates of caregivers in distress (β (95% CI)=-3.93 (-7.85 to -0.01), p<0.05), but the effect was not sustained (p=0.183). There was no significant impact on the level of age-standardised rates of caregiver with long care time (β (95 CI)=-4.25 (-9.61 to 1.10), p=0.120). Also, there was no significant delay of intervention impacts.

CONCLUSION

Our study finds that strengthening caregiver services provision could reduce distress rates among primary caregivers for older adults living with dementia. Expanding community services for caregiver could be a solution to the escalating burden of informal care for people living with dementia.

Older immigrant adults experiences with social isolation: a qualitative interpretive meta synthesis

Objectives: Older immigrants totaled 7.3 million in 2018, representing 13.9 percent of the population of seniors in the U.S. While this population is found to contribute significantly to society, along with new opportunities comes circumstantial challenges. Of these, one of the most salient issues for foreign-born older adults is social isolation. Additionally, this population may be at an increased risk for social isolation with poor mental health because migrating to a new country might result in resettlement challenges. Despite these concerns, less is known about the consequences of social isolation among older immigrant adults. Hence, this study seeks to explore consequences of social isolation among older immigrants, as well as interventions to combat isolation.Methods: Guided by the Population Interest Context (PICO) framework and the Qualitative Interpretive Meta-Synthesis (QIMS) guidelines.Results: The final sample of seven full text articles were published between 2011 and 2021, totaling 286 participants with ages ranging from 61 to 93 years old. Findings from the study indicated that older immigrants are at risk of social isolation and loneliness because they have fewer social connections due to leaving behind their familiar social group in the home country, encounter linguistic challenges that negatively contribute to greater social isolation and poor mental health. Despite these difficulties older immigrants reported various social interventions, access to senior centers, community programs and services to be of greater importance in building social networks.Conclusion: Authors discuss opportunities for future research, such as exploring evidence-based studies on interventions for social isolation and loneliness of older immigrant populations.

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

OBJECTIVE

The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing.

DESIGN

Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community.

INCLUSION CRITERIA

Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French.

RESULTS

305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13).

CONCLUSION

The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.

Ambient Assisted Living: Identifying New Challenges and Needs for Digital Technologies and Service Innovation

Background : The ambient assisted living (AAL) market is rapidly becoming fundamental to the delivery of health and social care services for the elderly. Worldwide many different steps have been taken to increase the engagement of older adults with these technologies. Much of this work has focused on the development of novel digital services that increase wellbeing or tackle social challenges.

Aim : The aim of the study was to identify and describe the demands for AAL-services from the perspective of older adults. We also examine the challenges and needs of the ambient assisted living market using a needs based approach.

Method : An exploratory case study was conducted with an aim to capture information about older adults’ demands for AAL services. A survey was used to collect the data. The survey study respondents validated the results.

Results : The results of the study indicate that the area of AAL needs be studied from a multiple-sided market perspective. Our research suggests there is a need to describe and understand the factors that facilitate or constrain the implementation of services with focus on health and social care. There is also a need to describe and analyze the relationship between policy and practice and its effects on the AAL market. It is necessary to capture expressed demand, to identify market challenges at the macro level and to be able to understand how services should operate and serve older adults in practice. Such research is critical to the development of guidance for policy makers, suppliers and service providers.

Discussion : Older adults are asking for intelligent, assistive living solutions that help them to continue to live independent lives and remain socially included in their networks, associations, and communities. The elderly need services that stimulate and maintain their physical and intellectual capital. The development of innovative AAL environments is, however, a complex social process that involves the use and delivery of innovative ICT–based services. The implementation and use of AAL to support older adults involve service providers and elderly consumers.

Conclusions : The results of the study may be of interest to policy makers, entrepreneurs, technology suppliers, service providers and health and social care organizations, who are willing to innovate and influence the development of the AAL market through their choices and decisions.

An international systematic review of dementia caregiving interventions for Chinese families

OBJECTIVES

Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally.

METHODS

Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800).

RESULTS

Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy.

CONCLUSIONS

To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.

Social isolation and loneliness among older adults in the context of COVID-19: a global challenge

We are experiencing a historical moment with an unprecedented challenge of the COVID-19 global pandemic. The outbreak of COVID-19 will have a long-term and profound impact on older adults’ health and well-being. Social isolation and loneliness are likely to be one of the most affected health outcomes. Social isolation and loneliness are major risk factors that have been linked with poor physical and mental health status. This paper discusses several approaches that may address the issues of social isolation and loneliness. These approaches include promoting social connection as public health messaging, mobilizing the resources from family members, community-based networks and resources, developing innovative technology-based interventions to improve social connections, and engaging the health care system to begin the process of developing methods to identify social isolation and loneliness in health care settings.

Research on the health of and interventions for family caregivers of people with dementia: a bibliometric analysis of research output during 1988-2018

BACKGROUND

Dementia is a serious and growing health problem, and since most people with dementia live at home, caring responsibilities generally fall on family members. Caregivers are often inadequately supported by formal health services and have poorer psychological and physical health. Our study aimed to compare the contributions of publications from different countries, institutions and authors and present a bibliometric analysis to determine the hotspots and trends in research concerning the health of and interventions for family dementia caregivers.

METHODS

Studies published during 1988-2018 were extracted from the Science Citation Index Expanded of the Web of Science. Each abstract of publications was evaluated to obtain the basic information. A bibliometric analysis was used to evaluate the number or cooperation networks of publications, countries, institutions, journals, citations, authors, references, and keywords. The resulting articles were analyzed descriptively, and the publication keywords were visualized using VOSviewer.

RESULTS

Five hundred forty-two articles were identified. The annual number of relevant publications has steadily increased since approximately 2006. The USA has the highest number of publications (36.2%), followed by the UK (12.9%). China entered the field late, but research conducted in China has rapidly developed. The most productive institution, journal, and author in this field are University College London, the Journal of the American Geriatrics Society, and Orrell M from the UK, respectively. A co-occurrence analysis of the keywords reveals a mainstream research focus on burden, depression, quality of life, and corresponding interventions for people with dementia caregivers. The keywords "psychosocial intervention", "long-term", "e-learning/online", "communication", and "qualitative research" reflect the latest hotspots, appearing in approximately 2017-2018.

CONCLUSION

Our study details the performance statistics, main topics and trends research on the health of and interventions for dementia caregivers from 1988 to 2018 and provides a comprehensive analysis.

Interventions to support family caregivers of people living with dementia in high, middle and low-income countries in Asia: a scoping review

INTRODUCTION

Despite increasing numbers of persons living with Alzheimer's disease and Alzheimer's-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia.

METHODS

The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English.

RESULTS

Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR-China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations.

CONCLUSION

This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.