Dealing with daily challenges in dementia (deal-id study): effectiveness of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia: design of a randomized controlled trial

Feedback based on experience sampling data: Examples of current approaches and considerations for future research

Methodologies such as the Experience Sampling Method (ESM) or Ecological Momentary Assessment allow the gathering of fine-graded, dynamic, personal data within a patient's daily life. Currently, it is studied whether feedback based on experience sampling data (ESM-based feedback) can be used as a clinical tool to inform shared decision-making in clinical practice. Although the potential of feedback is recognized, little is known on how to generate, use, and implement it. This article (i) presents n = 15 ongoing ESM projects within the Belgian-Dutch network for ESM research wherein ESM-based feedback is provided to various patient populations, and (ii) summarizes qualitative data on experiences with ESM-based feedback of researchers (n = 8) with extensive expertise with ESM (average of 10 years) involved in these ongoing studies. The following aspects appear to be of relevance when providing ESM-based feedback: training for healthcare professionals and researchers, the use of online interfaces and graphical visualizations to present data, and interacting with patients in a face-to-face setting when discussing the contextual relevance and potential implications. Prospectively, research may build on these aspects and create coherent consensus-based guidelines for the use of ESM-based feedback.

A systematic review of process evaluations for psychosocial interventions designed to improve the wellbeing and quality of life of community-dwelling people with dementia and their carers

BACKGROUND

Psychosocial interventions improve the wellbeing and quality of life of People Living with Dementia (PLWD) and their family carers; but due to their complexity it can be challenging to identify mechanisms of action. We reviewed process evaluations that have sought to elucidate how these interventions work, to inform their implementation.

METHOD

We systematically reviewed process evaluations of studies evaluating psychosocial interventions for PLWD in their own home and/or their family carers. We rated study quality using the Mixed Methods Appraisal Tool. We described, with reference to Medical Research Council (2015) process evaluation guidance, how implementation, mechanisms of impact and contextual factors were investigated; and describe commonalities in the mechanisms of action identified across studies.

RESULTS

Twenty four included studies evaluated the processes of 22 interventions. These studies collectively applied five frameworks; almost all frameworks' advised evaluations were theory-based and used mixed-methods analyses, but only 5/24 evaluation designs were informed by the intervention theory and 8/24 used mixed methods. 8/24 evaluations considered contextual factors in their design, though 20/24 cited contextual factors in findings. Interventions were more successful where PLWD were motivated and aware of potential benefits, and when carers could support engagement and were themselves supported by the intervention. How the intervention aligned with participants' current needs and stage of dementia were key influencing factors.

CONCLUSION

Knowing how interventions can influence change for community-dwelling people with dementia and their family carer's will improve translation of trial findings into practice. Robust, theory-driven process evaluations can enable this.

Mhealth interventions to improve health and quality of life related outcomes for informal dementia caregivers: A scoping review

BACKGROUND

The devastating effects of dementia extend to the health and well-being of informal dementia caregivers. The physical and mental requirements of serving as a dementia caregiver are evidenced in the negative health effects that this population experiences. There is a present need for effective interventions to improve health and quality of life in informal dementia caregivers.

OBJECTIVE

To investigate the health and well-being related outcomes following mHealth use in dementia caregiver and care recipient populations.

METHODS

A scoping review was undertaken to investigate mHealth use in dementia caregivers. Searches spanning four databases yielded 172 articles. Following screening procedures, 12 articles were included for data extraction..

RESULTS

Articles were organized into three major themes: social and indirect support, health education, and technology-supported monitoring. Social and indirect support apps may be valuable for caregiver stress relief, confidence, and fatigue. Health education apps were found to 1) assist with the organization of user's health information, and 2) impact depressive symptoms. Monitoring apps provided caregivers with methods of observing both physical and emotional well-being..

CONCLUSION

Currently, the limited evidence on the usability and usefulness of mHealth within dementia caregiver populations indicates that mHealth holds promise as an intervention platform and warrants continued investigation.Abbreviations: AD: Alzheimer's Disease; CANE: Camberwell Assessment of Need for the Elderly; CCS: Caregiver Competence Scale, CDN: COGKNOW Day Navigator; CES-D: Center for Epidemiologic Studies Depression Scale; CG: Caregivers; CQoL-AD: Carer's Overall Quality of Life in Alzheimer's Disease; Dx: Diagnosis; ESM: experience sampling methodology; FB: Facebook; PA: Positive Affect; Pss-14: Perceived Stress Scale; QOL: Quality of Life; RCSS: Revised Caregiving Satisfaction Scale; SSCQ: Short Sense of Competence Questionnaire.

Intervention mechanisms of an experience sampling intervention for spousal carers of people with dementia: a secondary analysis using momentary data

Objectives: A psychosocial intervention for spousal carers of people with dementia promoted emotional well-being through self-monitoring and personalized feedback, as demonstrated in a previous randomized controlled trial. The mechanism behind the intervention effects is thought to lie in increased awareness of, and thus, engagement in behaviours that elicit positive emotions (PA). This secondary analysis tests the assumption by investigating momentary data on activities, affect, and stress and explores the relevance of personalized feedback compared to self-monitoring only.Methods: The intervention was based on the experience sampling method (ESM), meaning that carers self-monitored own affect and behaviours 10 times/day over 6 weeks. The experimental group received personalized feedback on behaviours that elicit PA, while the pseudo-experimental group performed self-monitoring only. A control group was also included. ESM-data of 72 carers was analysed using multilevel mixed-effects models.Results: The experimental group reported significant increases in passive relaxation activities over the 6 weeks (B = 0.28, SE = 0.12, Z = 2.43, p < .05). Passive relaxation in this group was negatively associated with negative affect (r = -0.50, p = .01) and positively associated with activity-related stress (r = 0.52, p = .007) from baseline to post-intervention. Other activities in this or the other groups did not change significantly.Conclusion: Carer's daily behaviours were only affected when self-monitoring was combined with personalized feedback. Changing one's daily behaviour while caring for a person with dementia is challenging and aligned with mixed emotions. Acknowledging simultaneously positive and negative emotions, and feelings of stress is suggested to embrace the complexity of carer's life and provide sustainable support.

The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors

This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients’ behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001–1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414–8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers’ use of care resources (p < 0.01). Health professionals have to evaluate the patients’ BPSD and identify the caregivers’ essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.

Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies

BACKGROUND

The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life.

METHODS

A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review.

RESULTS

Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care.

CONCLUSIONS

Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.

Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

BACKGROUND

Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location.

OBJECTIVES

The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population.

SEARCH METHODS

We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another.

DATA COLLECTION AND ANALYSIS

Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively.

MAIN RESULTS

We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison.

AUTHORS' CONCLUSIONS

Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.

An Experience Sampling Method Intervention for Dementia Caregivers: Results of a Randomized Controlled Trial

OBJECTIVE

Ecological momentary interventions integrated with real-life assessments using the experience sampling method (ESM) could be promising to effectively support dementia caregivers in daily life. This study reports on the effectiveness of the ESM-based intervention "Partner in Sight."

DESIGN, SETTING, PARTICIPANTS

A randomized controlled trial with 76 dementia caregivers was performed. Participants were randomly assigned to the intervention group ("Partner in Sight": ESM self-monitoring and personalized feedback), the pseudo-intervention group (ESM self-monitoring without feedback), or the control group (usual care).

MEASUREMENTS

Effects were evaluated pre- and postintervention and at 2-month follow-up. Primary outcomes were retrospective measures of caregiver sense of competence and mastery. Secondary outcomes were retrospective measures of depression, anxiety, and perceived stress. Complementary ESM measures of positive and negative affect were collected pre- and postintervention.

RESULTS

Both the experimental and pseudo-experimental groups showed an increase in retrospective sense of competence and a decrease in perceived stress at 2-month follow-up. At postintervention, the experimental group showed a decrease in momentary negative affect compared with the pseudo-experimental and control groups. No effects were found for retrospective mastery, depression, anxiety, and momentary positive affect.

CONCLUSIONS

ESM interventions could be an important asset for increasing caregiver resources and could help caregivers to better adapt and manage difficult situations and to protect against negative emotions.

Dealing with daily challenges in dementia (deal-id study): process evaluation of the experience sampling method intervention 'Partner in Sight' for spousal caregivers of people with dementia

OBJECTIVES

This study describes the process evaluation of the experience sampling method (ESM) intervention 'Partner in Sight' for spousal caregivers of people with dementia. The aim was to determine internal and external validity of the intervention and provide information for future implementation in clinical practice.

METHOD

Qualitative and quantitative data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, adherence to protocol) were evaluated using descriptive statistics and conventional content analysis.

RESULTS

The participation rate included 31.4%. Due to recruitment difficulties and time constraints the original goal to include 90 caregivers was not met. The intervention was largely performed according to protocol and well received by the participants. Overall, the ESM-derived feedback was considered supportive and increased participants' awareness of their feelings and behavior. A large variance was found in the extent to which caregivers applied the feedback into their daily lives. The importance of the personal coach to provide face-to-face feedback and stimulate caregivers to implement new insights into their daily lives was emphasized. Suggestions for improvement were to reduce the time intensity of the program, to better tailor the program content to one's personal situation, and to improve the ESM device.

CONCLUSION

Although recruitment barriers were encountered, results indicate that future implementation of the ESM intervention 'Partner in Sight' is likely to be feasible in regular health care. If the intervention turns out to be (cost-) effective, a fine-tuned version of the program could be a valuable addition to the current health care system.

Emotional reactivity to daily life stress in spousal caregivers of people with dementia: An experience sampling study

Introduction

Caregivers differ in their emotional response when facing difficult situations during the caregiving process. Individual differences in vulnerabilities and resources could play an exacerbating or buffering role in caregivers’ reactivity to daily life stress. This study examines which caregiver characteristics modify emotional stress reactivity in dementia caregivers.

Methods

Thirty caregivers collected momentary data, as based on the experience sampling methodology, to assess (1) appraised subjective stress related to events and minor disturbances in daily life, and (2) emotional reactivity to these daily life stressors, conceptualized as changes in negative affect. Caregiver characteristics (i.e. vulnerabilities and resources) were administered retrospectively.

Results

Caregivers who more frequently used the coping strategies ‘seeking distraction’, ‘seeking social support’, and ‘fostering reassuring thoughts’ experienced less emotional reactivity towards stressful daily events. A higher educational level and a higher sense of competence and mastery lowered emotional reactivity towards minor disturbances in daily life. No effects were found for age, gender, and hours of care and contact with the person with dementia.

Discussion

Caregiver resources can impact emotional reactivity to daily life stress. Interventions aimed at empowerment of caregiver resources, such as sense of competence, mastery, and coping, could help to reduce stress reactivity in dementia caregivers.

La influencia del apoyo social en cuidadores de personas con deterioro cognitivo o demencia

El apoyo social se define como un conjunto de transacciones que implican ayuda, afecto y afirmación. El objetivo de la investigación ha sido desarrollar un modelo que explique como la frecuencia de cuidados influye en la satisfacción de los cuidadores de personas con deterioro cognitivo o demencia a través de variables como el apoyo social o la sobrecarga. Los resultados obtenidos confirman que la frecuencia de cuidados predice la satisfacción. Asimismo, se demuestra que están mediados por el apoyo social y la sobrecarga, conllevando el primero  a una mayor satisfacción y la sobrecarga a una disminución de la misma. 

Good and Bad Days: Fluctuations in the Burden of Informal Dementia Caregivers, an Experience Sampling Study

BACKGROUND

Informal dementia caregivers (IDCs) are often confronted with important fluctuations in care-related burden, commonly described as "good and bad days." These fluctuations are overlooked by traditional questionnaires focusing on the average experience. The experience sampling method (ESM) is based on the repeated collection of data in everyday life, thereby allowing the description of day-to-day fluctuations in IDC burden, and the identification of their correlates. ESM studies are still scarce among IDCs, with none focusing on day-to-day fluctuations in burden.

OBJECTIVES

This ESM study aimed to examine day-to-day fluctuations in the burden of IDCs and test their associations with six moment-to-moment predictors.

METHODS

Primary IDCs (N = 26, median age = 68 years, 77% women, 73% spouses) volunteered to answer questions about their daily burdens, patients' memories and behavioral problems (MBP), caregivers' MBP-related distress, psychological distress, self-efficacy and positive affects, and relationship quality; volunteers did this every evening for 2 weeks on a touchpad, resulting in 206 measures. Data were analyzed with multilevel linear regression.

RESULTS

Day-to-day fluctuations covered about two thirds of the total variance for most study variables. All six predictors had a significant bivariate relation with daily burden, explaining 15%-32% of its fluctuations, with significant differences between caregivers in the strength of these relations. The best multivariate model explained 51% of the day-to-day fluctuations in burden. It included caregiver MBP-related distress, psychological distress, and relationship quality.

DISCUSSION

This innovative study of IDC burden shows that day-to-day fluctuations are an important part of caregivers' real-life experiences and that half of this variability is predicted by currently understudied factors. Inviting caregivers to monitor clinical outcomes daily over 1 or 2 weeks could help tailor interventions to their individual needs and also empower them.

Effectiveness of an online social support intervention for caregivers of people with dementia: the study protocol of a randomised controlled trial

Background

Caregivers of people with dementia (PwD) face burden, feelings of loneliness, and social isolation. Previous studies have shown promising effects of online e-health interventions. Using social media may facilitate support for dementia caregiver networks. In an iterative step-wise approach, a social support tool entitled “Inlife” was developed. This paper describes the design of a study evaluating the effects of Inlife and its process characteristics.

Methods

A mixed-method, randomised controlled trial with 122 caregivers of PwD will be conducted. Participants will be assigned to either the Inlife social support intervention or a waiting-list control group. After 16 weeks, the control group will obtain access to the Inlife environment. Data will be collected at baseline (T₀) and at 8-week (T₁), 16-week (T₂) and 42-week follow up (T₃). The 16-week follow-up assessment (T₂) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. The primary outcomes include feelings of caregiver competence and perceived social support. The secondary outcomes include received support, feelings of loneliness, psychological complaints (e.g., anxiety, stress), and quality of life. A process evaluation, including semi-structured interviews, will be conducted to examine the internal and external validity of the intervention.

Discussion

Using a mixed-method design, our study will provide valuable insights into the usability, effectiveness, and factors related to implementation of the Inlife intervention. Our study results will indicate whether Inlife could be a valuable social support resource in future routine dementia care.

Trial registration

Dutch trial register, NTR6131. Registered on 20 October 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2097-y) contains supplementary material, which is available to authorized users.