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					EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
 Acton, G. J. &    To evaluate, using    Level I           Intervention:                Only 2 of the 27            Burden as a measure      An intervention for
 Kang, J. (2001)   meta-analytic                           This meta-analysis           treatments had a            of caregiver             caregivers may affect
                   techniques, those     Meta-Analysis     included studies that        statistically significant   outcomes was not         some of the tasks or
                   intervention                            tested an intervention to    positive effect on          well defined, with       time spent, but the
                   strategies (support   24 studies were   reduce the burden of         burden (respite             some studies             caregiver remains
                   group, education,     included in the   caregiving (support          intervention and            measuring objective      responsible for the
                   psychoeducation,      analysis.         group, education,            multicomponent              and others subjective    care, and thus, the
                   counseling, respite                     psychoeducation,             intervention), but          indicators. The effect   intervention is
                   care, and                               counseling and respite       pooled analyses             of interventions that    unlikely to change the
                   multicomponent)                         care). 17 of the studies     showed no significant       were evaluated by        perception of
                   designed to help                        reported using both a        effect.                     two different            responsibility, one of
                   caregivers cope                         treatment and a control                                  measures (Burden         the indicators most
                   with the burden of                      group, and 7 reported a      The multicomponent          Interview and Burden     often analyzed in
                   caregiving.                             one-group pretest/posttest   intervention category       Scale) were pooled,      burden measures.
                                                           design.                      appeared to reduce          which may have           While the quality of
                                                                                        subjective burden,          provided ambiguous       evidence is limited, it
                                                           Outcome Measures:            although only one           results.                 appears that a
                                                           Burden Interview, the        study showed                                         combination of
                                                           Burden Scale, and other      significant reduction.      Studies varied in        supportive and
                                                           burden scales designed       Respite care did not        participant size from    educational strategies
                                                           for each study.              significantly reduce        11 to 180; no other      is of most use to
                                                                                        burden in situations        descriptions of study    caregivers. Rather
                                                                                        where caregivers did        participants were        than blanketing
                                                                                        not understand how to       included in the meta-    caregivers with a
                                                                                        use the services or         analysis.                variety of
                                                                                        waited until crisis                                  interventions, these
                                                                                        situations before                                    interventions should
                                                                                        seeking services.                                    be implemented at the
                                                                                                                                             times they are needed,
                                                                                                                                             thus increasing the
                                                                                                                                             likelihood of better
                                                                                                                                             outcomes.

                                                                                                                                             Burden may not be the
                                                                                                                                             best outcome to
                                                                                                                                             demonstrate the
G:\Practice\EBP\Evidence Table5.05                                                                                                            page 1 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                                                                                                   effectiveness of
                                                                                                                                                   caregiver
                                                                                                                                                   interventions.
 Bank, A.L.;         To demonstrate the   Level III              Intervention:                The mean number of          Small sample size;       Occupational therapy
 Argüelles,          use of technology                           The CTIS system, an          sessions attended was       The effect of the        professionals should
 S.; Rubert,         for conducting       One group, non-        information network that     7.1. 81% of                 telephone support        consider enhancing
 M.; Eisdorfer,      telephone-based      randomized, survey     relies on computer –         participants found the      intervention by itself   their service with
 C.; & Czaja, S.J.   support groups in    after intervention.    telephone technology         group “valuable.”           on psychosocial          telephone-based
 (2006)              ethnically diverse                          (screen phones allow         There was no                outcomes could not       support for caregivers,
                     dementia             41 White American      both voice and text data     statistically significant   be examined because      particularly in rural
                     caregivers           and Cuban              to be sent and received      difference between          all components f the     areas or where
                                          American dementia      during interactive           White and Cuban-            CTIS system were         caregivers do not have
                                          caregivers             session).                    American caregivers.        delivered to all         easy access to care
                                          participation at the   All participants received    73% of individuals          participants.            centers. Such a
                                          Miami site of the      in-home family-therapy       reported their                                       system could serve to
                                          Resources for          sessions during the first    participation had           Only self-reported       follow-up on in-home
                                          Enhancing              12 months of the study.      increased their             data was obtained,       therapy.
                                          Alzheimer’s            In addition, CTIS phones     knowledge and skills        and was not verified,
                                          Caregiver Health       were placed in each          as caregivers; 70%                                   Occupational therapy
                                          (REACH) program.       participant’s home.          reported participation                               professionals’
                                          Participants were      Telephone support-group      had increased their                                  psychosocial
                                          predominantly          sessions with a maximum      knowledge about                                      education well
                                          female (76%),          of 6 caregivers,             memory disorders like                                prepares them to serve
                                          Cuban-American         facilitated by a study-      Alzheimer’s disease;                                 as co-facilitators for
                                          (54%); 18 were         certified therapist, and     68% reported their                                   such support groups
                                          wives and 10 were      approx 1 hr. in length       participation had                                    as part of an
                                          husbands of the        were held bimonthly at       increased their                                      interdisciplinary team.
                                          care recipients; 11    the beginning of the         knowledge of                                         Occupational therapy
                                          were either            intervention period and      community resources                                  professionals can
                                          daughters or           then monthly thereafter      for caregivers, and                                  particularly focus on
                                          daughters-in-law,      for 18 month.                62% reported                                         the activity of daily
                                          and 2 were sisters                                  participation had                                    living challenges
                                          of care recipients.    Non-Hispanic White           improved their                                       faced by caregivers
                                          The mean age of        caregivers participated in   relationships with                                   and assist them in
                                          care recipients was    English-language groups,     members of their                                     identifying strategies
                                          80 years.              and Hispanic caregivers      family; and 51%                                      with which they may
G:\Practice\EBP\Evidence Table5.05                                                                                                                  page 2 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                             participated in Spanish-    reported participation                             feel and be successful.
                                                             language groups.            in the telephone
                                                                                         support group had
                                                             Outcome Measures:           made them more
                                                             A Support Group             willing to attend a
                                                             Questionnaire (SGQ) was     support group in the
                                                             developed for this study    community.
 Brodaty, H;      To review             Level I              Intervention:               Overall, caregiver        Heterogeneity of         Caregiver
 Green, A. &      published reports n                        Interventions included      interventions have a      sample characteristics   interventions have the
 Koschera, A.     interventions for     Meta-analysis.       counseling of carers,       modest but significant    and study design.        potential to benefit
 (2003)           caregivers of                              education, family           benefit for caregiver                              patients and
                  persons with          30 studies           counseling, patient         knowledge,                Studies with small       caregivers. Programs
                  dementia,             (involving 2,040     involvement, support        psychological             sample sizes             that involve the
                  excluding respite     caregivers)          groups / programs, stress   morbidity, coping                                  patients and their
                  care, and provide     reporting on 34      management, and             skills and social                                  families and are more
                  recommendation        interventions were   training.                   support. Interventions                             intensive and
                  for clinicians.       included in the                                  did not appear to                                  modified to
                                        review.              Outcome Measures:           influence caregiver                                caregivers’ needs tend
                                                             Primary outcome             burden. A social skills                            to be more successful.
                                                             measures were               training program
                                                             psychological morbidity     showed a significant
                                                             (General Health             effect delay of nursing
                                                             Questionnaire, Hamilton     home admission and
                                                             Depressions Scale, Brief    overall, 68% of
                                                             Symptom Inventory, Self     interventions met the
                                                             Rating Depression Scale,    criteria for study
                                                             Hopkins Symptom             success.
                                                             Checklist, Center for
                                                             Epidemiological Studies
                                                             Depression Scale, and
                                                             Positive and Negative
                                                             Affect Scale) and burden
                                                             (Burden Interview,
                                                             Rankin Scale, Caregivers
                                                             Hassles Scale, Screen for
                                                             Caregiver Burden).
G:\Practice\EBP\Evidence Table5.05                                                                                                           page 3 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
 Burns, R.;         This study             Level I              Intervention:               During 24 months,          The intervention         Brief care
 Nichols, L. O.;    developed and                               Interventions, using        caregivers who             contact time was         interventions may be
 Martindale-        tested two 24-         Randomized           educational materials,      received the patient       shorter than planned     effective in reducing
 Adams, J.;         month primary care     clinical trial.      were patient behavior       behavior management        for both groups due      caregiver distress and
 Graney, M. J. &    interventions to                            management alone, and       component only,            to unexpected            burden in the long-
 Lummus, A.         alleviate the          167 caregiver-care   patient behavior            compared with those        intervening factors      term management of
 (2003).            psychological          recipient dyads.     management plus             who also received the      (i.e. scheduling         the dementia patient.
                    distress suffered by                        caregiver stress-coping     stress-coping              conflicts).              Interventions that
                    the caregivers of                           management.                 component, had                                      focus only on care
                    those with                                                              significantly worse        Sample size too small recipient behavior,
                    Alzheimer’s                                 Outcome Measures:           outcomes for general       to provide sufficient    without addressing
                    disease                                     Health Status Scale;        well-being and a trend     power to document        caregiving issues, may
                                                                Modified General Well-      toward increased risk      statistical significance not be as adequate for
                                                                Being scale; Center for     of depression              of interventions,        reducing caregiver
                                                                Epidemiologic Studies                                  although                 distress.
                                                                Depression Scale;                                      interventions
                                                                Revised Memory and                                     appeared to be           This type of
                                                                Behavior Problems                                      effective.               intervention can also
                                                                Checklist                                                                       be useful given the
                                                                                                                                                chronic, progressive
                                                                                                                                                nature of dementia
                                                                                                                                                because it provides
                                                                                                                                                support to caregivers
                                                                                                                                                and assists them in
                                                                                                                                                differentiating
                                                                                                                                                progression of disease
                                                                                                                                                from their own limited
                                                                                                                                                skills.
 Cooke, D. D.;      To identify the        Level I              Intervention:               Overall, there is little   Significantly varied     It is possible to
 McNally, L.;       type of components                                                      evidence that              sample size in studies produce consistent
 Mulligan, K. T.;   (e.g. education,       Systematic review    Interventions included      interventions              (5 – 5,307); high        improvement in
 Harrison, M. J.;   counseling) that                            improving the caregivers’   consistently produce       attrition rates (up to   caregivers’ knowledge
 & Newman, S. P.    have been utilized     40 studies           psychological well-being    benefits for caregivers    64%) for long-term       of the care-recipient’s
 (2001).            in                                          and/or social well-being    in terms of improved       follow-up.               illness, but knowledge
                    psychosocial/psych                          directly.                   caregiver                                           appears unrelated to
                    o-educational                                                           psychological well-        Baseline levels of       psychological and
G:\Practice\EBP\Evidence Table5.05                                                                                                               page 4 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                  interventions for                   Interventions included        being, caregiver          depression varied        social outcomes. The
                  dementia                            general education,            burden or social          among studies.           inclusion of social and
                  caregivers, and to                  general discussion,           outcomes. However,                                 cognitive components
                  evaluate the                        support group, social         these interventions       Caregiver burden         appears to be
                  success of the                      skills training, social       rarely produced any       measures appear          relatively effective in
                  different                           support, social activities,   deterioration in the      insensitive to change.   improving
                  components or                       cognitive problem             outcomes measured.                                 psychological well-
                  combination of                      solving, cognitive                                                               being.
                  components in                       therapy, cognitive skills,    One study found that a
                  producing positive                  practical caregiving          group receiving
                  outcomes for                        skills, record keeping,       telephone lectures
                  dementia                            relaxation, behavior          showed improved
                  caregivers.                         therapy, psychotherapy        levels of emotional
                                                      and counseling, respite,      support and knowledge
                                                      and miscellaneous.            about dementia when
                                                                                    compared to a peer
                                                      Outcome Measures:             telephone network
                                                      Alzheimer’s Disease           group.
                                                      Knowledge Test;
                                                      Beck Depression               Interventions with
                                                      Inventory,                    social components
                                                      General Health                were the most likely to
                                                      Questionnaire,                show improvements on
                                                      Brief Symptom                 measures of
                                                      Inventory;                    psychological well-
                                                      Revised Memory                being rather than on
                                                      Behavior Problem              burden
                                                      Checklist,
                                                      Zarit Burden Inventory;       Caregiver
                                                      Norbeck’s Social Support      interventions may
                                                      Questionnaire,                require delay before
                                                      Instrumental and              their effects become
                                                      Expressive Social             apparent.
                                                      Support Scale,
                                                      Negative Impact on
                                                      Elderly-Caregiver Family
G:\Practice\EBP\Evidence Table5.05                                                                                                      page 5 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                            Relationship Scale,
                                                            Social Support
                                                            Appraisals Scale.
 Curry, LC;       Evaluate a pilot      Level III           Intervention:                Attendees found           No baseline of            Informational sessions
 Walker,C; &      (phase II)                                Based on a needs             information valuable      knowledge obtained        are useful to increase
 Hogstel, MO.     workplace             One group, non-     assessment completed by      (relevant) to their       for comparison;           caregiver knowledge
 (2006)           educational project   randomized, post-   employees of a large         caregiving                                          and confidence in
                  which addressed       test.               institution, educational     responsibilities and      Small sample size;        their roles. Caregivers
                  the most salient                          sessions were offered        useful in their           only 29% participated     particularly can use
                  needs of employed     35 employees        during 3 consecutive         caregiver role.           in all sessions. No       information about
                  caregivers.           attended one or     months.                                                statistical adjustments   progression of
                                        more sessions.                                   Three highest ranked      were made for             disease, referral to
                                                            3.5 hours educational        content topics by value   inconsistencies in        community resources
                                                            sessions were offered        to attendees were         attendance.               and practical ideas for
                                                            during 3 consecutive         normal aging vs.                                    caregiving, all of
                                                            months. Topics included      disease, Area Agency                                which should be part
                                                            specific health              on Aging respite                                    of a basic
                                                            information, community       voucher information,                                occupational therapy
                                                            resources, supplemental      and practical ideas /                               plan for people with
                                                            services, housing and        legal forms.                                        Alzheimer’s dementia
                                                            long-term care options,                                                          and their caregivers.
                                                            Medicare/Medigap/other
                                                            insurance, support
                                                            groups, and end of life
                                                            legal information.

                                                            Outcome Measures:
                                                            Sessions were evaluated
                                                            by participants on a 5-
                                                            point Likert-type scale
                                                            for usefulness of
                                                            information, quality of
                                                            presentation, and value of
                                                            session.
 Gitlin, L.N;     Examine whether       Level I             Intervention:                At 6 months,              “Usual” care not          An in-home skills
 Hauck, W.W;      treatment effects                                                      caregivers in             described for             training program helps
G:\Practice\EBP\Evidence Table5.05                                                                                                            page 6 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
 Dennis, M.P;     found at 6 months     Randomized,            Experimental group           intervention reported    comparison;              sustain caregiver
 Winter, L        following active      stratified two group   received six OT sessions     improved skills, less                             affect; longer and
 (2005).          treatment were        design with three      (five 90-minute home         need for providing       Small sample size        more frequent
                  sustained at 12       assessment points      visits and one telephone     assistance, and fewer                             professional contact
                  months for family     (baseline, 6 months    session) to help family      behavioral occurrences   Brief maintenance        and ongoing skills
                  caregivers who        and 12 months)         modify the environment       compared to the          phase may not be         training may be
                  participated in an                           to support daily function    control group.           sufficiently intensive   necessary to maintain
                  occupational          127 family             of the person with                                    to maintain gains in     other clinically
                  therapy (OT)          caregivers who         dementia and reduce          At 12 months,            more domains             important outcomes
                  intervention tested   lived with a person    caregiver burden.            caregiver affect                                  such as reduced upset
                  as part of the        who had dementia;      Following 6-month active     improved                                          with behaviors.
                  National Institutes   all were older than    treatment, a maintenance
                  of Health             21 years, had been     phase consisted of one
                  Resources for         caregivers for at      home and three brief
                  Enhancing             least 6 months, and    telephone sessions to
                  Alzheimer’s           provided at least 4    reinforce strategy use and
                  Caregivers Health     hours of daily care    obtain closure.
                  (REACH)               to persons with one
                  initiative.           or more activity       OT sessions provided
                                        limitations.           caregivers with
                                                               education, problem
                                        78.7% female;          solving and technical
                                        64.6% non-             skills (task-
                                        spouses; 37%           simplification,
                                        White, 61%             communication), and
                                        African American,      simple home
                                        and 2% “other.”        modifications.

                                                               Control group received
                                                               usual care

                                                               Outcome Measures:
                                                               REACH modified
                                                               Revised Memory and
                                                               Problem behavior
                                                               Checklist; single REACH
G:\Practice\EBP\Evidence Table5.05                                                                                                             page 7 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                vigilance item; Days
                                                                Receiving ADL Help,
                                                                Task Management
                                                                Strategy Index.
 Gitlin, L.,      To test whether the   Level I                 Intervention:                 At 4 months,               Lack of an attention    Enhancements to
 Winter, L.,      Tailored Activity     Randomized               Six 90 minute home           compared with              control group;          patient function are
 Burke, J.,       Program (TAP)         controlled trial        visits and two 15 minute      controls, intervention     Reliance on caregiver   likely to reduce the
 Chernett, N.,    reduces dementia-                             telephone contacts.           caregivers reported        self-report of          objective burden of
 Dennis, M., &    related                                       Home sessions of              reduced frequency of       behavioral              caregivers as
 Hauck, W.        neuropsychiatric      60 dementia             occupational therapy          problem behaviors          occurrences, which      measured by time
 (2008).          behaviors,            patients and family     intervention involved         (specifically for          may be affected by      spent on caregiving.
                  promotes activity     caregivers.             neuropsychological and        shadowing and              caregiver mood          However,
                  engagement, and                               functional testing,           repetitive questioning)    and/or perceived        interventions must
                  enhances caregiver    Dementia patients       selection and                 and greater activity       study demands;          also be designed to
                  wellbeing.            were English            customization of              engagement, including                              target caregivers’
                                        speaking, physician     activities to match           the ability to keep                                subjective well-being
                                        diagnosis or            capabilities identified in    busy. Fewer                                        to complement patient
                                        MMSE score <24,         testing, and instruction to   caregivers reported                                intervention.
                                        able to feed self       caregivers in use of          argumentation and                                  Occupational therapy
                                        and participate in at   activities.                   agitation on the part of                           personnel should
                                        least two self care                                   the patient.                                       design interventions
                                        activities. They        4 month was main trial                                                           from which caregivers
                                        were also primarily     end-point.                    Caregiver benefits                                 can derive or see
                                        male (57%) and                                        included fewer hours                               immediate results.
                                        White (77%) with        At 4 months, controls         doing things and being                             Further, enhanced
                                        mean age of 79          received the TAP              on duty. Greater                                   understanding of
                                        years.                  intervention and were         mastery, self-efficacy,                            preserved strengths of
                                                                reassessed 4 months later.    and skill enhancement.                             the patient as well as
                                        Caregivers were                                       However, subjective                                how to adapt activities
                                        English-speaking,       Outcome Measures:             appraisals of burden                               to capitalize on those
                                        ≥21 years of age,                                     were not affected.                                 enhanced strengths are
                                        lived with the          Dementia patient                                                                 helpful for caregivers’
                                        patient, and            outcomes: Agitated                                                               sense of mastery and
                                        provided ≥4 hours       Behaviors in Dementia                                                            success in their role.
                                        of daily care.          Scale, Revised Memory
                                                                and Behavior Problem
G:\Practice\EBP\Evidence Table5.05                                                                                                                page 8 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                           Checklist, Cornell Scale
                                                           for Depression in
                                                           Dementia, investigator-
                                                           developed index of
                                                           caregiver report of
                                                           patient, Quality of Life-
                                                           AD.

                                                           Caregiver outcomes:
                                                           investigator-developed
                                                           mastery scale, Zarit
                                                           Burden Scale. Objective
                                                           burden estimated by
                                                           caregiver, Center for
                                                           Epidemiological Studies
                                                           Depression Scale,
                                                           investigator-developed
                                                           confidence using
                                                           activities scale, Task
                                                           Management Strategy
                                                           Index
 Graff, M. J. L.,   To determine the   Level I             Intervention:                 At 6 weeks there were      Not able to carry out   10 sessions of
 Vernooij-Dassen,   effectiveness of   Randomized                                        significant differences    double blind study      community
 M. J. M.,          community based    controlled trial    10 one-hour sessions of       between treatment and      conditions              occupational therapy
 Thijssen, M.,      occupational                           occupational therapy held     control groups.                                    given over 5 weeks
 Dekker, J.,        therapy on daily   135 patients aged   over 5 weeks, including       Patients who received      Unrepresentative        improves the daily
 Hoefnagels, W.     functioning of     ≥65 with mild to    cognitive and behavioral      occupational therapy       sample, recruited       functioning of patients
 H. L., & Olde      patients with      moderate dementia   interventions, to train       functioned                 from one university     with dementia and
 Rikkert, M. G.     dementia and the   living in the       patients in the use of aids   significantly better in    hospital                diminishes the burden
 M. (2006).         sense of           community and       to compensate for             daily life than those in                           on caregivers.
                    competence of      their primary       cognitive decline and         the control group.         Lack of an attention    Benefits to the patient
                    their caregivers   caregivers.         caregivers in coping          Primary caregivers         control group           appear to be sustained
                                                           behaviors and                 who received                                       when caregivers are
                                                           supervision. Treatment        occupational therapy                               trained to provide
                                                           delivered by experienced      felt significantly more                            supervision to patients
                                                           occupational therapists       competent than those                               and when they are
G:\Practice\EBP\Evidence Table5.05                                                                                                           page 9 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                      included four sessions of     who did not.                       provided with
                                                      diagnostics and goal          Statistical analysis               individual support.
                                                      defining for patients and     showed significant
                                                      caregivers to choose          differences in scores
                                                      meaningful activities.        for patient and
                                                      Environmental                 caregiver groups.
                                                      modifications and
                                                      compensatory strategies       At 12 weeks,
                                                      were used to adapt            differences between
                                                      activities of daily living.   patient and caregiver
                                                      In the remaining 6            groups remained
                                                      sessions patients were        significant, and 75% of
                                                      taught to optimize            patients in the
                                                      compensatory and              intervention group had
                                                      environmental strategies      clinically relevant
                                                      to improve ADL                improvement from the
                                                      performance.                  6th week assessment as
                                                                                    compared to 9% of the
                                                      Control group received        control group.
                                                      occupational therapy 12
                                                      weeks after the
                                                      completion of the study.

                                                      Outcome Measures:

                                                      Patient: MMSE; Brief
                                                      Cognitive Rating Scale;
                                                      Geriatric Depression
                                                      Scale; Revised Memory
                                                      and Behavioral Problems
                                                      Checklist; Process Scale
                                                      of the Assessment of
                                                      Motor and Process Skills;
                                                      age, sex and educational
                                                      level; comorbidity.

G:\Practice\EBP\Evidence Table5.05                                                                                      page 10 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                 Caregivers: Sense of
                                                                 Competence
                                                                 Questionnaire; Center for
                                                                 Epidemiologic Studies
                                                                 Depression Scale
 Graff, M.,          Investigate the         Level I             Intervention:                 All overall scores at 6     Not possible to carry   This study suggests
 Vernooij-Dassen,    effects of              Randomized                                        weeks differed              out a double-blind      that there is a strong
 M., Thijssen, M.,   community               controlled trial    Instead of including the      significantly between       study.                  positive association
 Dekker, J.,         occupational                                information in this           the intervention and                                between dementia
 Hoefnagels, W.,     therapy on              135 patients aged   column – what about:          control group. Patients     Non-representative,     patients’ daily
 & OldeRikkert,      dementia patients’      ≥65 with mild to    See Graff, et al 2006 or      and informal                convenience sample      functioning, mood,
 M. (2007)           and caregivers’         moderate dementia   same as above Graff et al     caregivers who                                      and quality of life on
                     quality of life,        living in the       2006                          received occupational                               caregivers’ sense of
                     mood and health         community and       10 one-hour sessions of       therapy improved                                    control over life.
                     status and              their primary       occupational therapy held     significantly relative to                           Training caregivers in
                     caregivers’ sense       caregivers.         over 5 weeks, including       baseline as compared                                supervision skills and
                     of control over life.                       cognitive and behavioral      to controls on overall                              providing them with
                                                                 interventions, to train       quality of life, health                             individualized support
                                                                 patients in the use of aids   status, and patient and                             as part of the
                                                                 to compensate for             caregiver mood.                                     occupational therapy
                                                                 cognitive decline and                                                             plan for patients with
                                                                 caregivers in coping          At 12 weeks, all                                    dementia is an
                                                                 behaviors and                 significant outcomes                                essential component
                                                                 supervision. Treatment        remained significant                                of occupational
                                                                 delivered by experienced      for the intervention                                therapy treatment for
                                                                 occupational therapists       group as compared to                                this population.
                                                                 included four sessions of     control.
                                                                 diagnostics and goal
                                                                 defining for patients and
                                                                 caregivers to choose
                                                                 meaningful activities.
                                                                 Environmental
                                                                 modifications and
                                                                 compensatory strategies
                                                                 were used to adapt
                                                                 activities of daily living.
G:\Practice\EBP\Evidence Table5.05                                                                                                                  page 11 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                      In the remaining 6
                                                      sessions patients were
                                                      taught to optimize
                                                      compensatory and
                                                      environmental strategies
                                                      to improve ADL
                                                      performance.

                                                      Primary caregivers were
                                                      trained by means of
                                                      cognitive and behavioral
                                                      interventions, to use
                                                      effective supervision,
                                                      problem solving, and
                                                      coping strategies to
                                                      sustain the patient’s and
                                                      their own autonomy and
                                                      social participation.

                                                      Control group received
                                                      no occupational therapy
                                                      during the study period,
                                                      but did receive
                                                      occupational therapy 12
                                                      weeks after the
                                                      completion of the study.

                                                      Outcome Measures:

                                                      Occupational
                                                      Performance History
                                                      Interview; Canadian
                                                      Occupational
                                                      Performance Measure;
                                                      Ethnographic interview;
                                                      Dementia Quality of Life
G:\Practice\EBP\Evidence Table5.05                                                                                      page 12 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                              Instrument; General
                                                              Health Questionnaire;
                                                              Cornell Scale for
                                                              Depression; Center for
                                                              Epidemiologic Studies
                                                              Depression Scale;
                                                              Mastery Scale;
                                                              Cumulative Illness
                                                              Rating Scale for
                                                              Geriatrics; Mini Mental
                                                              Status Examination;
                                                              Revised memory and
                                                              Behavioral Problems
                                                              Checklist; caregiver
                                                              relationship with the
                                                              patient.
 Graff, M.,         To assess the cost    Level I             Intervention:                 The economic           Lack of inclusion of a    Occupational therapy
 Adang, E.,         effectiveness of      Randomized                                        evaluation showed      generic quality of life   professionals are best
 Vernooij-Dassen,   community based       controlled trial    Instead of including the      average savings of     measure limits            equipped to carry out
 M., Dekker, J.,    occupational                              information in this           $2,621 per couple      comparability with        the specific tasks of
 Jomsson, L,        therapy compared      135 patients aged   column – what about:          successfully treated   other interventions.      this intervention.
 Thijssen, M.,      with usual care in    ≥65 with mild to    See Graff, et al 2006 or      with occupational                                Community OT is a
 Hoefnagels, W.,    older patients with   moderate dementia   same as Graff et al 2006      therapy. The           Not possible to carry     highly effective, cost
 OldeRikkert, M.    dementia and their    living in the                                     probability of OT      out a double-blind        effective therapy for
 (2008)             caregivers from a     community and       10 one-hour sessions of       being the dominant     study.                    community-dwelling
                    societal point.       their primary       occupational therapy held     and most efficient                               elders and their
                                          caregivers.         over 5 weeks, including       intervention was       Non-representative,       caregivers and should
                                                              cognitive and behavioral      estimated to be 94%.   convenience sample.       be advocated as an
                                                              interventions, to train                                                        included service in all
                                                              patients in the use of aids                                                    community health
                                                              to compensate for                                                              services, primary care
                                                              cognitive decline and                                                          services, and
                                                              caregivers in coping                                                           outpatient services for
                                                              behaviors and                                                                  people with dementia.
                                                              supervision. Treatment
                                                              delivered by experienced
G:\Practice\EBP\Evidence Table5.05                                                                                                            page 13 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                      occupational therapists
                                                      included four sessions of
                                                      diagnostics and goal
                                                      defining for patients and
                                                      caregivers to choose
                                                      meaningful activities.
                                                      Environmental
                                                      modifications and
                                                      compensatory strategies
                                                      were used to adapt
                                                      activities of daily living.
                                                      In the remaining 6
                                                      sessions patients were
                                                      taught to optimize
                                                      compensatory and
                                                      environmental strategies
                                                      to improve ADL
                                                      performance.

                                                      Primary caregivers were
                                                      trained by means of
                                                      cognitive and behavioral
                                                      interventions, to use
                                                      effective supervision,
                                                      problem solving, and
                                                      coping strategies to
                                                      sustain the patient’s and
                                                      their own autonomy and
                                                      social participation.

                                                      Control group received
                                                      no occupational therapy
                                                      during the study period,
                                                      but did receive
                                                      occupational therapy 12
                                                      weeks after the
G:\Practice\EBP\Evidence Table5.05                                                                                      page 14 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                      completion of the study.

                                                      Outcome Measures:

                                                      Primary outcome
                                                      measure for patient
                                                      function was process
                                                      scale of Assessment of
                                                      Motor and Process Skills.

                                                      Primary outcome for
                                                      caregivers was assessed
                                                      with the Sense of
                                                      Competence
                                                      Questionnaire.

                                                      Over three months
                                                      primary outcomes were
                                                      combined in one measure
                                                      for successful treatment
                                                      for economic evaluation.
                                                      Cost analysis measures
                                                      included caregivers’
                                                      records of patients’ visits
                                                      to the general
                                                      practitioner,
                                                      physiotherapist, social
                                                      worker, or other
                                                      healthcare suppliers
                                                      specifically related to
                                                      dementia. Caregivers also
                                                      recorded their own visits
                                                      to health care services
                                                      and hours spent in care of
                                                      the patient. Number of
                                                      hours patient received
G:\Practice\EBP\Evidence Table5.05                                                                                      page 15 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                              treatment at home as well
                                                              as if they received meals
                                                              on wheel was tracked.
 Hepburn, K.,      To test the ability    Level I             Intervention:                Trial initially designed   Convenience sample;   Given the progressive
 Lewis, M.,        of psychoeducation                                                      to compare                 All self-reported     nature of dementing
 Narayan, S.,      intervention to        Randomized          Partners in Caregiving       effectiveness of both      measures.             disorders, a
 Center, B.,       relieve or forestall   controlled trial    (PIC) program consisted      experimental                                     reasonable goal of
 Tornatore, J.,    dementia caregiver                         of two versions of a         interventions, but                               caregiver intervention
 Bremer, K., &     distress over a one    215 self-selected   multi-session                preliminary                                      for occupational
 Kirk, L. (2005)   year period.           care giver / care   multidisciplinary            examination revealed                             therapy professionals
                                          receiver dyads      program:                     no important                                     is the maintenance
                                          recruited from a                                 differences in effect.                           (rather than
                                          variety of          Experimental group #1:       Thus, the data from the                          improvement) of
                                          community sources   program concentrating on     two intervention                                 caregiver well-being.
                                          over a two-year     development of strategies    groups were combined                             This study suggests
                                          period.             for day-to-day               for comparison with                              that in addition to the
                                                              caregiving.                  controls.                                        traditional focus on
                                                                                                                                            caregiving skills
                                                              Experimental group #2:       Strengthening                                    occupational therapy
                                                              Caregiving practice in a     caregivers’ ability to                           personnel are likely to
                                                              decision-making              better understand and                            offer, additional focus
                                                              framework, identifying       undertake their                                  should be placed on
                                                              and using values and         caregiving role staves                           caregivers’ appraisal
                                                              preferences as a way to      off increasing distress                          of their situation and
                                                              evaluate the options         and improves                                     skills.
                                                              available in day-to-day      caregiving attitude at 6
                                                              caregiving decisions.        months.

                                                              Each program met for 2       However, at one year,
                                                              hours per week over a        between-group effects
                                                              period of six consecutive    deteriorated, although
                                                              weeks.                       still indicated
                                                                                           persistence of effect.
                                                              Programs were led by
                                                              teams of study
                                                              investigators (two leaders
G:\Practice\EBP\Evidence Table5.05                                                                                                           page 16 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                per group).

                                                                Control Group: Wait list
                                                                controls

                                                                Outcome Measures:
                                                                Mini Mental State Exam
                                                                (care-recipient);
                                                                Open-Ended Interview
                                                                Questionnaire (developed
                                                                for study) that included
                                                                scales reporting care
                                                                recipients’ abilities and
                                                                caregiver perceptions.
                                                                Follow-up telephone
                                                                interview at 6 and 12
                                                                months.
                                                                Caregiver Distress
                                                                Measure.
 Hepburn, K. W.;   To test role-         Level I                Intervention:                Significant within-       Homogeneous             While results of this
 Tornatore, J.;    training                                                                  group improvements        sample.                 study require careful
 Center, B.&       intervention as a     Randomized             Family care receiver         occurred 3 months post                            interpretation because
 Ostwald, S. W.    way to help family    controlled trial       dyads were randomly          intervention with         Large attrition.        the type of dementia
 (2001).           caregivers                                   assigned to training         treatment group                                   was not specified and
                   appreciate and        117 caregiver / care   beginning immediately or     caregivers on measures    Caregivers were help-   the main tool used for
                   assume a more         receiver dyads         were placed in a wait-list   of beliefs about          seekers.                outcome measurement
                   clinical belief set   referred from a        control group and            caregiving and                                    was not validated for
                   about caregiving      wide variety of        assigned to receive          reaction                  Results only            caregivers of people
                   and thereby           community              training in 5 to 6 months,   to behavior . When        measured at 3           with dementia, there is
                   ameliorate the        agencies.              following completion of      outcomes were             months; long term       evidence that
                   adverse outcomes                             data collection.             compared, treatment       effects not measured.   caregivers appear to
                   associated with       Care receivers were                                 group caregivers were                             benefit from
                   caregiving.           mostly male            Treatment: 2 hrs per         significantly different   Caregiver knowledge     information provided
                                         (55.6%) with a         session over 7 weeks was     (in the expected          changes not             in an ongoing manner,
                                         mean age of 77.        provided using a program     direction) from those     measured.               respond to specific
                                         Severity of            based on a stress and        in the control group on                           information about
G:\Practice\EBP\Evidence Table5.05                                                                                                              page 17 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                     dementia had not    coping theory framework.     measures of the stress    Instrument (BACS)      available services
                                     progressed beyond   The curriculum combined      mediator, beliefs, and    not specifically       (quality, reasonable
                                     the Functional      classroom instruction and    key outcomes,             validated for          expectation, length,
                                     Assessment          exercises and                response to behavior,     caregivers of people   etc.), and coaching
                                     Staging (FAST) 7b   assignments to read          depression, and burden    with dementia.         (particularly to
                                     stage.              additional materials.        .                                                understand that the
                                                         The training included five   There was a significant                          caregiving role is
                                     Caregivers were     main components:             positive association                             different from other
                                     mostly female       1) Information               between the                                      family roles).
                                     (70%) with a mean       provision;               strengthened
                                     age of 65).         2) Concept                   mediator, the
                                     Caregivers were         development;             caregivers’ having
                                     spouses (65.5%)     3) Role clarification;       less-emotionally
                                     and children        4) Belief clarification;     enmeshed beliefs
                                     (28.3%) of care     5) Mastery-focused           about caregiving roles
                                     receivers.              coaching.                and responsibilities,
                                                                                      and the outcome,
                                     All participants    Training was provided in     namely improvements
                                     identified          group settings in weekly     in burden (P=.019)
                                     themselves as       2-hour sessions over the     and depression
                                     Caucasian.          course of 7 weeks.           (P=.007).
                                                         Workshop faculty was
                                                         made up of a
                                                         multidisciplinary team
                                                         (nurse, educator, family
                                                         therapist, occupational
                                                         therapist). While
                                                         caregivers and other
                                                         family members attended
                                                         the training, a daycare-
                                                         like group was provided
                                                         for care receivers.

                                                         Outcome Measures


G:\Practice\EBP\Evidence Table5.05                                                                                                      page 18 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                              •   MMSE;
                                                              •   Lawton ADL Scale;
                                                              •   Revised Memory and
                                                                  Behavior Problem
                                                                  Checklist;
                                                              • Beliefs About
                                                                  Caregiving Scale
                                                                  (BACS);
                                                              • Center for
                                                                  Epidemiologic
                                                                  Studies Depression
                                                                  Scale
                                                              • Revised Zarit Burden
                                                                  Scale
 Hosaka,, T; &    Investigate the       Level III             Intervention:                Significant               Small sample size;    This study suggests
 Sugiyama, Y.     effects of a group    One group, pre/post   Five week structured         improvement (P<0.05)      Convenience sample;   occupational therapy
 (2003)           structured            assessment.           group intervention           in the scores of                                professionals should
                  intervention on the                         consisted of one 90-         depression, anger-                              include discussion and
                  mental and            20 female family      minute session per week.     hostility, fatigue, and                         social support
                  physical              caregivers; median    Participants listened to     confusion, physical                             opportunities in
                  discomfort and        age 54.7 (range 47-   lectures provided by the     symptoms, anxiety-                              caregiver training. In
                  immune function       66), and period of    researchers; participated    mood disorder, and                              addition, assisting
                  of family             home care ranged      in progressive muscle        suicidality-depression.                         caregivers in
                  caregivers of         from 1-12 years       relaxation exercises using                                                   developing basic
                  people with           (mean 5.8).           a 15 minute audio-tape                                                       relaxation skills
                  dementia in Japan.                          produced for this study;                                                     through autogenic
                                        8 care-recipients     and participated in group                                                    training aids can help
                                        had Alzheimer’s       discussion.                                                                  improve their own
                                        dementia, and 10                                                                                   well-being.
                                        had vascular          Outcome Measures:
                                        dementia.             Profile of Mood States;
                                                              General health
                                                              Questionnaire-30;
 Huang, H. L.;    Investigate the       Level I               Intervention:                The care-recipient        Small sample;         Caregiver training,
 Lotus Shyu, Y.   effectiveness of a    Randomized            Experimental group           scores of physically      Convenience sample;   even of short duration,

G:\Practice\EBP\Evidence Table5.05                                                                                                          page 19 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
 I.; Chen, M. C.;   home-based             controlled trial.    (n=24) received two in-      non-aggressive            Short follow up may       can help both decrease
 Chen, S. T. &      caregiver training                          home caregiving training     behavior, verbally        not indicate true         non-physically
 Lin, L. C.         program for            48 patients with     sessions (separated by 1     aggressive, and non-      effect of intervention.   aggressive behavioral
 (2003).            caregivers of elders   dementia and their   week) provided by one of     aggressive subscales                                symptoms of care-
                    with dementia and      caregivers.          the investigators. The       decreased significantly                             recipients with
                    behavioral                                  initial visit focused on     and continuously.                                   dementia and increase
                    problems in                                 obtaining assessment data                                                        the sense of self-
                    Taiwan.                                     on the conditions of the     Caregivers’ scores on                               efficacy of caregivers.
                                                                dementia patient,            the Agitation                                       Occupational therapy
                                                                identification of targeted   Management Self-                                    professionals should
                                                                behavioral problems, and     Efficacy Scale                                      take care of helping
                                                                exploration of the           increased significantly                             caregivers understand
                                                                causative environmental      and continuously in the                             the progressive nature
                                                                stimuli. The second visit    experimental group.                                 of the disease as well
                                                                further assessed family                                                          as causative
                                                                resources and finalized                                                          environmental factors
                                                                the plan for handling                                                            associated with
                                                                specific behavior                                                                behavioral problems.
                                                                problems with the                                                                Collaboration with the
                                                                caregiver. Two                                                                   caregiver in targeting
                                                                telephone consultations                                                          problems is more
                                                                focused on targeted                                                              likely to result in
                                                                behaviors. The training                                                          greater sense of self-
                                                                program was based on                                                             efficacy than when
                                                                the Progressively                                                                only following
                                                                Lowered Stress                                                                   prescribed
                                                                Threshold (PLST) model.                                                          interventions.

                                                                Control group received
                                                                educational materials and
                                                                two social telephone calls
                                                                (every two weeks).

                                                                Outcome Measures:
                                                                Chinese version of the
                                                                Cohen-Mansfield
G:\Practice\EBP\Evidence Table5.05                                                                                                                page 20 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                Agitation Inventory (for
                                                                care recipient);
                                                                Agitation Management
                                                                Self-efficacy Scale (for
                                                                caregiver).
                                                                Measures obtained at
                                                                baseline, three weeks and
                                                                3 months after
                                                                intervention.
 Kuhn, D. R. &     To investigate the     Level III             Intervention:               Significant                 Lack of control       Psychoeducation is
 Mendes de Leon,   effectiveness of an                          Five consecutive weekly     improvement in AD           group;                effective in increasing
 C. F. (2001).     Alzheimer’s            One group, pre/post   sessions, each 2 hours      knowledge (effect size      Convenience sample;   the knowledge of
                   dementia               test.                 long. Psychoeducational     of 0.8). No                 Relatively            caregivers related to
                   knowledge                                    model focused on the        statistically significant   homogeneous sample    the progression of the
                   building program       58 caregivers of 38   medical, psychological,     changes in caregiver                              disease and its
                   in increasing          patients.             and social issues           reports on the RMBPC                              symptoms.
                   caregiver              Caregivers were       associated with the early   or CES-D were noted.                              Knowledge of AD
                   knowledge of the       74% female,           stages of AD. Format of                                                       does not necessarily
                   disease and their      average age 54.       each session included       At 9 month post-test,                             translate into
                   management of                                lecture, slides and         AD knowledge                                      decreased burden or
                   their feelings about   Participants          discussion reinforced by    remained intact and no                            less depression on the
                   early Alzheimer’s-     recruited from two    the training manual.        significant changes                               part of caregivers.
                   related problems       outpatient clinics                                were noted on the                                 Occupational therapy
                   and emotions as        and two continuing    Outcome Measures:           RMBPC or CES-D.                                   professionals should
                   well as reduce their   care retirement       (pre, post and 9 month                                                        certainly educate
                   depression.            communities           follow-up)                                                                    caregivers about the
                                                                AD Knowledge Test;                                                            disease in addition to
                                                                Revised Memory and                                                            finding other forms of
                                                                Behavior Problems                                                             intervention for
                                                                Checklist (RMBPC);                                                            support in order to
                                                                Center for                                                                    assist caregivers in
                                                                Epidemiological Studies                                                       remaining in that role
                                                                Depression Scale (CES-                                                        and having a sense of
                                                                D);                                                                           success and mastery.
                                                                Brief survey completed at
                                                                end of intervention
G:\Practice\EBP\Evidence Table5.05                                                                                                             page 21 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                 asking participants to
                                                                 evaluate helpfulness of
                                                                 program.
 Lee, H.,          To assess the           Level I               Intervention:                 Current evidence does     Small number (3) of    Results should be
 Cameron, M.       effects of respite                            Included studies provided     not demonstrate any       studies met criteria   treated with caution as
 (2004).           care for people         Systematic review     interventions aimed to        benefits or adverse       for inclusion          they may reflect the
                   with dementia and                             provide rest or respite for   effects from the use of                          lack of high quality
                   their caregivers, in    Three randomized      the primary caregiver.        respite care for people                          research in the area
                   particular the effect   controlled trials                                   with dementia or their                           rather than lack of
                   of respite care on      were included in      Outcome Measures              caregivers.                                      benefit.
                   rates of                this review.          included:
                   institutionalization.                         Brief Symptom Inventory
                                                                 – Global Severity Index;
                                                                 Mortality;
                                                                 Number of days living in
                                                                 the community;
                                                                 Center for
                                                                 Epidemiological Studies
                                                                 Depression Scale;
                                                                 Bradburn Affect balance
                                                                 Scale;
                                                                 Zarit’s Caregiver Burden
                                                                 Scale;
                                                                 Duke-UC Functional
                                                                 Support Questionnaire;
                                                                 Health and Social Service
                                                                 Utilization.
 Mahoney, D. M.;   To investigate the      Level I               Intervention:                 Usage fell over the       Small sample size.     Occupational therapy
 Tarlow, B. ;      usefulness of a                                                             first four months and                            professionals can
 Jones, R. N.;     computer-mediated       Randomized            Intervention group            reached a plateau                                participate in the
 Tennstedt, S. &   interactive voice       controlled trial.     received training on how      beyond the fourth                                development of such a
 Kasten, L.        response system                               to use the REACH              month.                                           service, particularly
 (2001).           integrated with         100 caregivers who    Telephone Linked Care                                                          following direct
                   voicemail to help       were over the age     (TLC). This system            Adopters were                                    provision of service.
                   family caregivers       of 21 and provided    provided access to four       significantly older,                             A particular role for
                   manage disruptive       4 hours or more per   intervention modules:         more highly educated                             occupational therapy
G:\Practice\EBP\Evidence Table5.05                                                                                                               page 22 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                  behaviors in people   day of assistance or   1) Monitoring and           and reported a greater      personnel could be in
                  with Alzheimer’s      supervision for a          counseling (provided    sense of management         providing advice and
                  disease.              minimum of 6               weekly                  of the situation than       monitoring progress.
                                        months                 2) In home support          non-adopters. The           Low tolerance for
                                        From 60                    group (voicemail        majority of                 technological
                                        recruitment sites          system designed to      participants reported       difficulties should be
                                                                   mimic a computer        that using the TLC was      considered, and the
                                                                   chat group).            not difficult.              importance person-to-
                                                               3) Ask the expert                                       person contact should
                                                                   (confidential           The weekly caregiver        be considered in
                                                                   voicemail access to a   conversation,               setting up this type of
                                                                   multidisciplinary AD    providing monitoring        program.
                                                                   expert panel            and advice, was the
                                                               4) Activity / caregiver     most frequently used
                                                                   respite conversation    module of the four.
                                                                   (18 min. automated      The respite call
                                                                   IVR telephone           module was the second
                                                                   conversation using a    most frequently used.
                                                                   male voice in a         The ask-the-expert and
                                                                   soothing, didactic      bulletin board modules
                                                                   manner for the          were the least used.
                                                                   person with AD).
                                                               System was available to     Most participants
                                                               intervention group for 12   preferred in-person
                                                               months.                     support meetings, and
                                                                                           were clear about the
                                                               Control group received      importance of human
                                                               usual care and were         contact for them.
                                                               offered the TLC system
                                                               at the conclusion of the
                                                               study period.

                                                               Outcome Measures
                                                               include:

                                                               Technology: use of
G:\Practice\EBP\Evidence Table5.05                                                                                      page 23 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                             technology:
                                                             Proficiency: level of skill
                                                             using the TLC;
                                                             User characteristics
                                                             (gender, age, etc.);
                                                             Perceived stress;
                                                             Mastery: seven point
                                                             scale of sense of control;
                                                             Management of
                                                             Situation: indication of
                                                             caregiver coping
                                                             measured on a three point
                                                             index;
                                                             Care recipient
                                                             characteristics: measure
                                                             using the MMSE,
                                                             Dependencies in
                                                             Activities of Daily
                                                             Living, and Instrumental
                                                             Activities of Daily Living
                                                             scales.
 Mittelman, MS.,   To determine the     Level I              Intervention:                 Both caregiver            Support group            Occupational therapy
 Ferris, S.H.,     long-term                                                               depression and            participation was        professionals can be
 Shulman, E.,      effectiveness of     Randomized           Treatment consisted of        reaction to               required of caregivers   part of a team
 Steingberg, G.,   comprehensive        controlled trial     three components:             troublesome behavior      in the treatment group   providing support and
 and Levin, B.     support and                               • 2 individual and 4          were significant          but not denied to        information to spouse-
 (1996).           counseling for       206 spouse-             family counseling          predictors of             caregivers in control    caregivers.
                   spouse-caregivers    caregivers of AD        sessions in the first 4    placement.                group; 72% of            Information about
                   and families in      patients recruited      months after caregiver                               caregivers in the        progression of
                   postponing or        over a 3 ½ year         enrolled in the study;     Median time from          treatment group and      disease, personal
                   preventing nursing   period from             sessions were task-        baseline to nursing       40.8% in the control     coping skills, and
                   home placement of    community clinics       oriented and focused       home placement was        group joined a           management
                   patients with        and centers in New      on communication,          329 days longer for the   support group, so        strategies is
                   Alzheimer’s          York City.              problem-solving and        treatment group than      results related to       particularly useful.
                   disease                                      improving emotional        the control group.        support group not        Occupational therapy
                                        58.3% female.           and instrumental                                     unique to tested         professionals should
G:\Practice\EBP\Evidence Table5.05                                                                                                             page 24 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                              support of primary                                intervention.        monitor caregiver
                                                              caregiver.                                                             depression and
                                                            • Weekly support group                                                   provide resources for
                                                              for caregivers after                                                   support groups for
                                                              initial 4 months of                                                    caregivers. Such
                                                              participation in study;                                                interventions are
                                                            • Continuous                                                             likely to result in
                                                              availability of                                                        delayed nursing home
                                                              counselors to                                                          placement.
                                                              caregivers and
                                                              families to help deal
                                                              with the changing
                                                              nature and severity of
                                                              the patient’s
                                                              symptoms.
                                                            • Access to counseling
                                                              on an ongoing basis

                                                            Control group – usual
                                                            care

                                                            Outcome Measures:
                                                            Global Deterioration
                                                            Scale;
                                                            Memory and Behavior
                                                            Problem Checklist;
                                                            Social Network
                                                            Questionnaire;
                                                            Geriatric Depression
                                                            Scale
 Mittelman, M.      To examine the       Level I            Intervention:               Caregivers in the       Homogeneous sample   Psychosocial
 S.; Roth, D. L.;   effect of a                                                         active treatment        relative to race     intervention that
 Haley, W. E. &     caregiver program    Randomized         All caregivers were         condition reported      (>90% White).        includes education
 Zarit, S. H.       over a 4-year        controlled trial   interviewed at regular      lower reaction scores   Support group        and support and can
 (2004).            period on both the                      intervals following entry   (bother), on average,   participation was    provide caregivers

G:\Practice\EBP\Evidence Table5.05                                                                                                    page 25 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                    frequency of           406 spouse-          into the study every 4      than usual care           required of caregivers   with strategies to help
                    problem behavior       caregivers of AD     months during the first     caregivers across all     in the treatment group   them manage their
                    in people with AD      patients recruited   year, and every 6 moths     assessments after         but not denied to        reactions to behavior
                    and the reactions of   over a 8 ½ year      thereafter.                 baseline.                 caregivers in control    problems more
                    their family           period from                                                                group, so results        effectively. This, in
                    caregivers.            community clinics    Treatment group                                       related to support       turn, can have a
                                           and centers in Ney   participants received                                 group not unique to      favorable impact on
                                           York City.           counseling (2 individual                              tested intervention.     caregiver depression
                                                                and 4 family sessions) to                                                      and nursing home
                                           60.1 % were          focus on communication,                                                        placement
                                           female, 90.9% were   problem-solving, and
                                           White; 75.8% of      education depending on
                                           care receivers had   family needs. Also
                                           mild to moderate     support groups, and ad-
                                           dementia at          hoc telephone support /
                                           baseline.            counseling were
                                                                included.
                                           Caregivers
                                           followed             Control group – usual
                                           longitudinally for   care
                                           up to 12 years.
                                                                Outcome Measures:

                                                                Outcome Measures:
                                                                Memory and Behavior
                                                                Problem Checklist;
                                                                Global Deterioration
                                                                Scale;
                                                                Social Network
                                                                Questionnaire;
                                                                Geriatric Depression
                                                                Scale
 Mittelman, M.S.,   To determine the       Level I              Intervention:               Caregivers in the         As above                 Occupational therapy
 Haley, W.E.,       effectiveness of a                          As above                    intervention group        Homogeneous sample       professionals should
 Clay, O.J. &       counseling and         Randomized           All caregivers were         were able to keep their   relative to race         be alert to
 Roth, D.L.         support                controlled trial     interviewed at regular      spouses at home longer    (>90% White).            circumstances where
G:\Practice\EBP\Evidence Table5.05                                                                                                              page 26 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
 (2006)           intervention fro      as above             intervals following entry    than caregivers in the     Support group            placement should be
                  spouse caregivers     406 spouse-          into the study every 4       usual care group.          participation was        recommended to
                  in delaying time to   caregivers of AD     months during the first                                 required of caregivers   protect the care-
                  nursing home          patients recruited   year, and every 6 moths      Higher patient income      in the treatment group   givers’ health and
                  placement of          over a 8 ½ year      thereafter.                  was predictive of          but not denied to        well-being.
                  patients with         period from                                       longer time to             caregivers in control
                  Alzheimer’s           community clinics    Treatment group              placement.                 group, so results
                  disease, and          and centers in Ney   participants received                                   related to support
                  identify the          York City.           counseling (2 individual     Increased severity of      group not unique to
                  mechanisms                                 and 4 family sessions),      dementia, poorer           tested intervention.
                  through which the     60.1 % were          participated in support      caregiver physical
                  intervention          female, 90.9% were   groups, and received ad-     health, lower              Despite utilization of
                  accomplished this     White; 75.8% of      hoc telephone support /      satisfaction with social   random assignment,
                  goal.                 care receivers had   counseling.                  support, greater           there were
                                        mild to moderate                                  frequency of memory        imbalances at
                                        dementia at          Control group                and behavior               baseline between
                                        baseline.            participants were            problems, more             treatment and control
                                                             provided with normal         symptoms of                groups on several
                                        Caregivers           counseling services          depression, and higher     measures.
                                        followed             offered to all families of   caregiver burden were      Stratification may
                                        longitudinally for   the NYU- Aging and           all significant            solve this problem in
                                        up to 17 years.      Dementia Research            predictors of higher       the future.
                                                             Center (ARDC).               nursing home
                                                                                          placement rates.
                                                             Outcome Measures:

                                                             Outcome Measures:
                                                             Memory and Behavior
                                                             Problem Checklist;
                                                             Global Deterioration
                                                             Scale;
                                                             3 questions from the
                                                             physical health section of
                                                             the Alder Americans
                                                             Resources and Services
                                                             questionnaire;
G:\Practice\EBP\Evidence Table5.05                                                                                                             page 27 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                  Social Network
                                                                  Questionnaire;
                                                                  Geriatric Depression
                                                                  Scale
 Mittelman, M.S.,    To determine the      Level I                Intervention:                The control group           As above                 Psychosocial
 Roth, D.L., Clay,   effects of                                   As above                     reported significantly      Relatively               intervention for
 O.J. & Haley,       counseling and        Randomized,            Two individual               better subjective sense     homogeneous              caregivers,
 W.E. (2007)         educational support   controlled trial.      counseling sessions          of health than the          sample;                  emphasizing
                     on the physical                              tailored to each             control group at four                                enhancement of social
                     health of spouse      As above               caregiver’s specific         month follow up. The        Participants in the      support, are likely to
                     caregivers of         406 spouse             situation; four family       statistically significant   control group            lead to improvements
                     people with           caregivers of          counseling sessions with     difference between the      received benefit from    in caregiver health.
                     Alzheimer’s           community              the primary caregiver and    two groups was              the availability of      Encouraging
                     disease.              dwelling patients      family members selected      maintained over the         counseling on an as-     caregivers to
                                           recruited over a 9.5   by the caregiver;            first two years of          needed basis, which      strengthen their social
                                           year period            encouragement and            follow-up. Depressive       may have decreased       support system should
                                           recruited through      participation in locally     symptoms were a             the apparent             be a basic component
                                           the NYU                available support groups     significant predictor of    differential effect of   of occupational
                                           Alzheimer’s            that met weekly after the    subjective sense of         the intervention.        therapy intervention
                                           Disease Center and     fourth month follow-up;      health. The findings                                 for this population.
                                           referred from New      and continuous               suggest that enhanced                                Social support
                                           York City’s            availability of counselors   support intervention                                 interventions should
                                           Chapter of the         to caregivers and families   led to a significant                                 be structured and be
                                           Alzheimer’s            by telephone (ad-hoc         benefit to caregivers’                               provided over a long
                                           association.           counseling).                 self-rated health                                    period of time.

                                                                  Control group received
                                                                  usual care, but were
                                                                  given information on
                                                                  request. They did not
                                                                  receive individual or
                                                                  family counseling, nor
                                                                  were they asked to join a
                                                                  support group, although
                                                                  many did on their own.

G:\Practice\EBP\Evidence Table5.05                                                                                                                   page 28 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                 Outcome Measures:

                                                                 Questionnaire adapted
                                                                 from the Older
                                                                 Americans Resources and
                                                                 Services
                                                                 Multidimensional
                                                                 Assessment
                                                                 Questionnaire (OARS);
                                                                 Geriatric Depression
                                                                 Scale;
                                                                 Social Network
                                                                 Questionnaire.
 Peacock, S. C. &   To assess the         Level I                Intervention:                 No one intervention       Most studies had         Use of computers in
 Forbes, D. A.      effectiveness of                                                           had an overall            methodological           networking
 (2003).            interventions         Systematic review      Studies reported on four      significant impact on     problems, such as not    interventions is
                    designed to                                  types of intervention:        the well-being of         piloting tools or        especially interesting
                    enhance the well-     36 studies (11 rated   education, case               caregivers.               assessing                for rural caregivers
                    being of caregivers   as “strong,” 11 as     management,                                             appropriateness of       and may increase in
                    of people with        “moderate,” 13 as      psychotherapy, and            Case management did       tools for the            relevance as
                    dementia.             “weak, and 1 as        computer networking.          double the likelihood     population.              technology becomes
                                          “poor”).                                             of intervention groups                             more advanced. Case
                                                                 Outcome Measures:             using community           Most studies             management was
                                                                                               services, but did not     recruited participants   effective in increasing
                                                                 Most commonly                 impact levels of          who already had          the use of formal
                                                                 measured outcome was          depression or strain of   accessed services,       services.
                                                                 institutionalization of the   caregivers.               making it difficult to   Occupational therapy
                                                                 care recipient, followed                                distinguish the degree   professionals should
                                                                 by death of the care          Results indicated that    to which results of      consider participating
                                                                 recipient, perceived          education interventions   trials were related to   in such interventions
                                                                 behavior disturbances of      are insufficient to       tested interventions.    and providing
                                                                 the care recipient,           improve overall                                    consultations and
                                                                 caregiver depression,         caregiver                                          recommendations
                                                                 caregiver strain, stress      psychological well-                                through computer
                                                                 and use of formal             being; however,                                    networks.
                                                                 services.                     results indicated that
G:\Practice\EBP\Evidence Table5.05                                                                                                                 page 29 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                                               institutionalization and
                                                                                               death of the care
                                                                                               recipient were delayed
                                                                                               with caregiver training
                                                                                               programs.
 Schacke, C. &      To evaluate the       Level II                Intervention                 Use of day care is         Differences between     Occupational therapy
 Zank, S.R (2006)   effectiveness of                                                           significantly effective    intervention and        professionals should
                    adult day care        Non-randomized,         Treatment group: adult       in alleviating care-       control group           encourage use of adult
                    programs as           controlled trial with   day care users. Day care     related stress,            composition not         day programs,
                    supports for family   qualitative, semi-      offered group activities     especially in regards to   reported (i.e. length   recognizing hat they
                    caregivers of         structured              including cognitive          compatibility of           of time using adult     alleviate some, but not
                    patients with         interview               stimulation, ADL             family, job and            day care).              all aspects of
                    dementia.                                     training, or gymnastics      caregiving                                         caregiving stress.
                                          77 caregivers (58                                    responsibilities.          Small sample size       Occupational therapy
                                          years old on            Control group: non-users     Further, it enhances                               services can provide
                                          average, 87%            of adult day care.           caregivers’ opportunity    Variability between     services not provided
                                          women, 41%                                           to take part in social     programs offered at     by adult day care
                                          employed; 57%           Both groups were             and recreational           the adult day care      programs, particularly
                                          were caregiving         interviewed for a baseline   activities.                center not accounted    in training caregivers
                                          children, while         upon initiation of the                                  for.                    on how to provide
                                          32% were spouses).      study, and then again at 9   Adult day care                                     supervision for the
                                                                  months.                      programs were              High attrition rate     patient. In addition,
                                          Care recipients                                      selectively effective in   (48.6% of treatment     occupational therapy
                                          were on average 80      Interview focused on four    reducing stress            group and 45% of        professionals should
                                          years old, 73%          domains of caregiver         associated with            control group).         provide information
                                          were women, and         stress: objective            stereotyped patient                                regarding range of
                                          on average already      caregiving tasks,            behavior problems.         Baseline obtained       services available in
                                          severely demented       perceived stress caused                                 after patient and       the community.
                                          according to the        by patient behavior          Intervention did not       caregivers had
                                          MMSE.                   problems, perceived          appear to be effective     become accustomed
                                                                  restrictions concerning      in reducing caregiving     to the day care
                                          Participants            personal needs, and          tasks (i.e. supervision    program, which may
                                          recruited from an       perceived role conflicts     of the patient)            account for lack of
                                          undetermined            between care and family /                               change in certain
                                          number of adult         job obligations.                                        measures between
                                          day care programs                                                               baseline and 9 month
G:\Practice\EBP\Evidence Table5.05                                                                                                                 page 30 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                             and through            Outcomes Measures:                                      follow up interviews.
                                             community centers.
                                                                    MMSE used to evaluate
                                                                    severity of dementia of
                                                                    care receivers.
                                                                    Caregiving stress scale
                                                                    developed for present
                                                                    study
 Schulz, R;           Review                 Level I                Intervention:               Symptomatology:             Great variability in     Occupational therapy
 O'Brien, A;          intervention studies                                                      there were small to         type, dose and           professionals should
 Czaja, S; Ory,       that reported          Systematic review.     Interventions were design   modest improvements         intensity of             be aware that there is
 M; Norris, R;        dementia caregiver                            to achieve effects on       in depression               interventions in         limited consensus
 Martire, L.M;        outcomes               52 reports on 43       caregiver                   symptoms for                studies included in      regarding what
 Belle, S.H;          published between      distinct studies (27   symptomatology and          interventions in            this review makes it     constitutes clinical
 Burgio, L; Gitlin,   1996 and 2001,         used random            included a variety of       comparison to control       difficult to attribute   significance in
 L; Coon, D;          including              assignment of          educational and             conditions; benefits of     observed outcomes to     caregiving
 Burns, R;            psychosocial           participants to        psychotherapeutic           interventions for           any one component        intervention research.
 Gallagher-           interventions for      treatment              interventions such as       anxiety appear to be        of active treatment
 Thompson, D; &       caregivers and         conditions).           problem-solving, coping     equivocal; findings         conditions.              There is strong
 Stevens, A.          environmental and                             skills training, behavior   supporting a beneficial                              consensus that helping
 (2002)               pharmacological                               management, and support     impact of intervention      Because virtually all    a caregiver with a
                      interventions for                             groups.                     on distress are limited;.   interventions studied    clinical diagnosis of
                      care recipients.                                                                                      were                     major depression
                                                                    Interventions designed to   Quality of life:            multidimensional,        progress to a state
                                                                    address caregiver quality   overall, these studies      with caregivers          where he/she no
                                                                    of life included support    suggest that                receiving                longer meets criteria
                                                                    groups,                     statistically significant   combinations of          for this condition is a
                                                                    psychoeducational           reductions of burden,       treatment, attributing   clinically significant
                                                                    programs, stress            mood, and perceived         outcomes to specific     outcome. However,
                                                                    management training,        stress can be achieved      causes is difficult.     the interventions
                                                                    behavioral management,      with some populations                                included in the studies
                                                                    and environmentally         of caregivers, but the                               only had modest
                                                                    focused occupational        evidence of impact is                                influence on
                                                                    therapy..                   mixed with regards to                                depression symptoms
                                                                                                social support and                                   of caregivers.
                                                                    Interventions focused on    marital satisfaction.
G:\Practice\EBP\Evidence Table5.05                                                                                                                    page 31 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                 social significance          Psychoeducational                                 Postponement of
                                                                 included residential care    interventions, behavior                           institutionalization
                                                                 placement, patient           management training,                              appears to be possible
                                                                 longevity and patient        stress management,                                with very intense,
                                                                 functional status            support programs and                              multidimensional
                                                                                              relaxation training                               interventions that
                                                                 Outcome Measures:            showed the highest                                include heavy doses
                                                                                              impact.                                           of counseling, support
                                                                 Were categorized                                                               and education.
                                                                 according to four            Social significance:                              Occupational therapy
                                                                 proposed areas of clinical   significant effects                               can be an integral part
                                                                 significance:                reported in delaying                              of such intervention,
                                                                 Symptomatology:              institutionalization                              particularly in regards
                                                                 Quality of Life,             achieved only with                                to environmental
                                                                 Social Significance, and     multi dimensional                                 interventions as well
                                                                 Social Validity.             interventions.                                    as behavior
                                                                                                                                                management and
                                                                                              Social validity: All                              stress management
                                                                                              studies reported high                             training.
                                                                                              social validity (extent
                                                                                              to which the
                                                                                              intervention was found
                                                                                              to be helpful to
                                                                                              caregivers).
 Smits, C., de       Review the             Level I              Intervention:                Combined programs         Limited number and      Occupational therapy
 Lange, J., Droes,   evidence for effects                                                     may improve some,         varying quality of      personnel are
 R, Franka, M.,      of combined            Systematic Review    The included studies         but not all aspects of    available studies.      qualified to
 Vernooij-Dassen,    intervention                                were classified into three   functioning for                                   participation or direct
 M., & Pot, A.       programmes for         25 reports related   outcome categories with      caregivers and the        Use of multiple         combined programs
 (2007).             both the informal      to various aspects   respect to caregivers:       person with dementia.     measurement             for caregivers and
                     caregiver and the      of caregivers’       mental health, burden,                                 instruments for the     persons with
                     person with            mental health and    and competence.              Caregiver mental          same or similar         dementia. It is
                     dementia.              burden.                                           health is most likely     outcome increase the    important that the
                                                                 Outcome Measures:            positively affected by    complicates             outcome goals for
                                                                                              combined                  interpretation of the   these programs be
                                                                 Caregiver include:           programmes. Findings      results.                clearly defined before
G:\Practice\EBP\Evidence Table5.05                                                                                                               page 32 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                 Geriatric Depression        for other outcomes,                               advising client or
                                                                 Scale, Zarit Burden         such as depressive                                caregiver participation
                                                                 Inventory, Care Strain      symptoms, well-being,                             in such programmes.
                                                                 Questionnaire,, Feeling     and for burden, are not
                                                                 of Competence Scale;        conclusive.                                       Results suggest that
                                                                 Center for                                                                    attention needs to be
                                                                 Epidemiological Studies     Combined                                          paid to the different
                                                                 Depression Scale;           programmes are often                              needs of sub-groups.
                                                                 Revised Memory and          effective in delaying
                                                                 Behavioral Problems         admittance to long stay
                                                                 Checklist; Task             care of the care
                                                                 Management Strategy         recipient.
                                                                 Index; Dementia
                                                                 Knowledge Tests;
                                                                 Feeling of Competence
                                                                 Scale.
 Thompson, C.,       Examine the            Level I              Intervention:               Statistically significant   Outcome measures      Occupational therapy
 Spilsbury, K.,      evidence from                                                           evidence that group-        used in the studies   professionals must be
 Hall, J., Birks,    randomized             Systematic review.    Studies included in this   based supportive            included in the       aware that there is
 Y., Barnes, C., &   controlled trials in                        review were categorized     interventions impact        review were not       little evidence that
 Adamson, J.         which technology,      44 studies           according to three types    positively on caregiver     reported.             interventions aimed at
 (2007)              individualized or                           of intervention:            psychological                                     supporting and/or
                     group-based                                                             morbidity.                                        providing information
                     interventions built                         Technology-based                                                              to carers of people
                     around the                                  interventions, group        No evidence was                                   with dementia are
                     provision of                                based interventions, and    found for the                                     uniformly effective.
                     support and/or                              individual.                 effectiveness of any                              Such programs must
                     information were                                                        other form of                                     be well tailored to the
                     evaluated                                   Outcome Measures:           intervention on a range                           needs of the carer and
                                                                                             of physical and                                   be made relevant to
                                                                 Not reported                psychological health                              their particular
                                                                                             outcomes.                                         situation. However, it
                                                                                                                                               is recommended that
                                                                                                                                               carers be involved in
                                                                                                                                               supportive
                                                                                                                                               interventions, such as
G:\Practice\EBP\Evidence Table5.05                                                                                                              page 33 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                                                                                                                 support groups, as a
                                                                                                                                                 way to help them cope
                                                                                                                                                 with their role. Group
                                                                                                                                                 interventions
                                                                                                                                                 underpinned by
                                                                                                                                                 psychoeducational
                                                                                                                                                 theoretical
                                                                                                                                                 foundations also
                                                                                                                                                 appear to impact on
                                                                                                                                                 depressions in
                                                                                                                                                 caregivers.
 Winter, L; Gitlin,   Evaluate the         Level I               Intervention:                 No large or statistically   Small sample size.    Telesupport groups
 L.N. (2006)          feasibility and                                                          significant differences                           seemed to provide
                      effectiveness of     Randomized            Following an initial          between experimental        Non-representative    limited benefit mostly
                      professionally led   controlled trial.     interview, participants       and control group           sample, excluded      to older (65+ years)
                      telephone-based                            were randomly assigned        participants at 6           other ethnic groups   caregivers.
                      support groups for   103 female            to intervention or control.   months on the outcome       and male caregivers   Occupational therapy
                      female family        caregivers, all 50    Intervention consisted of     measures.                                         professionals may
                      caregivers of        years or older        participation in a                                                              consider inclusion of
                      community-           (mean age 66.6),      telephone-based support       All caregivers scored                             such intervention as
                      dwelling dementia    who had provided a    group over 6 months           high in depression, but                           part of an overall
                      patients.            minimum of 6          (possible 26 sessions).       older caregivers in the                           program if it appears
                                           months of care to a   Telesupport groups were       telesupport groups                                that the caregiver is
                                           relative with         conducted by trained          scored slightly lower,                            relatively isolated and
                                           Alzheimer’s           social workers who used       suggesting more                                   has greater need for
                                           Disease, and who      conference-calling            benefit to this group.                            social contact.
                                           had access to a       technology to link 5
                                           telephone for at      caregivers per group for      Race was not found to
                                           least 1 hour each     an hour weekly. Initially     be associated with any
                                           week. The majority    facilitators focused on       6 month outcomes.
                                           (68.3%) of            building group cohesion
                                           caregivers were       and caregivers expressed      Session attendance
                                           White, and the        emotions and shared           was not found to be
                                           remaining were        coping strategies             associated with
                                           African American.     including cognitive           depression, caregiver
                                                                 reframing and practical       burden, or gains at 6
G:\Practice\EBP\Evidence Table5.05                                                                                                                page 34 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
                                                               approaches to organizing    months.
                                                               care routines. They also
                                                               assisted each other in
                                                               problem solving and
                                                               shared educational
                                                               resources.

                                                               Control group – no
                                                               treatment

                                                               Outcome Measures:

                                                               Centers for
                                                               Epidemiological Studies
                                                               Depression Scale; Zarit
                                                               Burden Scale; Gains
                                                               Through Group
                                                               Involvement Scale.

References:

   1. Acton, G. J. & Kang, J. (2001) Interventions to reduce the burden of caregiving for an adult with dementia: a meta-analysis. Research in Nursing & Health
      24(5),349-360
   2. Bank, A.L.; Argüelles, S.; Rubert, M.; Eisdorfer, C.; & Czaja, S.J. (2006) The value of telephone support groups among ethnically diverse caregivers of
      persons with dementia. Gerontologist, 46, 134-138.
   3. Brodaty, H; Green, A; & Koschera, A. (2003) Meta-analysis of psychosocial interventions for caregivers of people with dementia. Journal Of The American
      Geriatrics Society; 51 (5), 657-664.
   4. Burns, R.; Nichols, L. O.; Martindale-Adams, J.; Graney, M. J. & Lummus, A. (2003). Primary care interventions for dementia caregivers: 2-year outcomes
      from the REACH study. Gerontologist, 43 (4); 547-555.
   5. Cooke, D. D.; McNally, L.; Mulligan, K. T.; Harrison, M. J.; & Newman, S. P. (2001). Psychosocial interventions for caregivers of people with dementia: a
      systematic review. Aging & Mental Health, 5 (2); 120-135
   6. Curry, LC; Walker,C; & Hogstel, MO. (2006) Educational needs of employed family caregivers of older adults: evaluation of a workplace project. Geriatric
      Nursing, 27(3): 166-73
   7. Gitlin, L.N; Hauck, W.W; Dennis, M.P; Winter, L (2005). Maintenance of effects of the home environmental skill-building program for family caregivers
      and individuals with Alzheimer's disease and related disorders. J-Gerontol-A-Biol-Sci-Med-Sci. 60(3): 368-74.

G:\Practice\EBP\Evidence Table5.05                                                                                                            page 35 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
   8. Gitlin, L., Winter, L., Burke, J., Chernett, N., Dennis, M., & Hauck, W. (2008). Tailored activities to manage neurpsychiatric behaviors in persons with
       dementia and reduce garegiver burden: A randomized pilot study. American Journal of Geriatric Psychiatry, 16, (3), 229-239.
   9. Graff, M. J. L., Vernooij-Dassen, M. J. M., Thijssen, M., Dekker, J., Hoefnagels, W. H. L., & Olde Rikkert, M. G. M. (2006). Community based
       occupational therapy for patients with dementia and their care givers: Randomized controlled trial. British Medical Journal, 333, 1196-1201.
   10. Graff, M., Vernooij-Dassen, M., Thijssen, M., Deller, J., Hoefnagels, W., & OldeRikkert, M. (2007) Effects of community occupational therapy on quality
       of life, mood, and health status in dementia patients and their caregivers: A randomized controlled trial. Journal of Gerontology: Medical Sciences, 62A, (9),
       1002-1009.
   11. Graff, M., Adang, E., Vernooij-Dassen, M., Dekker, J., Jomsson, L, Thijssen, M., Hoefnagels, W., Older Rikkert, M. (2008) Community occupational
       therapy for older patients with dementia and their care givers: Cost effectiveness study. British Medical Journal, 336 , 134-138.
   12. Hepburn, K., Lewis, M., Narayan, S., Center, B., Tornatore, J., Bremer, K., & Kirk, L. (2005) Partners in caregiving: A psychoeduaction program affecting
       dementia family caregivers' distress and caregiving outlook. Clinical Gerontologist 29 (1), 53-69.
   13. Hepburn, K. W.; Tornatore, J.; Center, B.& Ostwald, S. W. (2001). Dementia family caregiver training: affecting beliefs about caregiving and caregiver
       outcomes. Journal of the American Geriatrics Society, 49 (4); 450-457
   14. Hosaka,, T; & Sugiyama, Y. (2003) Structured intervention in family caregivers of the demented elderly and changes in their immune function. Psychiatry
       and Clinical Neurosciences, 57(2): 147-151.
   15. Huang, H. L.; Lotus Shyu, Y. I.; Chen, M. C.; Chen, S. T. & Lin, L. C. (2003). A pilot study on a home-based caregiver training program for improving
       caregiver self-efficacy and decreasing the behavioral problems of elders with dementia in Taiwan. International Journal of Geriatric Psychiatry, 18 (4);
       337-345
   16. Kuhn, D. R. & Mendes de Leon, C. F. (2001). Evaluating an educational intervention with relatives of persons in the early stages of Alzheimer’s disease.
       Research on Social Work Practice, 11, 531-48.
   17. Lee, H., Cameron, M. (2004). Respite care for people with dementia and their carers. The Cochrane Database of Systematic Reviews, 1, 1-18.
   18. Mahoney, D. M.; Tarlow, B. ; Jones, R. N.; Tennstedt, S. & Kasten, L. (2001). Factors affecting the use of a telephone-based intervention for caregivers of
       people with Alzheimer's disease. Journal of Telemedicine & Telecare, 7(3);139-148
   19. Mittelman, MS., Ferris, S.H., Shulman, E., Steingberg, G., and Levin, B. (1996). A family intervention to delay nursing home placement of patients with
       Alzheimer’s disease: A randomized controlled trial. Journal of the American Medical Association, 276, 1725-31.
   20. Mittelman, M. S.; Roth, D. L.; Haley, W. E. & Zarit, S. H. (2004). Effects of a caregiver intervention on negative caregiver appraisals of behavior problems
       in patients with Alzheimer's Disease: Results of a randomized trial. The Journals of Gerontology, 59 (1); P27-P34.
   21. Mittelman, M.S., Haley, W.E., Clay, O.J. & Roth, D.L. (2006) Improving caregiver well-being delays nursing home placement of patients with Alzheimer
       disease. Neurology, 4, 1592-1599.
   22. Mittelman, M.S., Roth, D.L., Clay, O.J. & Haley, W.E. (2007) Preserving health of Alzheimer caregivers: Impact of a spouse caregiver Intervention.
       American Journal of Geriatric Psychiatry, 15, 780-789.
   23. Peacock, S. C. & Forbes, D. A. (2003). Interventions for caregivers of persons with dementia: a systematic review. Canadian Journal of Nursing Research,
       35(4); 88-107.
   24. Schacke-C; Zank-SR (2006) Measuring the effectiveness of adult day care as a facility to support family caregivers of dementia patients Journal-of-Applied-
       Gerontology, 25(1): 65-81.

G:\Practice\EBP\Evidence Table5.05                                                                                                                page 36 of 37
EVIDENCE TABLE FOR QUESTION #5: What is the effectiveness of educational and supportive strategies for caregivers of persons with
dementia on the ability to maintain the participation in that role? (Contexts)
    Author/       Study Objectives Level/Design/Su              Intervention and Results        Study Limitations       Implications for
     Year                                     bjects           Outcome Measures                                               OT
   25. Schulz, R; O'Brien, A; Czaja, S; Ory, M; Norris, R; Martire, L.M; Belle, S.H; Burgio, L; Gitlin, L; Coon, D; Burns, R; Gallagher-Thompson, D; & Stevens,
       A. (2002) Dementia caregiver intervention research: in search of clinical significance. Gerontologist,42(5): 589-602
   26. Smits, C., de Lange, J., Droes, R, Franka, M., Vernooij-Dassen, M., & Pot, A. (2007). Effects of combined intervention programmes for people with
       dementia living at home and their caregivers: A systematic review. International Journal of Geriatric Psychiatry, 22, 1181-1193.
   27. Thompson, C., Spilsbury, K., Hall, J., Birks, Y., Barnes, C., & Adamson, J. (2007) Systematic review of information and interventions for caregivers of
       people with dementia. BMC Geriatrics, 7:18.
   28. Winter, L; Gitlin, L.N. (2006) Evaluation of a telephone-based support group intervention for female caregivers of community-dwelling individuals with
       dementia. American Journal of Alzheimer's Disease & Other Dementias, 21(6): 391-397.




G:\Practice\EBP\Evidence Table5.05                                                                                                            page 37 of 37

				
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