A benefit-finding intervention for family caregivers of persons with Alzheimer disease: study protocol of a randomized controlled trial

Trials

Diana TF Lee⁴  Timothy Kwok¹  Julian CL Lai²  Helene H Fung⁶  Linda CW Lam³  Natalie SS Ng⁵  Emily PM Mak⁵  Rosanna WL Lau⁵  Sheung-Tak Cheng⁵ 

[1] Department of Medicine and Therapeutics, Chinese University of Hong Kong, 9/F Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong;Department of Applied Social Studies, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong;Department of Psychiatry, Chinese University of Hong Kong, G/F Multicentre, Tai Po Hospital, 9 Chuen On Road, Tai Po, NT, Hong Kong;Nethersole School of Nursing, 7/F Esther Lee Building, Chinese University of Hong Kong, Shatin, NT, Hong Kong;Department of Psychological Studies, Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, NT, Hong Kong;Department of Psychology, Room 328 Sino Building, Chung Chi College, Chinese University of Hong Kong, Shatin, NT, Hong Kong

关键词: Positive reappraisal;    Positive aspects of caregiving;    Depression;    Burden;    Alzheimer’s disease;   

Others  :  1095502
DOI  :  10.1186/1745-6215-13-98

 received in 2012-01-26, accepted in 2012-07-02,  发布年份 2012

【 摘 要 】

Background

Caregivers of relatives with Alzheimer’s disease are highly stressed and at risk for physical and psychiatric conditions. Interventions are usually focused on providing caregivers with knowledge of dementia, skills, and/or support, to help them cope with the stress. This model, though true to a certain extent, ignores how caregiver stress is construed in the first place. Besides burden, caregivers also report rewards, uplifts, and gains, such as a sense of purpose and personal growth. Finding benefits through positive reappraisal may offset the effect of caregiving on caregiver outcomes.

Design

Two randomized controlled trials are planned. They are essentially the same except that Trial 1 is a cluster trial (that is, randomization based on groups of participants) whereas in Trial 2, randomization is based on individuals. Participants are randomized into three groups - benefit finding, psychoeducation, and simplified psychoeducation. Participants in each group receive a total of approximately 12 hours of training either in group or individually at home. Booster sessions are provided at around 14 months after the initial treatment. The primary outcomes are caregiver stress (subjective burden, role overload, and cortisol), perceived benefits, subjective health, psychological well-being, and depression. The secondary outcomes are caregiver coping, and behavioral problems and functional impairment of the care-recipient. Outcome measures are obtained at baseline, post-treatment (2 months), and 6, 12, 18 and 30 months.

Discussion

The emphasis on benefits, rather than losses and difficulties, provides a new dimension to the way interventions for caregivers can be conceptualized and delivered. By focusing on the positive, caregivers may be empowered to sustain caregiving efforts in the long term despite the day-to-day challenges. The two parallel trials will provide an assessment of whether the effectiveness of the intervention depends on the mode of delivery.

Trial registration

Chinese Clinical Trial Registry (http://www.chictr.org/en/ webcite) identifier number ChiCTR-TRC-10000881.

【 授权许可】

   
2012 Cheng et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Canadian Study of Health and Aging Working Group: Canadian study of health and aging: study methods and prevalence of dementia. CMAJ 1994, 150:899-913.
• [2]Schulz R, Beach SR: Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA 1999, 282:2215-2219.
• [3]Aneshensel CS, Pearlin LI, Mullan JT, Zarit SH, Whitlatch CJ: Profiles in Caregiving: The Unexpected Career. San Diego, CA: Academic Press; 1995.
• [4]Pinquart M, Sörensen S: Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging 2003, 18:250-267.
• [5]Vitaliano PP, Zhang J, Scanlan JM: Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull 2003, 129:946-972.
• [6]Bauer ME, Vedhara K, Perks P, Wilcock GK, Lightman SL, Shanks N: Chronic stress in caregivers of dementia patients is associated with reduced lymphocyte sensitivity to glucocorticoids. J Neuroimmunol 2000, 103:84-92.
• [7]Gallagher-Thompson D, Shurgot GR, Rider K, Gray HL, McKibbin CL, Kraemer HC, Sephton SE, Thompson LW: Ethnicity, stress, and cortisol function in Hispanic and non-Hispanic white women: a preliminary study of family dementia caregivers and noncaregivers. Am J Geriatr Psychiatry 2006, 14:334-342.
• [8]McCallum TJ, Sorocco KH, Fritsch T: Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers. Am J Geriatr Psychiatry 2006, 14:684-693.
• [9]Pinquart M, Sörensen S: Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 2003, 58B:P112-P128.
• [10]Dunkin JJ, Anderson-Hanley C: Dementia caregiver burden: a review of the literature and guidelines for assessment and intervention. Neurology 1998, 51:S53-S60.
• [11]Gitlin LN, Belle SH, Burgio LD, Czaja SJ, Mahoney D, Gallagher-Thompson D, Burns R, Hauck WW, Zhang S, Schulz R, Ory MG: Effect of multicomponent interventions on caregiver burden and depression: the REACH multisite initiative at 6-month follow-up. Psychol Aging 2003, 18:361-374.
• [12]Mittelman MS, Roth DL, Coon DW, Haley WE: Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disease. Am J Psychiatry 2004, 161:850-856.
• [13]Mittelman MS, Roth DL, Haley WE, Zarit SH: Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s disease: results of a randomized trial. J Gerontol B Psychol Sci Soc Sci 2004, 59B:P27-P34.
• [14]Schulz R, Burgio L, Burns R, Eisdorfer C, Gallagher-Thompson D, Gitlin LN, Mahoney DF: Resources for enhancing Alzheimer’s caregiver health (REACH): overview, site-specific outcomes, and future directions. Gerontologist 2003, 43:514-520.
• [15]Sörensen S, Pinquart M, Duberstein P: How effective are interventions with caregivers? An updated meta-analysis. Gerontologist 2002, 42:356-372.
• [16]Kim Y, Schulz R, Carver CS: Benefit finding in the cancer caregiving experience. Psychosom Med 2007, 69:283-291.
• [17]Beach DL: Family caregiving: the positive impact on adolescent relationships. Gerontologist 1997, 37:233-238.
• [18]Cohen CA, Colantonio A, Vernich L: Positive aspects of caregiving: rounding out the caregiver experience. Int J Geriatr Psychiatry 2002, 17:184-188.
• [19]Noonan AE, Tennstedt SL, Rebelsky FG: Making the best of it: themes of meaning among informal caregivers to the elderly. J Aging Stud 1996, 10:313-327.
• [20]Sheehan NW, Donorfio LM: Efforts to create meaning in the relationship between aging mothers and their caregiving daughters: a qualitative study of caregiving. J Aging Stud 1999, 13:161-176.
• [21]Folkman S: Positive psychological states and coping with severe stress. Soc Sci Med 1997, 45:1207-1221.
• [22]Lazarus RS, Folkman S: Stress, appraisal, and coping. New York NY: Springer; 1984.
• [23]Pinquart M, Sörensen S: Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison. Aging Ment Health 2004, 8:438-449.
• [24]Bower JE, Kemeny ME, Taylor SE, Fahey JL: Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. J Consult Clin Psychol 1998, 66:979-986.
• [25]Nolen-Hoeksema S, Davis CC: Theoretical and methodological issues in the assessment and interpretation of posttraumatic growth. Psychol Inquiry 2004, 15:60-64.
• [26]Cruess DG, Antoni MH, McGregor BA, Kilbourn KM, Boyers AE, Alferi SM, Carver CS, Kumar M: Cognitive-behavioral stress management reduces serum cortisol by enhancing benefit finding among women being treated for early stage breast cancer. Psychosom Med 2000, 62:304-308.
• [27]McGregor BA, Antoni MH, Boyers A, Alferi SM, Blomberg BB, Carver CS: Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res 2004, 56:1-8.
• [28]McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services task force on Alzheimer’s disease. Neurology 1984, 34:939-944.
• [29]Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993, 43:2412-2414.
• [30]Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM: The meaning of cognitive impairment in the elderly. J Am Geriatr Soc 1985, 33:228-235.
• [31]Zarit SH, Reever KE, Bach-Peterson J: Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist 1980, 20:649-655.
• [32]Chan TS, Lam LC, Chiu HF: Validation of the Chinese version of the Zarit Burden Interview. Hong Kong J Psychiatry 2005, 15:9-13.
• [33]Pearlin LI, Mullan JT, Semple SJ, Skaff MM: Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 1990, 30:583-594.
• [34]Cheng S, Fung H, Chan A: Maintaining self-rated health through social comparison in old age. J Gerontol B Psychol Sci Soc Sci 2007, 62B:P277-P285.
• [35]Ryff CD: Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989, 57:1069-1081.
• [36]Cheng S, Chan ACM: Measuring psychological well-being in the Chinese. Personal Individ Differ 2005, 38:1307-1316.
• [37]Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960, 23:56-61.
• [38]Zheng Y, Zhao J, Phillips M, Liu J: Validity and reliability of the Chinese Hamilton depression rating scale. Br J Psychiatry 1988, 152:660-664.
• [39]Carver CS: You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med 1997, 4:92-100.
• [40]Cummings JL: The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology 1997, 48:S10-S16.
• [41]Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL: Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry 2001, 16:789-793.
• [42]Fillenbaum GG, Smyer MA: The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 1981, 36:428-434.
• [43]Chiu HC, Chen YC, Mau LW, Shiao SH, Liu HW, Huang MS: An evaluation of the reliability and validity of the Chinese-version OARS multidimensional functional assessment questionnaire. Chinese J Public Health 1997, 16:119-132.
• [44]Rabe-Hesketh S, Skrondal A: Multilevel and Longitudinal Modeling Using Stata. College Station, TX: Stata Press; 2008.
• [45]Heo M, Leon AC: Sample size requirements to detect an intervention by time interaction in longitudinal cluster randomized clinical trials. Stat Med 2009, 28:1017-1027.
• [46]Murray DM, Blitstein JL, Hannan PJ, Baker WL, Lytle LA: Sizing a trial to alter the trajectory of health behaviours: methods, parameter estimates, and their application. Stat Med 2007, 26:2297-2316.
• [47]Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M: Global prevalence of dementia: a Delphi consensus study. Lancet 2005, 366:2112-2117.
• [48]Gaugler JE, Jarrott SE, Zarit SH, Stephens MP, Townsend A, Greene R: Adult day service use and reductions in caregiving hours: effects on stress and psychological well-being for dementia caregivers. Int J Geriatr Psychiatry 2003, 18:55-62.
• [49]Mossello E, Caleri V, Razzi E, Di Bari M, Cantini C, Tonon E, Lopilato E, Marini M, Simoni D, Cavallini MC, Marchionni N, Biagini CA, Masotti G: Day care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress. Int J Geriatr Psychiatry 2008, 23:1066-1072.
• [50]Brodaty H, Thomson C, Thompson C, Fine M: Why caregivers of people with dementia and memory loss don’t use services. Int J Geriatr Psychiatry 2005, 20:537-546.
• [51]Baltes P: Theoretical propositions of life-span developmental psychology: on the dynamics between growth and decline. Dev Psychol 1987, 23:611-626.