Posts Tagged ‘Caregiver’

The Benefits of Nondrug Therapies

March 13, 2013

This February’s Public Citizen Health Letter summarized an interesting and important study published in the September 2012 American Journal of Psychiatry. Randomized controlled trials (RCTs) are regarded as the gold standard for medical studies. The study was a meta-analysis of RCT testing of nondrug therapies involving family caregivers of patients with dementia. Dementia is caused by progressive deterioration of the brain that results in impaired cognition and memory loss. These patients are unable to perform such daily activities as dressing, washing, cooking, eating, and using the toilet. Alzheimer’s disease is the most common cause of dementia among the elderly and accounts for 60 to 80 percent of all cases. Currently around 4 million people in the US suffer from Alzheimer’s disease. It is estimated that by 2050, 11 million to 16 million Americans will have it.

Some of the problems occurring in advanced cases include screaming, physical aggression, arguments between patients and caregivers, repetitive questioning, wandering, depression, resistance to being helped with daily activities, paranoia, and not sleeping at night. The meta-analysis reviewed RCTs that collectively used 3279 dementia patients and their primary caregivers. The training was provided primarily to caregivers and included printed educational materials, telephone calls, individual sessions in the health care provider/office setting, group session in a classroom setting, and in-home sessions. The interventions included such skills training for caregivers as follows: managing behavioral and psychological symptoms of dementia. Communicating better with care recipients. Using role playing videos modeling behavior management strategies, cognitive-behavioral interventions, vignettes, and live interviews They also involved enhancing care recipients quality of life, improving daily activities, increasing pleasant events.

The following education was provided to caregivers: Psychoeducation. Improving home care. Tailored advice and recommendations. Problem solving methods. Improving support networks. Computer-mediated automated interactive voice. Planning emergencies, legal, financial,

The following activity planning and environmental redesign were provided: Planning activities with caregiver and care recipient. Modifying care recipients physical and social environment.

Enhancing the following support caregivers: Social support. Web or telephone support. Strategies on how to access support, Family counseling.

Providing the following self-care techniques for caregivers: Health management. Stress management. Coping with change as a result care giving. Music therapy and counseling.

And the following miscellaneous items: Collaborative care with a health professional or care manager. Exercise for the care recipient.

Not all these delivery methods were used in all the studies reviewed, but many of the studies used a variety of these methods. The interventions in the different studies varied from 6 to 24 months.

For the 17 RCTs that measured outcomes in dementia patients, the analyses of the pooled data showed overall beneficial effects measured by reduction in the troublesome behavioral and psychological symptoms of dementia. For the 13 RCTs that measured outcomes in the caregivers, there was a significant overall improvement in measures of stress, anxiety, depression, and quality. This is no small finding for the lot of caregivers is a difficult one and interventions that ease their discomfort are most welcome.

To fully appreciate the significance of this study one must realize that there are currently no effective drug treatments for dementia and Alzheimer’s. Although there are drugs that can slow the progression of the decline, the end remains inevitable. So there is some question as to whether these drugs are truly beneficial or are a means of prolonging the agony of both the sufferer and the caregiver.

This study also adds credence to the position of the renowned Alzheimer’s researcher, Peter J. Whitehous, Ph.D, M.D, who regards a drug cure for Alzheimer’s as being extremely unlikely. He argues for more research into nondrug therapies (See the healthymemory blog post, “The Myth of Alzheimer’s).

© Douglas Griffith and, 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and with appropriate and specific direction to the original content.