Intervenciones no farmacológicas para reducir la depresión, sobrecarga y ansiedad en personas cuidadoras de mayores con demenciaun metaanálisis

  1. Rosa Mª Bonoso García
  2. Rafael del Pino Casado
Revista:
Metas de enfermería

ISSN: 1138-7262

Ano de publicación: 2018

Volume: 21

Número: 2

Páxinas: 1

Tipo: Artigo

DOI: 10.35667/METASENF.2019.21.1003081191 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Metas de enfermería

Obxectivos de Desenvolvemento Sustentable

Resumo

Objective: to analyze the efficacy of non-pharmacological interventions targeted to a reduction in overload, anxiety and depression in caregivers for relatives with dementia. Methodology: a systematic review with meta-analysis of randomized clinical trials; a search in different databases (PubMed, Cinahl, Scopus, Cochrane, PsychInfo, Lilacs, IME and Cuiden Plus) up to February, 2017 (without any limitations by time or language), and in the bibliographic references of those articles retrieved. There was an assessment of educational, psycho-educational and therapy interventions regarding depression, overload and anxiety. Analysis was conducted through a meta-analysis of random effects with Cohen’s d as measure of combined effect. The Comprehensive Meta Analysis program, version 3.3.070, was used for calculations. Results: there was a review of 613 studies, and 37 were included. A statistical negative association was found between psycho-educational interventions and depression, both at short term (d= -0.55) and at mid-long term (d= -0.24), and with overload at mid-long term (d= -0.17). At the same time, a statistical negative association was found between therapy and anxiety and depression, both at short term (d for depression= -2.59 and d for anxiety= -2.06) and at mid-long term (d for depression= -1.40 and d for anxiety = -2.34). Conclusions: psychoeducational interventions will have a beneficial effect on the reduction of depression and overload at mid-long term. Therapy interventions have a beneficial effect on the reduction of anxiety and depression.

Referencias bibliográficas

  • Organización Mundial de la Salud. Informe mundial sobre el envejecimiento y la salud. Ginebra: OMS; 2015.
  • OECD. Health at a Glance 2013. OECD indicators. Paris: OECD Publishing; 2013.
  • Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E. Alzheimer’s disease. Lancet (London, England). 2011; 377(9770):1019-31.
  • Moreno Cámara S, Palomino Moral PA, Moral Fernández L, Frías Osuna A, Del Pino Casado R. Problemas en el proceso de adaptación a los cambios en personas cuidadoras familiares de mayores con demencia. Gac Sanit. 2016; 30(3):201-7.
  • Van der Lee J, Bakker TJ, Duivenvoorden HJ, Droes RM. Multivariate models of subjective caregiver burden in dementia; a systematic review. Ageing Res Rev. 2014; 15:76-93.
  • Vandepitte S, Van Den Noortgate N, Putman K, Verhaeghe S, Faes K, Annemans L. Effectiveness of supporting informal caregivers of people with dementia: a systematic review of randomized and non-randomized controlled trials. Journal of Alzheimer’s Disease. 2016; 52(3):929-65.
  • Gilhooly KJ, Gilhooly ML, Sullivan MP, McIntyre A, Wilson L, Harding E, et al. A meta-review of stress, coping and interventions in dementia and dementia caregiving. BMC geriatrics. 2016; 16:106.
  • Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62(10):1006-12.
  • Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928.
  • Centro Cochrane Iberoamericano. Manual Cochrane de Revisiones Sistemáticas de Intervenciones, versión 5.1.0. Barcelona: Centro Cochrane Iberoamericano; 2011.
  • Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328(7454):1490-4.
  • Meader N, King K, Llewellyn A, Norman G, Brown J, Rodgers M, et al. A checklist designed to aid consistency and reproducibility of GRADE assessments: development and pilot validation. Systematic reviews. 2014; 3:82.
  • Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence-study limitations (risk of bias). J Clin Epidemiol. 2011; 64(4):407-15.
  • Cohen J. A power primer. Psychol Bull. 1992; (112):155-9.
  • Cooper HM, Hedges LV, Valentine JC. The handbook of research synthesis and meta-analysis. New York, NY: Russell Sage Foundation Publications; 2009.
  • Higgins J, Thompson S, Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Health Serv Res Policy. 2002; 7:51-61.
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J. 1997; 315(7109):629-34.
  • Duval S, Tweedie R. Trim and Fill: A Simple Funnel Plot-Based Method of Testing and Adjusting for Publication Bias in Meta-Analysis. Biometrics. 2000; 56(2): 455-63.
  • Blom MM, Bosmans JE, Cuijpers P, Zarit SH, Pot AM. Effectiveness and cost-effectiveness of an internet intervention for family caregivers of people with dementia: design of a randomized controlled trial. BMC Psychiatry. 2013; 13:17.
  • Blom MM, Zarit SH, Groot Zwaaftink RB, Cuijpers P, Pot AM. Effectiveness of an Internet intervention for family caregivers of people with dementia: results of a randomized controlled trial. PLoS One. 2015; 10(2):e0116622.
  • Akkerman RL, Ostwald SK. Reducing anxiety in Alzheimer’s disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. American Journal of Alzheimer’s Disease & Other Dementias. 2004; 19(2):117-23.
  • Beauchamp N, Irvine AB, Seeley J, Johnson B. Worksite based internet multimedia program for family caregivers of persons with dementia. The Gerontologist. 2005; 45(6):793-801.
  • Burgio L, Stevens A, Guy D, Roth DL, Haley WE. Impact of two psychosocial interventions on white and African American family caregivers of individuals with dementia. Gerontologist. 2003; 43(4):568-79.
  • Chang BL. Cognitive-behavioral intervention for homebound caregivers of persons with dementia. Nurs Res. 1999; 48(3):173-82.
  • Connell CM, Janevic MR. Effects of a Telephone-Based Exercise Intervention for Dementia Caregiving Wives: A Randomized Controlled Trial. J Appl Gerontol. 2009; 28(2):171-94.
  • Coon DW, Thompson L, Steffen A, Sorocco K, Gallagher-Thompson D. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist. 2003; 43(5):678-89.
  • Cristancho-Lacroix V, Wrobel J, Cantegreil-Kallen I, Dub T, Rouquette A, Rigaud A. A web-based psychoeducational program for informal caregivers of patients with Alzheimer’s disease: a pilot randomized controlled trial. J Med Internet Res. 2015; 17(5):e117.
  • Davis LL, Burgio L, Buckwalter KC, Weaver M. A comparison of In-Home and Telephone-Based Skill Training Intervention with caregivers of persons with dementia. Journal of Mental Health & Aging. 2004; 10(1):31-44.
  • De Rotrou J, Cantegreil I, Faucounau V, Wenisch E, Chausson C, Jegou D, et al. Do patients diagnosed with Alzheimer’s disease benefit from a psycho-educational programme for family caregivers? A randomised controlled study. International Journal of Geriatric Psychiatry. 2011; 26(8):833-42.
  • Dias A, Dewey ME, D’Souza J, Dhume R, Motghare DD, Shaji KS, et al. The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India. PLoS One. 2008; 3(6):e2333.
  • Dowling GA, Merrilees J, Mastick J, Chang VY, Hubbard E, Moskowitz JT. Life enhancing activities for family caregivers of people with frontotemporal dementia. Alzheimer Disease & Associated Disorders. 2014; 28(2):175-81.
  • Finkel S, Czaja SJ, Schulz R, Martinovich Z, Harris C, Pezzuto D. E-care: a telecommunications technology intervention for family caregivers of dementia patients. Am J Geriatr Psychiatry. 2007; 15(5):443-8.
  • Gallagher-Thompson D, Gray HL, Dupart T, Jiménez D, Thompson LW. Effectiveness of cognitive/behavioral small group intervention for reduction of depression and stress in non-Hispanic white and Hispanic/Latino women dementia family caregivers: outcomes and mediators of change. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2008; 26(4):286.
  • Gallagher-Thompson D, Tzuang M, Hinton L, Alvarez P, Rengifo J, Valverde I, et al. Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers. Alzheimer Dis Assoc Disord. 2015; 29(2):146-53.
  • Gavrilova SI, Ferri CP, Mikhaylova N, Sokolova O, Banerjee S, Prince M. Helping carers to care--the 10/66 dementia research group’s randomized control trial of a caregiver intervention in Russia. Int J Geriatr Psychiatry. 2009; 24(4):347-54.
  • Gitlin LN, Winter L, Burke J, Chernett N, Dennis MP, Hauck WW. Tailored activities to manage neuropsychiatric behaviors in persons with dementia and reduce caregiver burden: a randomized pilot study. Am J Geriatr Psychiatry. 2008; 16(3):229-39.
  • Guerra M, Ferri CP, Fonseca M, Banerjee S, Prince M. Helping carers to care: the 10/66 dementia research group’s randomized control trial of a caregiver intervention in Peru. Rev Bras Psiquiatr. 2011; 33(1):47-54.
  • Hébert R, Lévesque L, Vézina J, Lavoie J-P, Ducharme F, Gendron C, et al. Efficacy of a Psychoeducative Group Program for Caregivers of Demented Persons Living at Home: A Randomized Controlled Trial. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences. 2003; 58(1):S58-S67.
  • Kajiyama B, Thompson LW, Eto-Iwase T, Yamashita M, Di Mario J, Marian Tzuang Y, et al. Exploring the effectiveness of an internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program. Aging Ment Health. 2013; 17(5):544-54.
  • Liddle J, Smith-Conway ER, Baker R, Angwin AJ, Gallois C, Copland DA, et al. Memory and communication support strategies in dementia: effect of a training program for informal caregivers. Int Psychogeriatr. 2012; 24(12):1927-42.
  • Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, Romeo R, et al. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technol Assess. 2014; 18(61):1-242.
  • Losada A, Márquez-González M, Romero-Moreno R. Mechanisms of action of a psychological intervention for dementia caregivers: effects of behavioral activation and modification of dysfunctional thoughts. Int J Geriatr Psychiatry. 2011; 26(11):1119-27.
  • Losada A, Márquez-González M, Romero-Moreno R, Mausbach BT, López J, Fernández-Fernández V, et al. Cognitive–behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology. 2015; 83(4):760-72.
  • Márquez-González M, Losada A, Izal M, Pérez-Rojo G, Montorio I. Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme. Aging & Mental Health. 2007; 11(6):616- 25.
  • Martín-Carrasco M, Martín MF, Valero CP, Millán PR, García CI, Montalbán SR, et al. Effectiveness of a psychoeducational intervention program in the reduction of caregiver burden in Alzheimer’s disease patients’ caregivers. International journal of geriatric psychiatry. 2009; 24(5):489-99.
  • Martindale-Adams J, Nichols LO, Burns R, Graney MJ, Zuber J. A trial of dementia caregiver telephone support. Can J Nurs Res. 2013; 45(4):30-48.
  • Martínez Menéndez B, Losada Baltar A, Martínez Sarriés FJ, Izal Fernández de Trocóniz M, Morlán Gracia L, Montorio Cerrato I, et al. Eficacia diferencial de dos intervenciones psicoeducativas para cuidadores de familiares con demencia. Rev Neurol. 2004; 38(8):701-8.
  • Mohide EA, Pringle DM, Streiner DL, Gilbert JR, Muir G, Tew M. A randomized trial of family caregiver support in the home management of dementia. J Am Geriatr Soc. 1990; 38(4):446-54.
  • Moore RC, Chattillion EA, Ceglowski J, Ho J, von Känel R, Mills PJ, et al. A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP). Behaviour Research and Therapy. 2013; 51(10):623-32.
  • Ostwald SK, Hepburn KW, Caron W, Burns T, Mantell R. Reducing caregiver burden: A randomized psychoeducational intervention for caregivers of persons with dementia. The Gerontologist. 1999; 39(3):299-309.
  • Rigaud AS, Leach MJ, Francis A, Ziaian T. Transcendental Meditation for the improvement of health and wellbeing in community-dwelling dementia caregivers [TRANSCENDENT]: a randomised wait-list controlled trial. J Med Internet Res. 2015; 15:145.
  • Steffen AM. Anger management for dementia caregivers: A preliminary study using video and telephone interventions. Behavior Therapy. 2000; 31(2):281-99.
  • Tanner JA, Black BS, Johnston D, Hess E, Leoutsakos J-M, Gitlin LN, et al. A randomized controlled trial of a community-based dementia care coordination intervention: Effects of MIND at home on caregiver outcomes. Am J Geriatr Psychiatry. 2015; 23(4):391-402.
  • Tremont G, Davis JD, Papandonatos GD, Ott BR, Fortinsky RH, Gozalo P, et al. Psychosocial telephone intervention for dementia caregivers: A randomized, controlled trial. Alzheimers Dement. 2015; 11(5):541-8.
  • Winter L, Gitlin LN. Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals with Dementia. Am J Alzheimers Dis Other Demen. 2007; 21(6):391-7.
  • Zarit SH, Anthony CR, Boutselis M. Interventions with care givers of dementia patients: comparison of two approaches. Psychol Aging. 1987; 2(3):225-32.
  • Cheng HY, Chair SY, Chau JP. The effectiveness of psychosocial interventions for stroke family caregivers and stroke survivors: a systematic review and meta-analysis. Patient Educ Couns. 2014; 95(1):30-44.
  • Ferre-Grau C, Sevilla-Casado M, Lleixa-Fortuno M, Aparicio-Casals MR, Cid-Buera D, Rodero-Sanchez V, et al. Effectiveness of problem-solving technique in caring for family caregivers: a clinical trial study in an urban area of Catalonia (Spain). J Clin Nurs. 2014; 23(1-2):288-95.
  • Vernooij-Dassen M, Draskovic I, McCleery J, Downs M. Cognitive reframing for carers of people with dementia. The Cochrane Library. 2011; 11:CD005318.