Carer Stress Syndrome Clinical Trial
Official title:
Effectiveness of the Reitman Centre CARERS Group Intervention on Family Caregivers of Persons With Dementia
Family caregivers (CG) of persons with dementia are vulnerable to disproportionate physical,
mental and social adverse health consequences . The Reitman Centre CARERS program is an
innovative, group psychotherapeutic skills-training intervention.
Study objective: to determine the effectiveness of the Reitman Centre CARERS program on key
outcomes in family CGs of people with dementia. Study sample: Family CGs of people with
dementia (n=264) referred to Reitman Center and the partner sites and wait-list control group
(n=83) who received regular care. Method: quasi-experimental, non-randomized, multiple group
trial; participants were evaluated before and after completion of the 8-week CARERS program
in comparison.
Addressing the adverse effects of caregiving on dementia CGs has been an increasing concern
of mental and social health scholars in recent decades. Many single and multi-component
programs have been developed but evidence for the effectiveness of interventions varies.
Single component interventions for CGs like education, psychotherapy, or skills training are
effective on various outcome measures but multicomponent programs appear to be preferred for
overall reduction of caregiver burden. Broad development and system-wide adoption of
interventions lags behind and there remains a need for evidence-based interventions that can
be scaled widely in systems of dementia care.
This study aimed to compare the effectiveness of the Reitman Centre CARERS group intervention
on measures of CG's health and well-being with a usual-care intervention control group. We
hypothesized that the integrated, multicomponent CARERS program would produce robust positive
effects on key outcome measures compared to waiting list controls. This was a
quasi-experimental design with a convenience sample and a non-randomized wait-list control
group implemented between 2013 and 2017. The control group received usual care before
starting the CARERS intervention.The waiting list control group was derived from all CGs who
were clinically assessed for the CARERS program, consented to enter the study and completed
initial study assessments before being put on the waiting list for a CARERS group. A waiting
list control was employed for practical recruitment purposes. This study was approved by the
Sinai Health System (SHS) Research Ethics Board. Every participant provided informed signed
written consent for all study components.Referrals to the study came from community agencies
serving older adults, self-referrals, and primary care, memory, general psychiatry and
geriatric medicine clinics. The intervention sites were located at Reitman Centre (CR) and
Wellness Centre at Mount Sinai Hospital, Bridgepoint Active Health, Ceridian LifeWorks® EAP,
Canadian Alzheimer Society chapters and community agencies serving older adults.
The intervention, called Carers, is a multicomponent, group psychotherapeutic,
skills-training intervention for family CGs comprised of 8 weekly 2 hour closed groups
sessions. of 4-6 CGs co-led by 2 mental health clinicians who follow a protocol that includes
predetermined agendas that structure the outline of each group. The group leaders are trained
to elicit and address the specific concerns of each CG during each session. The content of
each group is determined by the CGs based on an initial go-round check-in to elicit current
caregiving problems and challenges, emotional reactions and foster group cohesion. In
sessions 1-4, CGs are formally taught a form of problem-solving therapy (PST) adapted for
dementia CGs. Sessions 5-8 utilize simulation to train CGs to effectively communicate with
the person they are caring for and learn how to engage with them to manage dementia induced
behaviours such as resistance or demandingness. Communication training is done with live
therapeutic simulation a hands-on training method that employs specially trained standardized
patients (SP) in a tightly controlled intervention developed for the CARERS program. All
group leaders were trained in a standardized training protocol at the Reitman Centre. CGs
completed self-administered questionnaires at entry to the study, just prior to starting the
first group and, immediately after session 8 of the group therapy. Care recipient
(CR)function and demographic and socioeconomic information was gathered for each CG/CR at
entry into the study. Statistical analysis employed IBM SPSS 26 and univariate general linear
model (UNIANOVA) analysis and parametric tests.
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