Interventions for Care Partners of People With Alzheimer’s Disease or Other Related Neurological Conditions to Address Depression (2018

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents finding related to interventions for care partners for persons with Alzheimer’s disease and related dementias.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for people living with Alzheimer’s disease and other related neurological conditions and their care partners?”

Current Theme Reported

The main themes of the studies presented in this systematic review brief include care partner mental health outcomes and care partner knowledge outcomes.

Clinical Scenario

The population of older adults (Alzheimer’s disease and related dementias [ADRD]) is increasing, as well as the prevalence of ADRD (Nichols et al., 2022). As of 2022, the Alzheimer’s Association (2022) reports one in three older adults pass away with a form of ADRD, and this number is as high as 40% in African American/Latino older adults. The substantial demographic shift of people born in the baby boomer generation entering older adulthood will challenge current health-care and long-term care infrastructure for persons aging with ADRD. Evidence supports occupational therapy for individuals with ADRD as a mechanism to prolong occupational performance, behavioral symptom management, community residency, and improved quality of life (Raj et al., 2021). Reliance on care partners for intervention implementation for daily activities is a necessity; however, care provision in ADRD care is associated with poor mental and physical health outcomes for care partners (Alzheimer’s Association, 2022). For several reasons, having a well-informed and healthy care partner is most advantageous in promoting community-based residency for persons with ADRD (Stall et al., 2019). We provide the current evidence about interventions that can be provided by occupational therapy practitioners for care partners of persons with ADRD. This systematic review brief focuses on care partner mental health outcomes.

Summary of Key Findings

Five systematic reviews were included in this theme. Two addressed cognitive behavioral treatment and mindfulness, two addressed single or multicomponent educational with peer or psychological support interventions, and one addressed behavioral activation (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Table 1.

Evidence Table for Interventions for Care Partners of People with Dementia or Other Related Neurological Conditions to Address Depression

Author, YearLevel of Evidence(types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
Subtheme: CBT or Mindfulness Interventions One Level 1a SR provided moderate strength of evidence supporting the use of CBT or mindfulness interventions to reduce depression for care providers of people with ADRD.
Lee et al. (2020) Level 1a—SR of RCT RoB Low Setting Home-based caregivers	Participants N = 4,039 participants (n = 838 for CBT and n = 186 for mindfulness reported here), with individual study samples ranging from 16 to 487; mean age 62.2 yr (range: 50.5–71.1; SD = 5.2), and most care partners were women (78.2%, range: 62.5%–100%) Number of Articles 31 RCTs Databases Searched MEDLINE (Ovid), CINAHL, and PsycINFO Outcomes Depressive symptoms Intervention (a) CBT with 1/2 of those focusing on BA, (b) psychoeducational intervention, (c) emotional support intervention, (d) cognitive rehabilitation for care recipients, (e) multicomponent interventions, and (f) mindfulness interventions Delivery Methods Face-to-face delivery, telephone calls, Web-based courses, and an application for mobile devices were used as modes of delivery. Dose ranges CBT interventions. Eight RCTs used: the average number of sessions was 10 (range: 6–14) and the average intervention period was 12 wk (range: 6–20) (1/2 of these studies focused on BA (BA also focuses on XU review) Four RCTs applied mindfulness interventions. Three studies delivered 7–8 weekly sessions, and one study delivered a daily intervention for 8 wk (moderate affect)	CBT interventions significantly reduced depression for care partners (standardized mean difference = 0.905; 95% CI = [1.622, 0.187]; p = .013), and mindfulness interventions also significantly improved depression for care partners (standardized mean difference = 0.578; 95% CI = [0.881, 0.275]; p < .001)
Subtheme: Single or Multicomponent Educational With Peer or Psychological Support Interventions Three Level 1a SRs provided strong strength of evidence to support single or multicomponent educational interventions with or without peer support and in person or remote to address depression.
Liu et al. (2022) Level 1a—SR of RCT RoB Low Setting Home	Participants N = 815; care partners, mean age was 58.66 yr. A total of four articles reported participant gender, with 73.5% of participants who were female. Number of Articles Six RCT Databases Searched PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature Outcome(s) of Interest Depression Intervention(s) of Interest Two single-component interventions using information or education and four multicomponent interventions, including information or education and peer support (3/4) and information or professional education and psychological support (1/4). Delivery Methods Web-based Dose Ranges Varied	Web-based interventions significantly improved depression. Scores dropped an average of 0.23 (95% CI = [−0.38 to −0.07]; p < .01). In two studies of care partners who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI = [−0.50 to −0.14]; p < .01).
Wang et al. (2021) Level 1a—SR of RCT RoB Low to moderate Setting Community	Participants N = not reported; care partners of persons with dementia, no specification of type or stage of dementia Number of Articles 29 RCT Databases Searched PubMed, CINAHL, Embase, Cochrane and Web of Science Outcome(s) of Interest Depression Intervention(s) of Interest Four studies evaluated a single-element intervention (i.e., education, training), and the remaining 25 studies evaluated a multicomponent intervention (i.e., support group + training) Delivery Methods Individual in person and remote Dose Ranges Not reported	Significant improvement in care partner depression from both types of interventions.
Leng et al. (2020) Level 1a—SR and meta-analysis of RCT RoB Moderate Setting Home	Participants N = not reported, the number of participants in each study ranged from 25 to 547. Number of Articles 17 studies Databases Searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, and PsycINFO 2022 participants Outcomes Depressive symptoms Intervention The intervention was digitally delivered via any internet-based modality, which could include either single-component interventions or multiple-component interventions to family care partners. Delivery Methods Digital, internet based Dose Ranges 4 wk to 12 mo	The meta-analysis showed that internet-based supportive interventions significantly reduced depressive symptoms (SMD = −0.21; 95% CI = [−0.31 to −0.10]; p < .001) in dementia care partners.
Subtheme: BA Interventions One Level 1a SR provided moderate strength of evidence to support the use of BA interventions to reduce depression in care partners of people with ADRD.
Xu et al. (2020) Level 1a—SR of RCT RoB Moderate Setting Home-based care partners	Participants N = 895 participants with sample sizes ranging from 41 to 118; mean age ranged from 55.2 to 81.1 yr, and the majority were female (57%). Number of Articles 10 RCTs Databases Searched PubMed, Medline, CINAHL, Cochrane, Embase, and PsycINFO Outcomes Depression Intervention BA intervention: BA is a way to increase pleasant leisure activities among family dementia care partners. BA assumes that clients should be assisted with the ability to engage in behaviors that they find pleasurable or fulfilled. BA is an “outside in” treatment that focuses on changing the way a person acts (in contrast with CBT) Delivery Methods Four interventions were administered by telephone, while the other six were administered through direct contact. Dose Ranges Duration ranged from 5 to 20 wk, and each session ranged from 15 to 90 min.	Depression was significantly reduced after participants received BA (n = 9; 786 participants; SMD = 0.69; 95% CI = [1.12 to 0.25]; p = .002).

Note. ADRD = Alzheimer’s disease and related dementias; BA = behavioral activation; CBT = cognitive behavioral therapy; RCT = randomized controlled trial; RoB = risk of bias; SD = standard deviation.

Bottom Line for Occupational Therapy Practice

Occupational therapy practitioners can use several intervention approaches for improved depression outcomes of care partners of persons with ADRD. Interventions including cognitive behavioral therapy, mindfulness, single or multicomponent educational interventions, and behavioral activation interventions can be used to decrease depressive symptoms in care partners. Care partner mental health outcomes are vital for successful care provision of persons with ADRD. While all occupational therapy goals should remain client-centered, it is recommended that care partners be present when creating goals and receiving education to promote and prolong performance as a care partner, all the while encouraging engagement in daily occupation for care recipients (clients) living with ADRD.

Footnotes

*

Indicates articles included in the brief systematic review.

References

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Oxford Centre for Evidence-Based Medicine. (2009). Levels of evidence (March 2009). https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009

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U.S. Preventive Services Task Force. (2018). Grade definitions. https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions

10.

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(2021). Assessing psychosocial interventions for informal caregivers of older people with early dementia: A systematic review of randomized controlled evidence. Frontiers in Bioscience (Landmark Edition) , 26 , 556–571. https://doi.org/10.52586/4967

11.

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Interventions for Care Partners of People With Alzheimer’s Disease or Other Related Neurological Conditions to Address Depression (2018–2022)

Abstract

Full Systematic Review Question

Current Theme Reported

Clinical Scenario

Summary of Key Findings

Bottom Line for Occupational Therapy Practice

Footnotes

*

References