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G. Warner, S. Hutchinson, R. Genoe and N. Geddes,
Self-Management Interventions Targeted at Caregivers of Older Adults:
Preliminary Results from a Scoping Review
Special thanks to…. Robin Parker from Kellogg Library for assistance in conducting the database searchesFunded by…Nova Scotia Health Research Foundation through a REDI team development grant
Acknowledgements
What is known from the existing literature about the delivery and effectiveness of self-management interventions for family caregivers of older adults?
Our research question
What self-management components were included in the identified programs?
What did these programs look like? (e.g. participants, duration, group versus individual)
How effective were the programs?
What types of self-management programs are feasible?
Sub-Questions
Self-management programs teach individuals not only to medically manage their condition, but also to manage the psychological, social and lifestyle dimensions associated with living with the condition. (Barlow, 2002)
What is self-management for unpaid caregivers who care for a spouse/parent or friend with a debilitating condition.
Background
Where is the unpaid
caregiver?
1. Action planning, goal setting & follow-up
2. Caregiver self care & stress reduction3. Decision support tools4. Group education, coaching session5. Individual education, coaching
session6. Information via computer or 7. telephone or 8. video/audio or 9.
written10. Peer group support11. Problem solving
Self Management Components
deSilva (2011)
Must be an interventionMust include family
caregivers, either alone or as a caregiver /care receiver dyad
Participant caring for someone with an ongoing condition (or limitations due to aging)
Intervention described as a self-management/self-care/patient education /empowerment program
Inclusion criteria
Study published prior to the year 2000
Intervention only delivered psychotherapy or exercise
Delivered primarily as inpatient/resident program
Care recipients ≤55
Exclusion criteria
Databases Searched: Central, Cinahl, Medline, Embase, Cochrane from 2000 to 2012
Located 2227 sources2 stages: Two individuals
reviewed 1) abstracts then 2) full manuscripts
Conflicts discussed and consensus decision
Extracted information using NVivo and Excel
32 studies met inclusion criteria
Methods
Number of Abstracts reviewed =2227 Included/Reviewed= 130 Excluded= 2097
Included after manuscript review= 42After cross referencing by study = 32
Excluded after manuscript review= 88 Reasons: Study Design= 31 Participants= 31 Intervention= 21 Language= 5
Reasons for Exclusion
Of the 32 studies examined: Study Design:
RCTs = 18
Participants: Caregiver only = 17Dyads = 15
Delivery format: Individual/dyad = 17Group = 9Combination = 6
Findings-Description of
studies
29 out of the 32 interventions were disease specificConditions: Alz Dis/Dementia = 17Stroke = 5Osteoarthritis = 2 Heart failure=2Cancer = 2Parkinson’s Disease=1
Findings-Description of
studies
1. Won Won, 2008:Powerful tools for caregiving (PTC)
2. Ducharme, 2011:Learning to be a caregiver
3. van den Heuvel ,2000: Group and individual support program for caregivers of stroke patients
4. Johnston, 2007: Workbook intervention for stroke patients and carers
5. Gitlin, 2010: Advancing Caregiver Training (ACT)
6. Glueckauf, 2007: Telephone-based cognitive-behavioral intervention
Examples of studies
Self-management programs are most commonly provided to only the caregiver who is caring for someone with dementia
There are some care partner/dyad interventions for persons with stroke or chronic heart failure that look interesting
The sample size for some of the studies was too small to see if the intervention is effective, many were pilots of planned RCTs
Findings-Description of
studies
All 32 interventions had an education/ coaching component
Other components included were:• Information delivered (written,
telephone, computer or video) = 28• Addressed caregiver self-care or
stress reduction = 28• Involved problem solving = 25• Had action planning or goal setting
with follow-up = 18• Included a peer group support = 9
Findings –Self-
management components
Not possible to conduct a meta-analysis because of clinical heterogeneity: Diverse conditions 161 outcome measures
used, of these 42 were developed for the study
only ~50% had an RCT design
Findings – Effectiveness
1) Grouped individual outcome measures by general categories, three most prevalent categories werePsycho-social Self-carePhysical health/fitness
2) Ranked results by: Statistically significant
difference Positive results but not
statically significant No effect
Findings – Effectiveness
The number of studies with statistically results was not substantially difference by : Delivery method – (in-person,
telephone, computer) Format – (group, individual, both) Location – (home, community) Duration of intervention – (< 6
weeks, 6-11 weeks, 12-20 weeks, >21 weeks)
Number of sessions – (< 5, 6 -10, 11-20, > 20)
Number of self management components (range 3 – 10)
Findings – Effectiveness
• Pros:• If in home, convenient for caregivers • Better for communication
• Cons:• Time consuming for staff • High cost to provider• If in community not convenient for
caregivers
In-person = 9
• Pros:• Less disruption to care duties• Low cost to caregivers and providers• Easy to organise and participate in • Can reach rural populations
• Cons:• Can hinder communication• Requires equipment and a
connection
Telephone = 6Computer = 3
• Pros:• More flexible for individually tailoring
the intervention• Allows participants opportunity to
meet facilitator but convenience of telephone access
• Cost effective • Cons:
• None reported
In-person + telephone = 13
Findings –Feasibility
Self management programs had two common objectives; teach caregivers self-care or self-management
principles and; provide information or education tailored to
caregiver concerns, usually related to the care recipients health condition
Self-management programs are diverse –conditions, change they hope to effect in the participant, sometimes in conjunction with exercise, outcomes
What is feasible? one-to-one in person can be high resources outside the home may be hard for caregivers to
access Telephone is cost efficient but may not be
acceptable for caregivers Combo of phone/in person may work the best
Conclusions