Dementias and psychological treatment for families
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Transcript of Dementias and psychological treatment for families
Psychological interventions with
families of people with dementia:
the challenges
Georgina Charlesworth
UCL and NEFLT
The Dementias 10th February 2017
Overview of presentation
• What works?
• Are we providing what works?
• If not, why not?
• How can we enhance caregiver
support within constrained resources?
What works?
Resources for Enhancing Alzheimer’s Caregiver
Health: REACH II Translational studyCheung et al (2014). Int J Geriatric Psychiatry. doi:10.1002/gps.4160
• Individualized, psycho-educational, skills-training programme
delivered on average 9 x 1h home and 3 x .5h individual telephone
sessions over 6 months
• Addresses multiple caregiving domains, including disease education,
home safety, CG health, emotional well-being, social support, and CR
behavioural problems (Belle et al., 2006)
• Outcomes:
– Sig. improvement in the perception of positive aspects of caregiving
– reduction in depressive symptoms, subjective burden, bother and
caregiving risks among caregivers
– abatement in behavioral problems among care recipients
Online CBT for carers
Emerging evidence for benefit
of internet interventions
Boots, et al. (2014) A
systematic review of
Internet‐based supportive
interventions for caregivers of
patients with dementia.
International Journal of
Geriatric Psychiatry 29.4: 331-
344
The UK picture: policy
• Psychoeducation
• dementia care problem-
solving (individual, group,
telephone, internet);
• peer support,
• psychological therapy for
psychological distress,
including CBTReferral for advice,
information & support
NICE CG42
Strategies for relatives (START; Livingston 2013; 2014)
• 8 session manual based coping intervention
delivered on 1 to 1 basis by psychology graduates
• Psychoeducation, behaviour & stress
management, maintenance plans
• Significant advantage for intervention carers for
anxiety and depression clinically & cost effective
at 2yr follow-up
• Implementation challenges
Advice, information and support
Stress: only part of the picture
Roth D.L., Fredman L.
& Haley W.E. (2015)
Informal caregiving
and its impact on
health: a reappraisal
from population-based
studies. The
Gerontologist 55 (2),
309–319.
Donnelly N-A et al
(2015) Systematic
Review and Meta-
Analysis of the Impact of
Carer Stress on
Subsequent
Institutionalisation of
Community-Dwelling
Older People. PLoS
ONE 10(6): e0128213.
The mixed emotions of caregivingReduce negative Increase positive
Depression Positive affect
Burden Confidence / Self-efficacy
Stress Resilience
Distress Coping
Anxiety Problem-solving
Anger Social support
Guilt Reciprocity
Grief Altruism
Theories of Mixed Emotion
• Bipolar opposites (Russell & Carroll, 1999)
• Independent constructs (Bradburn, 1969).
• Dynamic model of Affect (DMA; Zautra et al 1997)
• Robertson et al. (2007)
Negative Affect
Positive Affect
Well-
Adjusted
LOW
HIGH
Ambivalent
LOW
LOW
Distressed
HIGH
LOW
Intense
HIGH
HIGH
Demographics by category (N=178)
Demographics Well-adjusted
(high +, low -)
Ambivalent
(low +, low -)
Distressed
(low +, high -)
Intense
(high +, high
-)
N 69 40 43 26
Gender
N (%) female
44 (63.7%) 26 (65%) 31 (72.1%) 16 (61.5%)
Age
Mean (sd) years
66.2 (10.9) 67.1 (11.6) 70.0 (10.8) 63.69 (11.0)
Kinship
N (%) spouse
51 (73.9%) 25 (62.5%) 35 (81.4%) 14 (53.8%)
Duration of Care
Mean (sd) years
3.6 (2.7) 3.7 (2.9) 4.8 (3.6) 4.0 (3.3)
Baseline depression and PwD status at 2 years
• PwD: living at
home, in care, or
deceased
• Depression
(HADS) caseness
at baseline not
significantly
associated with
PwD status at 2
years
• x²(2) = .945, p =
.624
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
non-caseN=109
caseN=69
Depression Baseline (HADS)
Deceased
In Care
At Home
Baseline Mixed emotion & PwD status at 2 yrs
x²(6) =
15.43,
p = .017
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Well adjustedN=69
AmbivalentN=40
DistressedN=43
IntenseN=26
Patterns of Positive and Negative Affect: Baseline
Deceased
In Care
At Home
Conclusions
• Old news: comprehensive and ongoing carer
support is associated with better outcomes for
family carers and people with dementia
• Current models of service in the UK make it difficult
to implement evidence-based practice
• Collaboration between services & sectors is vital
• Lack of positive aspects of caring (PAC) is not the
same as presence of stress/distress;
• Low PAC - important indicator of need for support?