Interventions to Support Carers of People with Dementia

This review considers what works to support carers of older people with dementia to prevent or delay entry into residential aged care. It adopts a rigorous and systematic approach to identify and appraise the evidence, aiming to inform dementia policy.

The review identified 44 randomised controlled trials (RCTs) of interventions (from 48 research studies). Most of these studies (80 per cent) were published since 2000. Very few studies had been conducted in Australia. There were only two, one of which was conducted in the late 1980s. The majority of studies were from the United States or Europe.

There was considerable variation across the interventions, but they were grouped according to their key components into four broad categories:

• case management — involves identifying the needs of the person with dementia and their carer, and planning and co-ordinating the care required, including the purchasing of services
• education and skills building — involves building carers’ knowledge about dementia and available resources, and helping them to develop skills to address identified problems, such as managing difficult behaviours
• counselling — involves emotion-orientated or education-based counselling, including individual, family and group therapy
• respite care — involves temporary care services (day or overnight) provided to the person with dementia to provide a break for the carer.

While some interventions were relatively easy to categorise, many were difficult as they were multicomponent and could have been included under multiple categories. Despite variation across interventions, there were some key common features:

• the majority were of 12 months or less duration
• most started with an initial short period of intense contact that decreased over time
• all but one were delivered by skilled people such as nurses and occupational therapists
• over half the studies had less than 200 participants.

Of the 48 studies, 28 (covering 26 interventions) were assessed at relatively low risk of bias (high quality). The review primarily focused on these studies in order to ensure that the results presented reflected the effectiveness of interventions, and not potential problems with study design and evaluation.