Effectivity of early psychosocial counselling for family caregivers in general practioner based dementia care

Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz.
DMW - Deutsche Medizinische Wochenschrift (Impact Factor: 0.54). 10/2012; 137(43):2201-6. DOI: 10.1055/s-0032-1305320
Source: PubMed


Psychoeducation and professional support of family caregivers are regarded as important aspects in dementia care. In the context of a general practitioner's (GP) based dementia care project we investigated if professional counselling after making a diagnosis of dementia can reduce the development of depression in family caregivers.

42 patients with dementia and their family caregivers took part in the prospective, randomized study with a follow-up after 18 months. 29 families received psychosocial counselling, the control group was provided an information brochure about dementia including helpful contact addresses. Counselling included education about the illness. Additionally, the current individual needs were identified and assistance was administered if necessary.

The counseling was rated as "very helpful" or "helpful" by most of the caregivers as well as by the partaking GPs. While depression rate between counseling and control group did not differ significantly at baseline, the depression rate was significantly increased in the control group after 18 month as compared to the intervention group.

Despite the small study size we provide first strong evidence that early psychosocial counselling can reduce the development of depression in family caregivers. Early, professional counselling improves the quality of dementia care within a GP-based dementia care setting and it might stabilize and extend the home care duration of dementia patients.

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    ABSTRACT: Within the last years various interventions for cognitively impaired persons and their informal caregivers have been developed and evaluated. As different these interventions are, as different are the outcome dimensions and instruments used. There might be the potential to affect outcomes on both sides. Therefore, the aim of this review is to analyze the amount of studies that report on care recipient outcomes, to show what main outcome dimensions can be categorized, and which validated instruments are most frequently used. A systematic literature search of the electronic databases PubMed, Medline and PsycINFO was conducted. Overall 1547 studies were identified. After exclusion of duplicates and screening of titles and abstracts 162 records remained. Of those 105 would have met the inclusion criteria but 36 records (34.3%) didn’t assess any care recipient outcomes. Sixty nine studies (65.7%) reported on care recipient outcomes and were finally analyzed. The following assessments were used most in the main outcome dimensions: the Revised Memory and Behavior Problem Checklist and the Neuro-Psychiatric Inventory for problem behaviors, the Cornell Scale for Depression in Dementia for depressive symptoms, Quality of Life in Alzheimer's Disease for quality of life, the Mini Mental State Examination for cognition, and Lawton and Brody’s Instrumental Activities of Daily Living scale for activities of daily living. In dementia caregiver studies care recipient outcomes should more often be assessed. For a better comparability between interventions and target groups more homogeneity of the instruments is necessary. Instruments that are not specifically developed for cognitively impaired persons should only be used if they have been validated for persons with a comparable cognitive status.
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