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Effectiveness of family meetings for caregivers of persons with dementia a pragmatic RCT

Explore the effectiveness of family meetings for caregivers of persons with dementia, aiming to prevent anxiety, depression, and premature long-term care admission. Psycho-education, preparation sessions, and evaluation stages improve caregiver understanding and support mobilization. Results indicate no preventive effects on admissions but highlight high caregiver satisfaction and potential for wide adoption. Subgroup analyses show no specific effects based on initial distress, dementia severity, or case management involvement. Further research suggested.

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Effectiveness of family meetings for caregivers of persons with dementia a pragmatic RCT

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  1. Effectiveness of family meetings for caregivers of persons with dementiaa pragmatic RCT • Karlijn Joling • Hein van Hout, PhD

  2. Background • Prevalence & workforce • Empowerment & prevention  • Wellbeing informal caregiver main determinant for (premature) long term care admission PwD • Interventions including family meetings beneficial (Mittelman 1995, 1996, 2004) • Family meetings rarely used in routine practice • Efficacy vs effectiveness?

  3. Spectre of Mrazek & Haggerty Family meetings -> selective prevention

  4. Objective • -Can family meetings prevent anxiety and depression in caregivers en delay LTC admission? ____________________________________________________________________________________________

  5. Psycho-education • Improve understanding social support • Mobilize family, max their contribution Relieve primary caregiver ____________________________________________________________________________________________

  6. Preparation session carer • Purpose & benefits • Discuss perspectives • Identify problems • Problem solving behaviour • Solutions, allocate tasks • Planning next session 4 family meetings Evaluation session

  7. Flow diagram Approached N = 683 Excluded 81 not eligbile 410 refusal Randomized (n=192) Family meetings (n=96) Usual care (n=96) Completed 12 month follow up (n=81) Completed 12 month follow up (n=86) ____________________________________________________________________________________________

  8. Baseline characteristics N=192 Caregivers Patients ____________________________________________________________________________________________

  9. Participation in intervention stages (N=96)

  10. Results  40% new disorder in 12 months! Incident Rate Ratio 0.98

  11. Severity of symptoms CESD Effect size Cohens D = 0.24 HADS Non sign ____________________________________________________________________________________________

  12. Nursing home admission over 18 mnths HR 1.46 (p=0.38) Family meetings 24% Control 19%

  13. Secondary outcome: Burden Linear regression analyses corrected for unbalanced baseline scores and clustering ____________________________________________________________________________________________

  14. Subgroup analyses • Subgroup analyses: no subgroup effects • high initial distress carer (SSCQ) • severe dementia (mmse) • Receiving case management yes/no

  15. Conclusions • High incidence depression & anxiety (40%) • No preventive effects • No delay Long Term Cate admissions ….. nevertheless • High satisfaction cares • Wide adoption by care organisations ____________________________________________________________________________________________

  16. Why no effects? • Wrong target group (selective vs indicative?) • Follow up too short? • Wrong outcome measures? • Limited contrast with usual care? • Treatment fidelity insufficient? • …

  17. Finally 2012; 7(1) Jan 27 Manual & video family meetings at: www.alzheimercentrum.nl/ dementie/informatieve-films/ Hpj.vanhout@vumc.nl

  18. Thank you for your attention! • hpj.vanhout@vumc.nl • k.joling@vumc.nl

  19. EXTRA sheets

  20. Thema’s (Over)belasting en inzicht familie Hulp durven vragen Praktische problemen Onzekerheid toekomst Gedragsproblemen pt Evaluatie gespreksleiders Meerwaarden Bewustwording en betrokkenheid familie  Gestructureerd contact Hulp bij praktische kant

  21. Process analysis

  22. Kwetsbare groep: hoge incidentie Uitgebreide steun via reguliere zorg Deelname aan interventie niet optimaal >> Familiegesprekken meerwaarde voor bepaalde mantelzorgers? Conclusies

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