A therapy program designed to teach coping strategies to people who care for family members with dementia has been shown to effectively improve caregivers’ mental health for at least a six-year follow-up, according to a new study at the University College London (UCL).
Caregivers who participated in the program were five times less likely to have clinically significant depression than those who did not have the therapy. The intervention was also shown to be cost-effective in a prior study.
“Taking care of a family member with dementia can be immensely difficult, particularly as their condition deteriorates and they may not appreciate their carer, so close to four in 10 family carers experience depression or anxiety,” said Professor Gill Livingston (UCL Psychiatry), the trial’s principal investigator.
“We now can offer an evidence-based approach to support their mental health in the short- and long-term, which benefits both the carer and the person they’re caring for.”
The START (STrAtegies for RelaTives) program is delivered by psychology graduates, trained and supervised by the research team, instead of qualified clinicians, making it easy to implement in many settings.
Those delivering the therapy worked with caregivers to develop coping strategies, helping them manage their own wellbeing in the long run without needing further therapy sessions. Caregivers received eight sessions, during which there was an emphasis on planning for the future and accessing further support if needed.
A total of 260 family caregivers participated in the trial, most of whom were caring for a family member who had only recently been diagnosed with dementia. Of these, 173 were enrolled in the START program for a two-year period and the other 87 were randomly assigned to a control group that did not receive the intervention.
Six years after receiving START therapy, caregivers had significantly fewer symptoms of depression and anxiety, and the researchers say the therapy program appeared to be both preventative and improve existing mental health.
In addition, patient-related costs were close to three times lower among the families in the START program, which the researchers say is likely due to the caregivers being more able to cope and provide care for their loved one.
The difference of patient-related costs did not reach statistical significance, but the researchers say this is due to the fact that medical costs can be very large and variable. However, their results do strongly suggest the program is not only cost-effective, but could save money for healthcare services.
“We’ve designed our programme to keep costs low, and our results suggest it could actually result in cost savings in the longer term as dementia patients will have fewer costly medical problems if their family carer is healthy and supported,” said Livingston.
The START team has developed manuals to make it easier for any healthcare provider to deliver the intervention, and plans to provide accredited training at UCL in the near future. Alzheimer’s Society are supporting the team to explore different options for getting the intervention further implemented into practice, and provided funding to make cultural adaptations to widen access to minority ethnic groups. The training manuals are also available in Japanese and Spanish, and are currently being translated into Urdu.
“Being a carer can be a grueling job; physically and emotionally demanding, 24 hours a day and often done purely out of love,” said James Pickett, Head of Research at Alzheimer’s Society.
“Unfortunately, depression and anxiety can be an inevitable side effect — with 90% of carers telling us they experience stress and anxiety several times a week. Yet, for the 700,000 carers across the UK, many receive little or no support, despite NICE guidelines recommending that they do.
“This is a major breakthrough. We are absolutely thrilled to see this monumental evidence that START is clinically effective at reducing depression and anxiety in carers, and that the effects can still be seen six years later. This could turn the tide for carers and we would love for it to be available to all people who care for someone with dementia. Alzheimer’s Society is delighted to be supporting the further development and implementation of the START programme so as many people can benefit as possible.”
The findings are published in the British Journal of Psychiatry.
Source: University College London