Psychobiological effects of an eHealth psychoeducational intervention to informal caregivers of persons with dementia: a pilot study during the COVID-19 pandemic in Italy.
Caregiver burden
Caregivers
Cortisol
Dementia
Psychoeducation
Self-efficacy
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
09 Nov 2023
09 Nov 2023
Historique:
received:
12
07
2023
accepted:
25
10
2023
medline:
9
11
2023
pubmed:
9
11
2023
entrez:
9
11
2023
Statut:
aheadofprint
Résumé
The workload associated with caring for a person with dementia (PwD) could negatively affect informal caregivers' physical and mental health. According to the recent literature, there is a need for studies testing the implementation of affordable and accessible interventions for improving caregivers' well-being. This study aimed to explore the feasibility and effectiveness of an 8 week eHealth psychoeducation intervention held during the COVID-19 pandemic in Italy in reducing the psychological burden and neuroendocrine markers of stress in caregivers of PwD. Forty-one informal caregivers of PwD completed the eHealth psychoeducation intervention. Self-reported (i.e., caregiver burden, anxiety symptoms, depressive symptoms, and caregiver self-efficacy) and cortisol measurements were collected before and after the intervention. Following the intervention, the caregivers' self-efficacy regarding the ability to respond to disruptive behaviours improved (t = - 2.817, p = 0.007), anxiety and burden levels decreased (state anxiety: t = 3.170, p = 0.003; trait anxiety: t = 2.327, p = 0.025; caregiver burden: t = 2.290, p = 0.027), while depressive symptoms and cortisol levels did not change significantly. Correlation analyses showed that the increase in self-efficacy was positively associated with the improvement of caregiver burden from pre- to post-intervention (r = 0.386, p = 0.014). The intervention had a low rate of dropout (n = 1, due to the patient's death) and high levels of appreciation. The positive evidence and participation rate support the feasibility and effectiveness of the proposed eHealth psychoeducational intervention to meet the need for knowledge of disease management and possibly reduce detrimental effects on caregivers' psychological well-being. Further placebo-controlled trials are needed to test the generalizability and specificity of our results.
Sections du résumé
BACKGROUND
BACKGROUND
The workload associated with caring for a person with dementia (PwD) could negatively affect informal caregivers' physical and mental health. According to the recent literature, there is a need for studies testing the implementation of affordable and accessible interventions for improving caregivers' well-being.
AIMS
OBJECTIVE
This study aimed to explore the feasibility and effectiveness of an 8 week eHealth psychoeducation intervention held during the COVID-19 pandemic in Italy in reducing the psychological burden and neuroendocrine markers of stress in caregivers of PwD.
METHODS
METHODS
Forty-one informal caregivers of PwD completed the eHealth psychoeducation intervention. Self-reported (i.e., caregiver burden, anxiety symptoms, depressive symptoms, and caregiver self-efficacy) and cortisol measurements were collected before and after the intervention.
RESULTS
RESULTS
Following the intervention, the caregivers' self-efficacy regarding the ability to respond to disruptive behaviours improved (t = - 2.817, p = 0.007), anxiety and burden levels decreased (state anxiety: t = 3.170, p = 0.003; trait anxiety: t = 2.327, p = 0.025; caregiver burden: t = 2.290, p = 0.027), while depressive symptoms and cortisol levels did not change significantly. Correlation analyses showed that the increase in self-efficacy was positively associated with the improvement of caregiver burden from pre- to post-intervention (r = 0.386, p = 0.014). The intervention had a low rate of dropout (n = 1, due to the patient's death) and high levels of appreciation.
DISCUSSION
CONCLUSIONS
The positive evidence and participation rate support the feasibility and effectiveness of the proposed eHealth psychoeducational intervention to meet the need for knowledge of disease management and possibly reduce detrimental effects on caregivers' psychological well-being.
CONCLUSION
CONCLUSIONS
Further placebo-controlled trials are needed to test the generalizability and specificity of our results.
Identifiants
pubmed: 37943404
doi: 10.1007/s40520-023-02610-9
pii: 10.1007/s40520-023-02610-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Fondazione della Comunità Bresciana
ID : 2019-0518
Organisme : Ministero della Salute
ID : Ricerca Corrente
Organisme : Ministero della Salute
ID : Ricerca Corrente
Informations de copyright
© 2023. The Author(s).
Références
WHO (2021) Global status report on the public health response to dementia. https://apps.who.int/iris/bitstream/handle/10665/344701/9789240033245-eng.pdf . Accessed 17 Mar 2023
Alzheimer’s Association (2023) 2023 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia. https://doi.org/10.1002/alz.13016
Whittaker AC, Gallagher S (2019) Caregiving alters immunity and stress hormones: a review of recent research. Curr Opin Behav Sci 28:93–97. https://doi.org/10.1016/j.cobeha.2019.02.002
doi: 10.1016/j.cobeha.2019.02.002
Allen AP, Curran EA, Duggan Á et al (2017) A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev 73:123–164
doi: 10.1016/j.neubiorev.2016.12.006
pubmed: 27986469
Roth DL, Haley WE, Sheehan OC et al (2020) The transition to family caregiving and its effect on biomarkers of inflammation. Proc Natl Acad Sci 117:16258–16263. https://doi.org/10.1073/pnas.2000792117
doi: 10.1073/pnas.2000792117
pubmed: 32581123
Adam EK, Quinn ME, Tavernier R et al (2017) Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology 83:25–41. https://doi.org/10.1016/j.psyneuen.2017.05.018
doi: 10.1016/j.psyneuen.2017.05.018
pubmed: 28578301
pmcid: 5568897
McEwen BS (1998) Protective and Damaging Effects of Stress Mediators. N Engl J Med 338:171–179. https://doi.org/10.1056/NEJM199801153380307
doi: 10.1056/NEJM199801153380307
pubmed: 9428819
Walker WH, Walton JC, DeVries AC et al (2020) Circadian rhythm disruption and mental health. Transl Psychiatry 10:28. https://doi.org/10.1038/s41398-020-0694-0
doi: 10.1038/s41398-020-0694-0
pubmed: 32066704
pmcid: 7026420
Dickinson C, Dow J, Gibson G et al (2017) Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews. Int Psychogeriatr 29:31–43. https://doi.org/10.1017/S1041610216001447
doi: 10.1017/S1041610216001447
pubmed: 27666669
Sun Y, Ji M, Leng M et al (2022) Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis. Int J Nurs Stud 129:104204. https://doi.org/10.1016/j.ijnurstu.2022.104204
doi: 10.1016/j.ijnurstu.2022.104204
pubmed: 35247788
Naunton Morgan B, Windle G, Sharp R et al (2022) eHealth and Web-Based Interventions for Informal Carers of People With Dementia in the Community: Umbrella Review. J Med Internet Res 24:e36727. https://doi.org/10.2196/36727
doi: 10.2196/36727
pubmed: 35867388
pmcid: 9356334
Deeken F, Rezo A, Hinz M et al (2019) Evaluation of Technology-Based Interventions for Informal Caregivers of Patients With Dementia—A Meta-Analysis of Randomized Controlled Trials. Am J Geriatr Psychiatry 27:426–445. https://doi.org/10.1016/J.JAGP.2018.12.003
doi: 10.1016/J.JAGP.2018.12.003
pubmed: 30642650
Boyt N, Ho AK, Morris-Bankole H et al (2022) Internet-facilitated interventions for informal caregivers of patients with neurodegenerative disorders: Systematic review and meta-analysis. Digit Health 8:205520762211290. https://doi.org/10.1177/20552076221129069
doi: 10.1177/20552076221129069
Yu Y, Xiao L, Ullah S et al (2023) The effectiveness of internet-based psychoeducation programs for caregivers of people living with dementia: a systematic review and meta-analysis. Aging Ment Health. https://doi.org/10.1080/13607863.2023.2190082
doi: 10.1080/13607863.2023.2190082
pubmed: 37646779
pmcid: 10529124
Wen Y, Xing Y, Ding Y et al (2023) Challenges of conducting of online educational programs for family caregivers of people with dementia living at home: An integrative review. Int J Nurs Sci 10:121–128. https://doi.org/10.1016/j.ijnss.2022.12.017
doi: 10.1016/j.ijnss.2022.12.017
pubmed: 36860711
Altieri M, Santangelo G (2021) The Psychological Impact of COVID-19 Pandemic and Lockdown on Caregivers of People With Dementia. Am J Geriatr Psychiatry 29:27–34. https://doi.org/10.1016/j.jagp.2020.10.009
doi: 10.1016/j.jagp.2020.10.009
pubmed: 33153872
Chirico I, Pappadà A, Giebel C et al (2023) The impact of COVID-19 restrictions and care home strategies on residents with dementia as experienced by family carers in Italy. Aging Ment Health 27:512–520. https://doi.org/10.1080/13607863.2022.2056137
doi: 10.1080/13607863.2022.2056137
pubmed: 35333142
Karagiozi K, Margaritidou P, Tsatali M et al (2022) Comparison of on Site versus Online Psycho Education Groups and Reducing Caregiver Burden. Clin Gerontol 45:1330–1340. https://doi.org/10.1080/07317115.2021.1940409
doi: 10.1080/07317115.2021.1940409
pubmed: 34219617
Noel MA, Lackey E, Labi V et al (2022) Efficacy of a Virtual Education Program for Family Caregivers of Persons Living with Dementia. J Alzheimer’s Disease 86:1667–1678. https://doi.org/10.3233/JAD-215359
doi: 10.3233/JAD-215359
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6
doi: 10.1016/0022-3956(75)90026-6
pubmed: 1202204
Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population. J Am Geriatr Soc 43:130–137. https://doi.org/10.1111/j.1532-5415.1995.tb06377.x
doi: 10.1111/j.1532-5415.1995.tb06377.x
pubmed: 7836636
Hepburn KW, Lewis M, Sherman CW et al (2003) The Savvy Caregiver Program: Developing and Testing a Transportable Dementia Family Caregiver Training Program. Gerontologist 43:908–915. https://doi.org/10.1093/geront/43.6.908
doi: 10.1093/geront/43.6.908
pubmed: 14704391
Milne A, Guss R, Russ A (2014) Psychoeducational support for relatives of people with a recent diagnosis of mild to moderate dementia: An evaluation of a ‘Course for Carers.’ Dementia 13:768–787. https://doi.org/10.1177/1471301213485233
doi: 10.1177/1471301213485233
pubmed: 24339082
Hepburn K, Nocera J, Higgins M et al (2022) Results of a Randomised Trial Testing the Efficacy of Tele-Savvy, an Online Synchronous/Asynchronous Psychoeducation Program for Family Caregivers of Persons Living with Dementia. Gerontologist 62:616–628. https://doi.org/10.1093/geront/gnab029
doi: 10.1093/geront/gnab029
pubmed: 33640979
Wimo A, Gustavsson A, Jönsson L et al (2013) Application of Resource Utilization in Dementia (RUD) instrument in a global setting. Alzheimer’s & Dementia 9:429. https://doi.org/10.1016/j.jalz.2012.06.008
doi: 10.1016/j.jalz.2012.06.008
Cummings JL, Mega M, Gray K et al (1994) The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2308. https://doi.org/10.1212/WNL.44.12.2308
doi: 10.1212/WNL.44.12.2308
pubmed: 7991117
Chattat R, Cortesi V, Izzicupo F et al (2011) The Italian version of the Zarit Burden Interview: a validation study. Int Psychogeriatr 23:797–805. https://doi.org/10.1017/S1041610210002218
doi: 10.1017/S1041610210002218
pubmed: 21205379
Zarit SH, Reever KE, Bach-Peterson J (1980) Relatives of the Impaired Elderly: Correlates of Feelings of Burden. Gerontologist 20:649–655. https://doi.org/10.1093/geront/20.6.649
doi: 10.1093/geront/20.6.649
pubmed: 7203086
Bédard M, Pedlar D, Martin NJ et al (2000) Burden in Caregivers of Cognitively Impaired Older Adults Living in the Community: Methodological Issues and Determinants. Int Psychogeriatr 12:307–332. https://doi.org/10.1017/S1041610200006426
doi: 10.1017/S1041610200006426
pubmed: 11081952
Tu JY, Jin G, Chen J-H et al (2022) Caregiver Burden and Dementia: A Systematic Review of Self-Report Instruments. J Alzheimer’s Disease 86:1527–1543. https://doi.org/10.3233/JAD-215082
doi: 10.3233/JAD-215082
Pedrabissi L, Santinello M (1989) Inventario per l’ansia di «Stato» e di «Tratto»: nuova versione italiana dello STAI Forma Y: Manuale. Organizzazioni Speciali, Firenze
Spielberger CD, Gorsuch RL, Lushene RE (1970) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto
Grös DF, Antony MM, Simms LJ et al (2007) Psychometric properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): Comparison to the State-Trait Anxiety Inventory (STAI). Psychol Assess 19:369–381. https://doi.org/10.1037/1040-3590.19.4.369
doi: 10.1037/1040-3590.19.4.369
pubmed: 18085930
Kaddour L, Kishita N (2020) Anxiety in Informal Dementia Carers: A Meta-Analysis of Prevalence. J Geriatr Psychiatry Neurol 33:161–172. https://doi.org/10.1177/0891988719868313
doi: 10.1177/0891988719868313
pubmed: 31409196
Beck AT, Steer RA, Brown GK (1996) Manual for the beck depression inventory-II. Psychological Corporation, San Antonio, TX
Sica C, Ghisi M (2007) The Italian versions of the Beck Anxiety Inventory and the Beck Depression Inventory-II: Psychometric properties and discriminant power. Leading-edge psychological tests and testing research. Nova Science Publishers, Hauppauge, pp 27–50
Collins RN, Kishita N (2020) Prevalence of depression and burden among informal caregivers of people with dementia: a meta-analysis. Ageing Soc 40:2355–2392. https://doi.org/10.1017/S0144686X19000527
doi: 10.1017/S0144686X19000527
Grano C, Lucidi F, Crisci B et al (2013) Validazione italiana della Revised Scale for Caregiving Self-Efficacy: un contributo preliminare basato su un campione di caregiver di familiari con Alzheimer. Rassegna di Psicologia 30:9–30. https://doi.org/10.7379/75663
doi: 10.7379/75663
Steffen AM, McKibbin C, Zeiss AM et al (2002) The Revised Scale for Caregiving Self-Efficacy: Reliability and Validity Studies. J Gerontol B Psychol Sci Soc Sci 57:P74–P86. https://doi.org/10.1093/geronb/57.1.P74
doi: 10.1093/geronb/57.1.P74
pubmed: 11773226
Khan TS, Hirschman KB, McHugh MD et al (2021) Self-efficacy of family caregivers of older adults with cognitive impairment: A concept analysis. Nurs Forum (Auckl) 56:112–126. https://doi.org/10.1111/nuf.12499
doi: 10.1111/nuf.12499
Phongtankuel V, Moxley J, Reid MC et al (2022) The relationship of caregiver self-efficacy to caregiver outcomes: a correlation and mediation analysis. Aging Ment Health. https://doi.org/10.1080/13607863.2022.2118666
doi: 10.1080/13607863.2022.2118666
pubmed: 36068999
Samia LW, O’Sullivan A, Fallon KC et al (2018) Building on Self-efficacy for Experienced Family Caregivers: The Savvy Advanced Program. Gerontologist 59:973–982. https://doi.org/10.1093/geront/gny016
doi: 10.1093/geront/gny016
Pruessner JC, Kirschbaum C, Meinlschmid G et al (2003) Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology 28:916–931. https://doi.org/10.1016/S0306-4530(02)00108-7
doi: 10.1016/S0306-4530(02)00108-7
pubmed: 12892658
Whitehead AL, Julious SA, Cooper CL et al (2016) Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res 25:1057–1073. https://doi.org/10.1177/0962280215588241
doi: 10.1177/0962280215588241
pubmed: 26092476
Sorensen S, Pinquart M, Duberstein P (2002) How Effective Are Interventions With Caregivers? An Updated Meta-Analysis. Gerontologist 42:356–372. https://doi.org/10.1093/geront/42.3.356
doi: 10.1093/geront/42.3.356
pubmed: 12040138
Hayes AF, Coutts JJ (2020) Use Omega Rather than Cronbach’s Alpha for Estimating Reliability. But…. Commun Methods Meas 14:1–24. https://doi.org/10.1080/19312458.2020.1718629
doi: 10.1080/19312458.2020.1718629
Cohen J (2013) Statistical power analysis for the behavioral sciences. Routledge Academic
Baharudin AD, Din NC, Subramaniam P et al (2019) The associations between behavioral-psychological symptoms of dementia (BPSD) and coping strategy, burden of care and personality style among low-income caregivers of patients with dementia. BMC Public Health 19:447. https://doi.org/10.1186/s12889-019-6868-0
doi: 10.1186/s12889-019-6868-0
pubmed: 31196141
pmcid: 6565534
Zhang S, Guo Q, Edwards H et al (2014) Self-efficacy moderation and mediation roles on BPSD and social support influences on subjective caregiver burden in Chinese spouse caregivers of dementia patients. Int Psychogeriatr 26:1465–1473. https://doi.org/10.1017/S1041610214000994
doi: 10.1017/S1041610214000994
Fossey J, Charlesworth G, Fowler JA et al (2021) Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers’ Mental Health: A Randomised Trial. J Am Med Dir Assoc 22:1403-1409.e1. https://doi.org/10.1016/J.JAMDA.2020.10.009
doi: 10.1016/J.JAMDA.2020.10.009
pubmed: 33288467
Segerstrom SC, Boggero IA, Smith GT et al (2014) Variability and reliability of diurnal cortisol in younger and older adults: Implications for design decisions. Psychoneuroendocrinology 49:299–309. https://doi.org/10.1016/j.psyneuen.2014.07.022
doi: 10.1016/j.psyneuen.2014.07.022
pubmed: 25137484
pmcid: 4165809
McAuliffe L, Wright BJ, Hazi A et al (2021) Social support moderates the effect of stress on the cortisol awakening response in dementia family caregivers. Physiol Behav 240:113532. https://doi.org/10.1016/j.physbeh.2021.113532
doi: 10.1016/j.physbeh.2021.113532
pubmed: 34289401
Aboulafia-Brakha T, Suchecki D, Gouveia-Paulino F et al (2014) Cognitive–behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer’s disease. Aging Ment Health 18:801–808. https://doi.org/10.1080/13607863.2014.880406
doi: 10.1080/13607863.2014.880406
pubmed: 24499394
Holland JM, Thompson LW, Cucciare MA et al (2011) Cortisol outcomes among caucasian and latina/hispanic women caring for a family member with dementia: a preliminary examination of psychosocial predictors and effects of a psychoeducational intervention. Stress Health 27:334–346. https://doi.org/10.1002/smi.1375
doi: 10.1002/smi.1375
Theorell T, Engström G, Hallinder H et al (2021) The use of saliva steroids (cortisol and DHEA-s) as biomarkers of changing stress levels in people with dementia and their caregivers: A pilot study. Sci Prog 104:003685042110198. https://doi.org/10.1177/00368504211019856
doi: 10.1177/00368504211019856
Wuttke-Linnemann A, Henrici C, Skoluda N et al (2022) Psychobiological Monitoring of a Home-Based Dyadic Intervention for People Living with Dementia and Their Caregivers: Added Value to Evaluate Treatment Success and Understand Underlying Mechanisms. Journal of Alzheimer’s Disease 87:1725–1739. https://doi.org/10.3233/JAD-210618
doi: 10.3233/JAD-210618
pubmed: 35527544
Bressan V, Visintini C, Palese A (2020) What do family caregivers of people with dementia need? A mixed-method systematic review. Health Soc Care Community 28:1942–1960. https://doi.org/10.1111/hsc.13048
doi: 10.1111/hsc.13048
pubmed: 32542963
Frias CE, Garcia-Pascual M, Montoro M et al (2020) Effectiveness of a psychoeducational intervention for caregivers of People With Dementia with regard to burden, anxiety and depression: A systematic review. J Adv Nurs 76:787–802. https://doi.org/10.1111/JAN.14286
doi: 10.1111/JAN.14286
pubmed: 31808211
Crellin NE, Orrell M, McDermott O et al (2014) Self-efficacy and health-related quality of life in family carers of people with dementia: a systematic review. Aging Ment Health 18:954–969. https://doi.org/10.1080/13607863.2014.915921
doi: 10.1080/13607863.2014.915921
pubmed: 24943873
pmcid: 4192898
Merrilees JJ, Bernstein A, Dulaney S et al (2020) The Care Ecosystem: Promoting self-efficacy among dementia family caregivers. Dementia 19:1955–1973. https://doi.org/10.1177/1471301218814121
doi: 10.1177/1471301218814121
pubmed: 30497302
Lamont RA, Quinn C, Nelis SM et al (2019) Self-esteem, self-efficacy, and optimism as psychological resources among caregivers of people with dementia: findings from the IDEAL study. Int Psychogeriatr 31:1259–1266. https://doi.org/10.1017/S1041610219001236
doi: 10.1017/S1041610219001236
pubmed: 34658313
Griffiths PC, Kovaleva M, Higgins M et al (2018) Tele-Savvy: An Online Program for Dementia Caregivers. American Journal of Alzheimer’s Disease & Other Dementiasr 33:269–276. https://doi.org/10.1177/1533317518755331
doi: 10.1177/1533317518755331
Qiu D, Hu M, Yu Y et al (2019) Acceptability of psychosocial interventions for dementia caregivers: a systematic review. BMC Psychiatry 19:23. https://doi.org/10.1186/s12888-018-1976-4
doi: 10.1186/s12888-018-1976-4
pubmed: 30642300
pmcid: 6332684