title: Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care.
abstract: BACKGROUND
  The value of care provided by informal carers in Canada is estimated at $26 billion annually (Hollander et al., 2009). However, carers' needs are often overlooked, limiting their capacity to provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional distress and improve carers' competence (Chiu et al., 2013). This study evaluated the effectiveness of problem-solving techniques-based intervention based on adapted PST methods, in enhancing carers' physical and emotional capacity to care for relatives with dementia living in the community.
  
  
  METHODS
  56 carers were equally allocated to a problem-solving techniques-based intervention group or a control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC) who had been given advanced training in PS techniques-based intervention. Coping, mastery, competence, burden, and perceived stress of the carers were evaluated at baseline and post-intervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA was performed on the data.
  
  
  RESULTS
  Post-intervention measures completion rate was 82% and 92% for the intervention and control groups, respectively. Carers in the intervention group showed significantly improved task-oriented coping, mastery, and competence and significantly reduced emotion-oriented coping, burden and stress (p < 0.01-0.001). Control carers showed no change.
  
  
  CONCLUSIONS
  PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-to-day caregiving, improves carers' caregiving competence, coping, burden, and perceived stress. This may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence that establishing effective partnerships between inter-professional clinicians in academic clinical health science centers, and community agencies can extend the reach of the expertise of specialized health care institutions.
authors.affiliation: The Cyril and Dorothy,Joel and Jill Reitman Centre for Alzheimer's Support and Training,Mount Sinai Hospital,Toronto,Ontario,M5G 1X5,Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Chiu
authors.affiliation: Department of Research and Evaluation,Toronto Central Community Care Access Centre,Toronto,Ontario,M5T 2Z5,Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Pauley
authors.affiliation: The Cyril and Dorothy,Joel and Jill Reitman Centre for Alzheimer's Support and Training,Mount Sinai Hospital,Toronto,Ontario,M5G 1X5,Canada.
authors.forename: Virginia
authors.initials: V
authors.lastname: Wesson
authors.affiliation: The Cyril and Dorothy,Joel and Jill Reitman Centre for Alzheimer's Support and Training,Mount Sinai Hospital,Toronto,Ontario,M5G 1X5,Canada.
authors.forename: Dunstan
authors.initials: D
authors.lastname: Pushpakumar
authors.affiliation: The Cyril and Dorothy,Joel and Jill Reitman Centre for Alzheimer's Support and Training,Mount Sinai Hospital,Toronto,Ontario,M5G 1X5,Canada.
authors.forename: Joel
authors.initials: J
authors.lastname: Sadavoy
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D011340:Problem Solving
keywords: cognitive behavioral therapy