title: The effects of a multi-component dyadic intervention on the psychological distress of family caregivers providing care to people with dementia: a randomized controlled trial.
abstract: BACKGROUND
  Earlier research showed that multi-component dyadic interventions - including a combination of intervention strategies and addressing both the person with dementia and caregiver - have a beneficial impact on the mental and physical health of people with dementia and their family caregivers. A randomized controlled trial (RCT) of a multi-component dyadic intervention, which is a translated and adapted version of an intervention that has been shown to be effective in the US by Teri et al. (2003), was performed. The effects on caregivers' mood (primary outcome), burden, general health, and salivary cortisol levels (secondary outcomes) were studied.
  
  
  METHODS
  Community-dwelling people with dementia and their family caregivers (N = 111 dyads) were randomly assigned. The experimental group received eight home visits during three months, combining physical exercise and support (psycho-education, communication skills training, and planning of pleasant activities). Both the physical exercise and support component were directed at both the person with dementia and the caregiver. The comparison group received monthly information bulletins and phone calls. There were three measurements at baseline (prior to the intervention), at three months, and at six months into the intervention. Data were analyzed with Generalized Estimating Equations (GEE) based on an intention-to-treat analysis of all available data.
  
  
  RESULTS
  All analyses showed no benefits of the intervention over time on any of the outcomes.
  
  
  CONCLUSIONS
  The negative results might be explained by the translation and adaptation of the intervention that has been shown to be effective in the US: the intervention was shortened and did not include cognitive reframing. However, only the health effects on people with dementia and not on caregivers were studied in the US. Several other factors might also have played a role, which are important for future studies to take into account. These are: the usual health care in the country or region of implementation; the wishes and needs of participants for specific intervention components; the room for improvement regarding these components; the inclusion of positive outcome measures, such as pleasure, and the quality of the relationship.
authors.affiliation: Department of Clinical Psychology and the EMGO institute for Health and Care Research,Faculty of Psychology and Education,VU University,Van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands.
authors.forename: Anna-Eva
authors.initials: AE
authors.lastname: Prick
authors.affiliation: Research Centre Innovations in Care,Rotterdam University of Applied Sciences,Rochussenstraat 198,3015 EK Rotterdam,the Netherlands.
authors.forename: Jacomine
authors.initials: J
authors.lastname: de Lange
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research,VU University Medical Centre,De Boelelaan 1118,1081 HV Amsterdam,the Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.affiliation: Department of Clinical Psychology and the EMGO institute for Health and Care Research,Faculty of Psychology and Education,VU University,Van der Boechorststraat 1,1081 BT Amsterdam,the Netherlands.
authors.forename: Anne Margriet
authors.initials: AM
authors.lastname: Pot
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D003704:Dementia / Q000523:psychology*; D003863:Depression; D015444:Exercise; D005260:Female; D006792:House Calls; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D006854:Hydrocortisone
keywords: Alzheimer’s disease; mental health; prevention; treatment