Interventions to Reduce Burden for Rural Caregivers of Patients with Dementia: A Review

摘要

Background/Purpose: Caregiving for a person with dementia persons with dementia involves a variety of challenges, mostly physical and psychological, leading to mental health problems. Psychosocial interventions to support caregivers s of persons with dementia described in the literature mostly involve urban samples. This study‘s main objective was to review interventions studied in rural areas of caregivers of persons with dementia and examine their outcomes.Methods: Pubmed, Psychinfo, Embase and Google were searched to find randomized controlled trials, systematic reviews, and clinical studies, using dementia and rural as initial key words/medical-subject headings. The following terms were then added: dementia caregivers in rural setting and dementia caregiver burden in the rural setting. Studies were limited to those published in English. Titles were initially reviewed to exclude irrelevant articles; then abstracts and full articles were evaluated. Duplicate articles were excluded, as were studies with abstracts that did not fit criteria.Results: Of 750 articles originally identified, all but 7 were deemed unsuitable for inclusion. Among the 7 selected studies, only 2 were randomized controlled trials. Although their results were mixed, results of the other 5 studies showed improvement with interventions designed to support caregivers.Conclusions: Future studies would benefit from employing randomized controlled trials methodology and measure outcomes to compare data among caregivers of persons with dementia in the rural population. Possible innovative strategies to reach rural caregivers include therapies delivered through telephone/video or therapies provided in person but in a condensed, brief format. Introduction With an aging population, the numbers of persons with dementia will increase to 63 million by 2030, making the need for informal care even more important than it is now.1 Most persons with dementia receive ongoing care and support in their home from family members, who confront a variety of challenges in providing emotional support, supervision, assistance with daily activities, and social and financial support. Unfortunately, these challenges are surmounted at high cost and with psychological burden. Most caregivers need support to address their burden when taking care of their loved ones.2There is a consensus that caring for a family member with dementia, who can become agitated, forgetful, repetitive and completely dependent on the caregiver for assistance with activities of daily living as the illness progresses, is associated with unique stressors related to the continuous work and worry of care as well as disruption in the caregiver social activities and sometimes even neglect of their own physical needs. Burden is influenced by duration, dependence, degenerative stage, social isolation, emotional strain, behavioral problems, levels of personal assistance, mobility and medical assistance required.3The negative consequences leave caregivers at high risk for mental health problems, especially anxiety and depressive disorder, with some studies suggesting that approximately 43% to 65% of caregivers of persons with dementia meet criteria for clinical depression.4Rural caregivers may have a higher degree of stress than urban caregivers; however, comparative data are scarce. Rural Americans face a unique combination of factors that create an imbalance in health care and social services not found in urban areas, such as lack of physicians, lack of healthcare services, less exposure to education, and cultural and economic factors, all important to deal with chronic diseases such as dementia.5 One study suggests that the negative association between caregiving and health outcomes, including mental health, depends upon urban-rural status, finding that rural caregivers may experience more detrimental health-related issues as a consequence of informal caregiving than urban caregivers.6Although several systematic review