Brief Article
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World J Psychiatr. Sep 22, 2013; 3(3): 65-73
Published online Sep 22, 2013. doi: 10.5498/wjp.v3.i3.65
Improving caregiving competence, stress coping, and mental well-being in informal dementia carers
Mary Chiu, Virginia Wesson, Joel Sadavoy
Mary Chiu, Virginia Wesson, Joel Sadavoy, Department of Psychiatry, The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer’s Support and Training, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
Mary Chiu, Virginia Wesson, Joel Sadavoy, Department of Geriatric and General Psychiatry, Mount Sinai Hospital, Toronto, Ontario, M5T 3L9, Canada
Virginia Wesson, Joel Sadavoy, Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 3L9, Canada
Author contributions: Chiu M was responsible for study design, data collection and analysis, and wrote the introduction, methods and results sections of the manuscript; Wesson V wrote the introduction, discussion and comments sections, is a co-developer of the CARERS program and has delivered the intervention to carers; Sadavoy J is the founding Reitman Centre program director, designed the intervention and evaluation framework, supervised the study design and edited the manuscript.
Supported by Social Development Partnerships Program, Human Resources and Skills Development Canada, No. 8470775
Correspondence to: Mary Chiu, PhD, Department of Psychiatry, The Cyril and Dorothy, Joel and Jill Reitman Centre for Alzheimer’s Support and Training, Mount Sinai Hospital, 60 Murray Street, Room L1-012, Toronto, Ontario, M5G 1X5, Canada. mchiu@mtsinai.on.ca
Telephone: +1-416-586-4800 Fax: +1-416-586-3231
Received: May 7, 2013
Revised: September 14, 2013
Accepted: September 16, 2013
Published online: September 22, 2013
Processing time: 197 Days and 12.5 Hours
Abstract

AIM: To study the effectiveness of Reitman Centre “Coaching, Advocacy, Respite, Education, Relationship, and Simulation” (CARERS) program, which uses problem-solving techniques and simulation to train informal dementia carers.

METHODS: Seventy-three carers for family members with dementia were included in the pilot study. Pre- and post-intervention data were collected from carers using validated measures of depression, mastery, role captivity and overload, caregiving competence and burden, and coping styles. To assess program effectiveness, mean differences for these measures were calculated. One-way ANOVA was used to determine if change in scores is dependent on the respective baseline scores. Clinical effects for measures were expressed as Cohen’s D values.

RESULTS: Data from 73 carers were analyzed. The majority of these participants were female (79.5%). A total of 69.9% were spouses and 30.1% were children of the care recipient. Participants had an overall mean age of 68.34 ± 12.01 years. About 31.5% of participating carers had a past history of psychiatric illness (e.g., depression), and 34.2% sustained strained relationships with their respective care recipients. Results from carers demonstrated improvement in carers’ self-perception of competence (1.26 ± 1.92, P < 0.0001), and significant reduction in emotion-focused coping (measured by the Coping Inventory of Stressful Situations, -2.37 ± 6.73, P < 0.01), Geriatric Depression scale (-0.67 ± 2.63, P < 0.05) and Pearlin’s overload scale (-0.55 ± 2.07, P < 0.05), upon completion of the Program. Secondly, it was found that carers with more compromised baseline scores benefited most from the intervention, as they experienced statistically significant improvement in the following constructs: competence, stress-coping style (less emotion-oriented), sense of mastery, burden, overload.

CONCLUSION: Study results supported the effectiveness of the CARERS Program in improving caregiving competence, stress coping ability and mental well-being in carers caring for family members with dementia.

Keywords: Informal carers; Dementia; Problem solving techniques; Competence; Stress coping; Skills-training; Simulated patients

Core tip: The “Coaching, Advocacy, Respite, Education, Relationship, and Simulation” (CARERS) Program is a comprehensive package of evidence-based interventions for informal carers comprised of 3 integrated components: group psychotherapy, Problem-Solving Techniques and skill acquisition for specific current challenging interactions in caregiving. The demonstrated outcomes are reduction of emotion-based coping, enhanced mastery, and reduced burden. The Program is structured, and requires active participation of carers as they acquire knowledge and develop caregiving competence. It is the first carer intervention to make systematic use of standardized patients to role play the spouse or parent with dementia, which allows for real-time coaching in managing current, specific, emotionally difficult interpersonal interactions.