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Effectiveness of family meetings for caregivers of persons with dementia a pragmatic RCT

Effectiveness of family meetings for caregivers of persons with dementia a pragmatic RCT. Karlijn Joling Hein van Hout, PhD. Background. Prevalence  & workforce Empowerment & prevention  Wellbeing informal caregiver main determinant for (premature) long term care admission PwD

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Effectiveness of family meetings for caregivers of persons with dementia a pragmatic RCT

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  1. Effectiveness of family meetings for caregivers of persons with dementiaa pragmatic RCT • Karlijn Joling • Hein van Hout, PhD

  2. Background • Prevalence & workforce • Empowerment & prevention  • Wellbeing informal caregiver main determinant for (premature) long term care admission PwD • Interventions including family meetings beneficial (Mittelman 1995, 1996, 2004) • Family meetings rarely used in routine practice • Efficacy vs effectiveness?

  3. Spectre of Mrazek & Haggerty Family meetings -> selective prevention

  4. Objective • -Can family meetings prevent anxiety and depression in caregivers en delay LTC admission? ____________________________________________________________________________________________

  5. Psycho-education • Improve understanding social support • Mobilize family, max their contribution Relieve primary caregiver ____________________________________________________________________________________________

  6. Preparation session carer • Purpose & benefits • Discuss perspectives • Identify problems • Problem solving behaviour • Solutions, allocate tasks • Planning next session 4 family meetings Evaluation session

  7. Flow diagram Approached N = 683 Excluded 81 not eligbile 410 refusal Randomized (n=192) Family meetings (n=96) Usual care (n=96) Completed 12 month follow up (n=81) Completed 12 month follow up (n=86) ____________________________________________________________________________________________

  8. Baseline characteristics N=192 Caregivers Patients ____________________________________________________________________________________________

  9. Participation in intervention stages (N=96)

  10. Results  40% new disorder in 12 months! Incident Rate Ratio 0.98

  11. Severity of symptoms CESD Effect size Cohens D = 0.24 HADS Non sign ____________________________________________________________________________________________

  12. Nursing home admission over 18 mnths HR 1.46 (p=0.38) Family meetings 24% Control 19%

  13. Secondary outcome: Burden Linear regression analyses corrected for unbalanced baseline scores and clustering ____________________________________________________________________________________________

  14. Subgroup analyses • Subgroup analyses: no subgroup effects • high initial distress carer (SSCQ) • severe dementia (mmse) • Receiving case management yes/no

  15. Conclusions • High incidence depression & anxiety (40%) • No preventive effects • No delay Long Term Cate admissions ….. nevertheless • High satisfaction cares • Wide adoption by care organisations ____________________________________________________________________________________________

  16. Why no effects? • Wrong target group (selective vs indicative?) • Follow up too short? • Wrong outcome measures? • Limited contrast with usual care? • Treatment fidelity insufficient? • …

  17. Finally 2012; 7(1) Jan 27 Manual & video family meetings at: www.alzheimercentrum.nl/ dementie/informatieve-films/ Hpj.vanhout@vumc.nl

  18. Thank you for your attention! • hpj.vanhout@vumc.nl • k.joling@vumc.nl

  19. EXTRA sheets

  20. Thema’s (Over)belasting en inzicht familie Hulp durven vragen Praktische problemen Onzekerheid toekomst Gedragsproblemen pt Evaluatie gespreksleiders Meerwaarden Bewustwording en betrokkenheid familie  Gestructureerd contact Hulp bij praktische kant

  21. Process analysis

  22. Kwetsbare groep: hoge incidentie Uitgebreide steun via reguliere zorg Deelname aan interventie niet optimaal >> Familiegesprekken meerwaarde voor bepaalde mantelzorgers? Conclusies

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