July 25, 2019
By Anne Harding
NEW YORK (Reuters Health) - An intervention to reduce depression and anxiety in people caring for a relative with dementia continues to be clinically effective six years after delivery, new research shows.
"You can help family carers of people with dementia. It lasts for years, and it saves money," Dr. Gill Livingston, a professor at University College London and the study's principal investigator, told Reuters Health by phone.
Caregivers of individuals with dementia are sicker, miss more time from work, have a poorer quality of life and suffer more from anxiety and depression than non-caregivers, Dr. Livingston and her team note in The British Journal of Psychiatry, online July 12.
The researchers previously found that the eight-session, manualized START (StrAtegies for RelaTives) intervention, delivered by supervised psychology graduates, improved quality of life and reduced anxiety and depression in caregivers compared to treatment as usual (TAU). START participiants were one-fifth as likely as those who received TAU to have case-level depression eight months after receiving the intervention.
To investigate the long-term effectiveness of START, Dr. Livingston and her team followed up with 150 carers who received the intervention and 72 who received TAU.
At six years, the START group's Hospital Anxiety and Depression Scale total scores were two points higher, on average, than the TAU group's, a significant difference.
Patient-related costs during the final year totaled a median £5,759 ($7,194) with START, and £16,964 ($21,192) with TAU (P=0.07).
Carers who received START "had fewer emergencies and they needed to take people to casualty less often and they needed to have inpatient admissions less often because they were just managing better and intervening earlier," Dr. Livingston said.
The most important message of the intervention, the researcher said, was to explain to carers that "it wasn't people with dementia's fault if they behaved in a way that's difficult, it's part of the illness. They couldn't change themselves, it was pointless to tell them not to do things."
She added, "That makes a huge difference to relationships, because people often find the relative gets quite difficult, when they think the person with dementia is behaving in an awkward way on purpose, but when they just think that they're ill, they're not angry."
Carers must also look after themselves, Dr. Livingston said. "We give them various strategies and ways of looking at the difficulties they might have and the problems they might have," she added. "You can do lots of little pleasant things like have a cup of coffee or go out for a short walk, and these can add up to a great deal of enjoyment."
She and her colleagues have translated the manual into Spanish and Tamil, and are planning an Urdu translation as well.
"We want to make this more international and more available within the U.K., and more applicable to all sorts of different groups, like minority ethnic groups," Dr. Livingston said.
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