Title : Problem solving reduces subjective burden levels in caregivers of family members with a new cognitive diagnosis
Introduction: Interventions have limited impact when evaluated among family caregivers who have provided dementia care for several years and report high burden levels. We sought to evaluate the effects of problem solving therapy (PST) on burdens levels among a sample of family members new to the caregiver role.
Methods: We randomly assigned 73 family caregivers of persons with a recent Alzheimer ’s disease Research Center diagnosis of mild cognitive impairment (n = 43) or early-stage dementia (n= 30) to receive problem solving therapy (PST) or nutritional training (NT, comparison intervention matched to PST for time and attention). Burden levels were assessed at baseline and at 1-, 3-, 6-, and 12-months post-intervention using three measures of objective caregiving burden and two measures of subjective caregiving burden. Objective caregiver burden refers to events and activities associated with the caregiving experience (i.e., new responsibility managing medications, providing transportation) and practical consequences of cognitive deficits in the care recipient (such as the frequency of bothersome or embarrassing behaviors exhibited by the care recipient and infringement on the caregiver’s time and lifestyle). Subjective caregiver burden describes perceived burden or the emotional reactions of the caregiver (such as worry, fear, frustration and emotional exhaustion) and the caregiver’s reaction to frequently occurring bothersome or embarrassing behaviors exhibited by the care recipient.
Results: Results of this study suggest that the PST intervention positively impacts subjective (not objective) caregiving burden over time. Specifically, negative reactions to dementia-related behaviors among MCI caregivers in the PSTgroup remained relatively low and stable over time, while similar burden levels among MCI caregivers in the NT-group increased steadily over one year of follow-up. The opposite was true for early-stage dementia caregivers. Those in the PST-group showed reductions in burden levels associated with dementia-related behaviors in the care recipient over time, while similar burden levels in the early-stage dementia caregivers in the NT-group increased steadily for six months after the intervention. Compared to caregivers in the NT group, caregivers in the PST group also endorsed improved (lower) perceived burden levels up to six months after the intervention, regardless of the type of caregiver (MCI or early-stage dementia). By one-year of follow-up, perceived burden levels of MCI caregivers were almost as high as early-stage dementia caregivers in both treatment groups.
Discussion: PST, taught early in the caregiving trajectory, prevents or reducessubjective burden levels among caregivers of family members with relatively mild cognitive deficits (MCI or early-stage dementia). These results are promising since a substantial body of literature shows that negative reactions to dementia-related (bothersome) behaviors are the strongest predictors of caregiver burden and depression.