ABSTRACT
BACKGROUND AND OBJECTIVES: Many community dementia services such as home-visiting services and center-based activities were suspended during the COVID-19 pandemic. This study investigated the efficacy of a caregiver-delivered cognitive stimulation therapy (CDCST) on people with dementia during the pandemic. RESEARCH DESIGN AND METHODS: This was a two-arm randomized controlled trial involving 241 patient-caregiver dyads assigned to a 15-week CDCST or control group (usual care). We hypothesized that CDCST would facilitate significant improvements among people with dementia (cognition, behavioral/psychiatric symptoms, quality of life) and their caregivers (caregiving appraisal, attitudes, psychological well-being) at post-intervention (T1) and at the 12-week follow-up (T2). Generalized estimating equations evaluated the study outcomes. RESULTS: A total of 230 dyads completed the study, with good program adherence (93%). Participants in the CDCST showed significant improvements in cognition (p < .001), behavioral and psychiatric symptoms (p = .027), and quality of life (p = .001) at the 3-month follow-up period. Family caregivers had improved positive aspects of caregiving (p = .008; p = .049) and decreased negative attitudes toward people with dementia (p = .013; p < .001) at both T1 and T2. There were non-significant changes in the caregivers' perceived burden, distress, and psychological well-being. DISCUSSION AND IMPLICATIONS: Family caregivers could be trained to provide cognitive stimulation at home for people with dementia, which could benefit both parties. CDCST could manage to improve the cognition, neuropsychiatric symptoms, and quality of life of people with dementia, while also improving caregiving appraisal and negative attitudes among family caregivers.
ABSTRACT
BACKGROUND: Mindfulness-based intervention (MBI), an emotion-focused approach, has been shown promising and sustainable effects on enhancing the well-being of caregivers of patients with dementia (PWD). However, the conventional MBI was quite demanding, had high rates of attrition and inconsistent long-term effect. The social distancing measures introduced during the COVID-19 pandemic also restricted face-to-face psychosocial intervention. The study aims to evaluate the effectiveness of a 6-week hybrid MBI in caregivers of PWD over a 6-month follow up. METHODS: This is a single-blinded, parallel-group randomized controlled trial (RCT). Eligible participants from three local nongovernmental organizations (NGOs) will be randomly divided into intervention groups and control groups in a ratio of 1:1. The participants in the intervention group will receive 6 weekly 90-min group-based sessions delivered through a face-to-face and online approach. The participants in the control group will receive brief education on dementia care with the same group size, duration, and frequency as the sessions in the intervention group. Immediately after the intervention and at the 6-month follow-up, caring stress and other outcomes will be assessed. Besides, a focus group interview will be conducted to identify the strengths, limitations, and therapeutic components of the intervention from their perspectives. For quantitative data, intention-to-treat analysis and Generalized Estimating Equations (GEE) will be used. For qualitative data, content analysis will be used. DISCUSSION: This proposed hybrid model of MBI has several advantages, such as lower duration, longer follow-up period and easier access by family caregivers. Also, physiological indicators (e.g., heart rate viability and neuropsychiatric symptoms) will be measured in this study to show the body change after MBI. The quantitative and qualitative data of this research can also benefit the development of online or hybrid MBI for caregivers of PWD during the COVID-19 pandemic. Despite these strengths, it does have practical challenges and limitations. However, this proposed intervention has the potential to benefit not only the participants, but also the researcher as well as public health providers. TRIAL REGISTRATION: NCT05242614. Registered on 2022-02-16, https://clinicaltrials.gov/ct2/show/NCT05242614.