Improving the quality of life of dementia carers

Dementia is a major and growing global public health issue.  According to the Alzheimer’s Society, around 800,000 people in the UK have the condition, and as people live longer this figure is likely to double in the coming decades.

The December G8 Dementia Summit has focused attention on the need for a global research strategy, and made a call for greater innovation to improve the quality of life for people with dementia and their carers while reducing emotional and financial burden.1

Dementia not only affects the person with the condition but impacts upon their family and carers. In the UK, carers are the mainstay of dementia care as most sufferers live at home. Carers are known to experience high rates of potentially treatable anxiety and depression. Although NICE guidance2 states that carers who experience psychological distress should be offered psychological therapy, evidence on interventions to support carers that have been shown to be cost effective has been lacking. Recent research funded by NIHR3 has sought to address this gap.  

The START (STrAtegies for RelaTives) RCT sought to determine the effectiveness and cost effectiveness of a manual based coping strategy intervention to promote the mental health of carers of people with dementia.3 The intervention entailed eight sessions of manual based coping strategy therapy as an adjunct to usual care. Sessions were delivered to carers over 8 to 14 weeks, by supervised psychology graduates who did not have clinical qualifications. Carers also received a manual and CD to guide relaxation exercises.

The study found that at eight months, the START coping intervention was cost-effective compared to usual care. The intervention was associated with reductions in depressive symptoms (measured by changes in the Hospital Anxiety and Depression Scale) and improvements in health related quality of life. Cost effectiveness was driven by outcome differences between the groups rather than the cost differences.

Overall the study was well conducted and the findings are reliable.

This study and other critically appraised systematic reviews and economic evaluations relevant to the management of dementia are available on the CRD Databases.

References
  1. G8 UK. G8 Dementia Summit Declaration. RDD/10495. Issued: 11 December 2013
  2. National Institute for Health and Clinical Excellence. Dementia: Supporting people with dementia and their carers in health and social care. NICE Clinical guideline CG42. Issued: November 2006
  3. Knapp M, King D, Romeo R, Schehl B, Barber J, Griffin M, Rapaport P, Livingston D, Mummery C, Walker Z, Hoe J, Sampson EL, Cooper C, Livingston G. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ 2013; f6342 

Page last updated: 19 December, 2013