The Effectiveness of a Home Care Program for Supporting Caregivers of Persons with Dementia in Developing Countries: A Randomised Controlled Trial from Goa, India

被引：139

作者：

Dias, Amit ^{[1
]}

Dewey, Michael E. ^{[2
]}

D'Souza, Jean ^{[3
]}

Dhume, Rajesh ^{[4
]}

Motghare, Dilip D. ^{[1
]}

Shaji, K. S. ^{[5
]}

Menon, Rajiv ^{[6
]}

Prince, Martin ^{[2
]}

Patel, Vikram ^{[7
]}

机构：

[1] Goa Med Coll, Dept Prevent & Social Med, Goa, India

[2] Kings Coll London, Inst Psychiat, Sect Epidemiol, London, England

[3] Dementia Soc Goa, Goa, India

[4] Directorate Hlth Serv, Goa, India

[5] Med Coll, Dept Psychiat, Trichur, India

[6] Chelsea & Westminster Hosp, Mental Hlth Ctr, London, England

[7] London Sch Hyg & Trop Med, Dept Epidemiol & Populat Hlth, London, England

来源：

PLOS ONE | 2008年 / 3卷 / 06期

关键词：

D O I：

10.1371/journal.pone.0002333

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Objectives: To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden, promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia. Methodology and Principal Findings: This was a randomised controlled trial in which the person with dementia-caregiver dyad was randomly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months. It was carried out in communities based in two talukas (administrative blocks) in Goa, India. Mild to moderate cases with dementia (diagnosed using the DSM IV criteria and graded using the Clinical Dementia Rating scale) and their caregivers were included in the trial. Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist, focusing on supporting the caregiver through information on dementia, guidance on behaviour management, a single psychiatric assessment and psychotropic medication if needed. We measured caregiver mental health (General Health Questionnaire), caregiver burden (Zarit Burden Score), distress due to behavioural disturbances (NPI-D), behavioural problems in the subject (NPI-S) and activities of daily living in the elder with dementia (EASI). Outcome evaluations were masked to the allocation status. We analysed each outcome with a mixed effects model. 81 families enrolled in the trial; 41 were randomly allocated to the intervention. 59 completed the trial and 18 died during the trial. The intervention led to a significant reduction of GHQ (-1.12, 95% CI -2.07 to -0.17) and NPI-D scores (-1.96, 95% CI -3.51 to -0.41) and non-significant reductions in the ZBS, EASI and NPI-S scores. We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm (OR 0.34, 95% Cl 0.01 to 1.03). Conclusion: Home based support for caregivers of persons with dementia, which emphasizes the use of locally available, low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring.

引用

页数：7

共 22 条

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