Steffen Ann M, Gant Judith R
Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
Int J Geriatr Psychiatry. 2016 Feb;31(2):195-203. doi: 10.1002/gps.4312. Epub 2015 Jun 15.
This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self-efficacy.
Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14-week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre-intervention, post-intervention, and 6 months following intervention.
For those providing in-home care at post-treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self-efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6-month follow-up.
This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost.
本研究考察了两种远程医疗项目对照顾患有神经认知障碍的老年人的女性的不同影响。所考察的结果包括抑郁症状、破坏性行为后的心烦意乱、焦虑和愤怒情绪状态以及照顾者自我效能感。
与被诊断患有神经认知障碍的家庭成员同居的女性通过随机分配被分为以下两组：（1）一个为期14周的行为干预组，使用视频教学材料、工作手册以及关于行为管理、愉快事件安排和放松的电话辅导；（2）一个基础教育指南和电话支持对照组。在干预前、干预后以及干预后6个月，由对治疗条件不知情的访谈者进行电话评估。
对于那些在治疗后提供居家护理的人来说，行为辅导组的抑郁症状、破坏性行为后的心烦意乱以及负面情绪状态在统计学上低于基础教育和支持组。贝克抑郁量表II得分的可靠变化指数分析支持行为辅导组。在辅导组中，获得喘息机会和管理患者行为干扰的照顾者自我效能感得分显著更高。效应量中等，但在6个月随访时未保持。
本研究为远程医疗行为辅导干预与基础教育和电话支持相比的疗效提供了一些初步证据。在诸如阿尔茨海默病等进行性疾病期间，照顾者维持策略使用的能力可能需要比本研究提供的更长时间的干预接触。痴呆症照顾者，包括那些生活在农村地区的照顾者，可以从可获得且有实证支持的干预措施中受益，这些干预措施可以以适度成本轻松地远距离传播。
