Hinton Ladson, Tran Duyen, Nguyen Thuc-Nhi, Ho Janis, Gitlin Laura
Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA.
University of California Davis, Davis, California, USA.
BMJ Glob Health. 2019 Nov 12;4(6):e001830. doi: 10.1136/bmjgh-2019-001830. eCollection 2019.
Despite increasing numbers of persons living with Alzheimer's disease and Alzheimer's-related dementias (AD/ADRD) in Asia, particularly in low-income countries (LIC) and middle-income countries (MIC), surprisingly little is known about the current state of the evidence for family caregiver interventions. The objectives of this scoping review were to: (1) describe the evidence for efficacy of family dementia-caregiver psychosocial interventions in Asian countries, (2) compare evidence across LIC, MIC, and high-income countries (HIC), and (3) characterise cultural adaptions to interventions developed outside Asia.
The inclusion criteria included: (1) conducted in Asia (2) included an intervention delivered to a family caregiver of a person living with AD/ADRD, (3) reported quantitative outcomes for the family caregiver and (4) published in a peer-reviewed journal with full text available in English.
Thirty intervention trials were identified meeting inclusion criteria and all reported statistically significant (p<0.05) improvement in one or more caregiver outcomes. Interventions usually included multiple components. The most frequently reported outcomes (ie, by ≥20% of studies) were caregiver depression, burden, quality of life and self-efficacy. Overall, 26 (87%) of the studies were conducted in HIC in Asia, primarily in Hong Kong SAR-China and Taiwan, and only 4 (13%) in LIC and MIC in Asia. Seven studies (23%) used interventions developed in USA and several described cultural adaptations.
This scoping review found substantial evidence, particularly from high-income Asian countries, that a wide range of interventions improve AD/ADRD family caregiver outcomes. However, critical knowledge gaps exist, particularly for LIC and MIC in Asia, where the number of persons with dementia is numerically largest and projected to increase dramatically in coming decades. The field could also benefit from more detailed descriptions of the process and types of cultural adaptations to interventions.
尽管亚洲，尤其是低收入国家（LIC）和中等收入国家（MIC）中患有阿尔茨海默病及与阿尔茨海默病相关痴呆症（AD/ADRD）的人数不断增加，但令人惊讶的是，对于家庭照顾者干预措施的现有证据状况知之甚少。本范围综述的目的是：（1）描述亚洲国家家庭痴呆症照顾者心理社会干预措施的疗效证据；（2）比较低收入国家、中等收入国家和高收入国家（HIC）的证据；（3）描述对在亚洲以外地区开发的干预措施的文化适应性。
纳入标准包括：（1）在亚洲进行；（2）包括对AD/ADRD患者的家庭照顾者实施的干预措施；（3）报告了家庭照顾者的定量结果；（4）发表在同行评审期刊上且有英文全文。
确定了30项符合纳入标准的干预试验，所有试验均报告了一项或多项照顾者结果有统计学显著改善（p<0.05）。干预措施通常包括多个组成部分。最常报告的结果（即≥20%的研究报告的结果）是照顾者抑郁、负担、生活质量和自我效能感。总体而言，26项（87%）研究在亚洲的高收入国家进行，主要在中国香港特别行政区和台湾，只有4项（13%）在亚洲的低收入国家和中等收入国家进行。7项研究（23%）使用了在美国开发的干预措施，有几项描述了文化适应性。
本范围综述发现了大量证据，特别是来自亚洲高收入国家的证据，表明广泛的干预措施可改善AD/ADRD家庭照顾者的结果。然而，关键的知识空白仍然存在，特别是在亚洲的低收入国家和中等收入国家，那里痴呆症患者数量最多，预计在未来几十年还将大幅增加。该领域还可从对干预措施文化适应性的过程和类型进行更详细的描述中受益。
