Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
Department of Medicine, Emory University, Atlanta, Georgia, USA.
Gerontologist. 2022 Apr 20;62(4):616-628. doi: 10.1093/geront/gnab029.
Family caregivers will grow in number as dementia prevalence increases, underscoring the continued importance of equipping these individuals for their new roles and ameliorating the adverse effects of caregiving.
A three-armed, waitlist, randomized trial design tested Tele-Savvy, an online adaptation of a successful in-person psychoeducation program, the Savvy Caregiver. Tele-Savvy is delivered over 43 days to groups of 6-8 caregivers in 7 weekly synchronous sessions accompanied by 36 brief asynchronous video lessons. We enrolled 23 cohorts of 15 eligible caregivers (N = 261), randomized 2:2:1 to active, attention control, and usual care arms. We assessed caregiver psychological well-being and caregiving mastery at baseline and 3, 6, 9, and 12 months. Multilevel linear models assessed outcomes over the 3 time points examined. The trial was slightly truncated, with Data and Safety Monitoring Board approval, because of the apparent confounding psychological effects of coronavirus disease 2019 restrictions.
Study findings indicate statistically and clinically significant benefits to Tele-Savvy arm caregivers (with moderate to large effect sizes) in the areas of depression, perceived stress, reaction to care recipients' behaviors, and enhancement of caregiver mastery. Expected benefits for caregiver burden and anxiety were not found.
Findings attest to program efficacy and the viability of employing distance means to improve family caregivers' emotional well-being and sense of mastery in the caregiving role over a 6-month period. Next steps entail finding alternate ways to deliver the program to those with connectivity and/or time constraint problems.
随着痴呆症患病率的增加，家庭照顾者的数量将会增加，这凸显了继续为这些人提供新角色所需的装备并减轻照顾者不良影响的重要性。
采用三臂、等待名单、随机试验设计，测试了 Tele-Savvy，这是成功的面对面心理教育计划——精明照顾者的在线改编版。Tele-Savvy 在 43 天内向 6-8 名照顾者的小组提供，每周进行 7 次同步会议，同时提供 36 个简短的异步视频课程。我们招募了 23 组 15 名符合条件的照顾者（N=261），随机分为活跃组、对照组和常规护理组，比例为 2:2:1。我们在基线和 3、6、9 和 12 个月时评估照顾者的心理幸福感和照顾能力。多层次线性模型评估了 3 个时间点的结果。由于 2019 年冠状病毒病限制的明显心理混淆效应，经过数据和安全监测委员会批准，试验略有缩短。
研究结果表明，Tele-Savvy 组的照顾者在抑郁、感知压力、对照顾对象行为的反应以及增强照顾者能力方面具有统计学和临床意义上的益处（具有中到大的效应量）。预期的照顾者负担和焦虑的益处没有发现。
研究结果证明了该计划的有效性，以及在 6 个月的时间内利用远程手段改善家庭照顾者的情绪健康和照顾角色掌控感的可行性。下一步是寻找其他方法将该计划交付给那些有网络连接和/或时间限制问题的人。
