Department of Social and Behavioral Sciences (JMA), Yale University School of Public Health, New Haven, CT; Instituto de Investigación y Postgrado Facultad de Ciencias de la Salud (JMA), Universidad Central de Chile, Santiago, Chile.
Facultad de Ciencias para el Cuidado de la Salud (JG), Universidad San Sebastián, Santiago, Chile; Department of Occupational Therapy and Occupational Science (JG), University of Chile, Santiago, Chile.
Am J Geriatr Psychiatry. 2022 Aug;30(8):859-877. doi: 10.1016/j.jagp.2021.10.013. Epub 2021 Nov 2.
Dementia prevalence in Latin America (LATAM) is rapidly increasing, contributing to significant family burden. As families are responsible for care, supportive interventions are critical. To understand the state-of-the-science, a scoping review was conducted of non-pharmacologic interventions for caregivers of people living with dementia (PLWD) in LATAM.
Eight databases were searched (PubMed, Embase, PsycINFO, Scopus, Scielo, Lilacs, Redalyc, Google Scholar) for nonpharmacological intervention studies published up to July, 2021 in LATAM reporting at least 1 caregiver outcome. A qualitative synthesis examined study designs, participants, and outcomes characteristics.
Forty-five studies were identified from 25.8% (n = 8/31) of LATAM countries (28 = Brazil, 4 = Chile, 4 = Cuba, 4 = México, 2 = Colombia, 1 = Perú, 1 = Ecuador, 1 = Argentina): 29% (n = 17) were randomized clinical trials (RCT), 7% (n = 3) nonrandomized comparison trials, 42% (n = 19) pre-post trials, 9% (n = 4) postintervention analyses, and 4% (n = 2) single case studies, comprising a total of 1,171 caregivers and 817 PLWD. For 20 RCT and nonrandomized comparison trials, 31 interventions were tested of which 48.4% (n = 15) targeted caregivers and 32.3% (n = 10) dyads. Most studies involved daughters with less than 12 years of education and tested multicomponent interventions involving disease education (90%), and cognitive behavioral coping (45%). Half of interventions (51.6%; n = 16/31) tested were adapted from other countries, and reported benefits for caregiver depression, quality of life, and burden.
Studies were conducted in a limited number of LATAM countries and few were RCTs. Results of RCTs showed benefits for socially vulnerable caregivers on psychosocial outcomes. There is an urgent need to rigorously evaluate more country/culturally specific interventions addressing unmet familial needs beyond psychosocial support.
拉丁美洲（LATAM）的痴呆症患病率正在迅速上升，这给家庭带来了巨大的负担。由于家庭负责照顾患者，因此支持性干预措施至关重要。为了了解该领域的现状，对 LATAM 地区针对痴呆症患者照顾者的非药物干预措施进行了范围界定审查。
在PubMed、Embase、PsycINFO、Scopus、Scielo、Lilacs、Redalyc 和 Google Scholar 这 8 个数据库中搜索了截至 2021 年 7 月在 LATAM 地区发表的至少有 1 项照顾者结局的非药物干预研究。定性综合分析了研究设计、参与者和结局特征。
从 31 个 LATAM 国家中的 25.8%（n=8/31）国家中确定了 45 项研究（28%=巴西，4%=智利，4%=古巴，4%=墨西哥，2%=哥伦比亚，1%=秘鲁，1%=厄瓜多尔，1%=阿根廷）：29%（n=17）为随机临床试验（RCT），7%（n=3）为非随机对照试验，42%（n=19）为前后对照试验，9%（n=4）为干预后分析，4%（n=2）为单病例研究，共纳入 1171 名照顾者和 817 名痴呆症患者。对于 20 项 RCT 和非随机对照试验，共测试了 31 种干预措施，其中 48.4%（n=15）针对照顾者，32.3%（n=10）针对照护者和患者。大多数研究涉及受教育程度低于 12 年的女儿，且测试了多种成分的干预措施，包括疾病教育（90%）和认知行为应对（45%）。一半的干预措施（51.6%；n=31）是从其他国家改编而来的，并报告了对照顾者抑郁、生活质量和负担的益处。
研究在有限的几个 LATAM 国家进行，且很少为 RCT。RCT 的结果表明，对社会弱势群体的照顾者的心理社会结局有益。迫切需要严格评估更多针对超出心理社会支持之外的家庭未满足需求的具有国家/文化特异性的干预措施。
