A Meta-Analysis of the Impact of Community Interventions on the Burden, Depression, and Anxiety of Family Caregivers for Elderly Individuals with Dementia
- 1. Development of Social School, Tianjin University of Technology, China
Abstract
Background: As society ages rapidly, the prevalence of dementia among the elderly is increasing, which imposes a significant burden on families and society. Family caregivers, who primarily support elderly individuals with dementia, experience various pressures, including physical, psychological, economic, and social stresses during long-term care. These pressures make them particularly vulnerable to depression and other psychological disorders. Consequently, alleviating the stress and depressive symptoms of these family caregivers has emerged as a pressing societal concern. Communities, serving as essential links between families and the broader society, offer unique opportunities for support and intervention.
Objective: This study aims to evaluate the impact of community interventions on the burden, anxiety, and depression experienced by family caregivers of elderly individuals with dementia residing at home.
Methods: A comprehensive electronic search was conducted in databases such as PubMed, EMBASE, Web of Science, CINAHL, Cochrane Library, and PsycINFO until January 2025. Two independent reviewers selected randomized controlled trials (RCTs) that met the inclusion criteria and extracted data separately. The quality of the included RCTs was assessed using the methodology recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Pooled effect sizes were calculated using standardized mean differences (SMDs) with 95% confidence intervals (CIs).
Results: The meta-analysis of 23 studies showed that community interventions positively affect the burden, depression, and anxiety of family caregivers for elderly individuals with dementia, as well as reduce caregiving stress (SMD = -0.3; 95% CI -0.39 to -0.21; p < .001), depression (SMD = -0.6; 95% CI-0.75 to -0.47; p < .001), and anxiety (SMD = -0.32; 95% CI -0.5 to -0.14; p < .001). Additional findings suggest that these interventions may also enhance the quality of life.
Conclusion: Community-based supportive interventions significantly improve depressive symptoms, perceived stress, and anxiety among family caregivers of individuals with dementia and potentially benefit the care recipients themselves. Both online and offline interventions are effective, suggesting that future research should explore hybrid models that integrate these approaches to optimize the health outcomes of family caregivers and their care recipients
Keywords
- Community Intervention
- Dementia Meta-Analyses
- Family Caregiver
Citation
Zhihui WEI, Yue HAN (2025) A Meta-Analysis of the Impact of Community Interventions on the Burden, Depression, and Anxiety of Family Caregivers for Elderly Individuals with Dementia. Ann Community Med Pract 10(1): 1065.
INTRODUCTION
As the global population ages and life expectancy increases, the number of elderly individuals is rising, many of whom experience cognitive decline. Alzheimer’s disease (AD), a progressively worsening neurodegenerative disorder, is characterized by progressive memory loss, significant declines in daily living skills, and impaired temporal and spatial orientation [1]. Currently, most caregivers are unpaid family members, who support individuals with reduced daily living capabilities, especially those with dementia. In the United States, approximately 15 million Americans provide unpaid care for persons with dementia (PWD). Conversely, in China, only 1% of elderly people with dementia receive formal care, such as hiring nannies or hourly workers, while the remaining 99% rely on informal care [2]. This study includes spouses, children, children’s spouses, and other relatives of patients with dementia, irrespective of whether they cohabit with the patient. However, caregivers for individuals residing in institutions were not considered. These caregivers endure significant economic [3], physical [4], social, and psychological burdens [5], while caring for those with dementia. The role is emotionally and physically demanding, often necessitating additional support systems. Caring for individuals with Alzheimer’s disease or other forms of dementia involves numerous challenges, potentially leading to substantial caregiver burden. Caregivers often experience elevated risks of depression, anxiety, and chronic stress, which further deteriorate their overall physical and mental health [6]. The pressure primarily arises from the need for constant proximity due to the patients’ poor mental condition [7]. The constant vigilance required to manage the unpredictable behaviors and needs of elderly individuals with dementia can be overwhelming, often resulting in feelings of helplessness and burnout. The psychological burden primarily stems from self-imposed pressure due to societal biases. Socially, caregivers may feel isolated as they dedicate more time and energy to caregiving responsibilities, leading to reduced social activities and support networks [8]. It is estimated that primary caregivers of Alzheimer’s disease (AD) patients dedicate approximately 70 hours per week to caregiving tasks [9]. Moreover, the financial pressure of providing care, including medical expenses, medication costs, and potential income loss due to reduced working hours or job abandonment, adds another layer of complexity. Given these challenges, comprehensive support services such as respite care, counseling, and community resources are crucial for alleviating some of the burdens on unpaid caregivers. Caregiving for individuals with AD or other dementias can lead to physical and psychological morbidity, including caregiver burden, depression, anxiety, stress, and strain. These phenomena not only threaten family caregivers but also negatively impact the health of elderly individuals with dementia. Therefore, there is an urgent need for interventions aimed at family caregivers, which can improve their mental state and further enhance their ability to care for elderly individuals with dementia, thereby improving the quality of life for these seniors.
Community interventions, although not specifically defined, typically involve multifaceted strategies and measures implemented at the community level to enhance the health and well-being of community members. Four models of community intervention exist: treating the community as the site for interventions, targeting the community, utilizing the community as a resource, and engaging the community as an agent [10]. When viewed as a location, community interventions are often geographically defined, with interventions being implemented within community institutions such as neighborhoods, schools, churches, workplaces, volunteer organizations, or other groups. These interventions might involve city-wide strategies, delivered through mass media or other methods. They can include educational strategies or other approaches targeting individuals, families, social networks, organizations, and public policies. In summary, an approach that targets a specific community group, employs planned strategies, assesses effectiveness, and offers sustainable benefits can be classified as a community intervention. Such interventions aim to enhance both individual health and community development.
In recent years, psychological interventions for caregivers of dementia patients have gained popularity and shown beneficial outcomes in enhancing the mental health of caregivers [11-13]. Research suggests that caregivers primarily need informational support, instrumental support, and social companionship. Although many studies have focused on intervention methods for family caregivers, research on the impact of community interventions on family caregivers is still limited. This study assesses the effects of community interventions on the psychosocial well-being of family caregivers of dementia patients through a systematic literature review, focusing on mental health indicators such as depression, burden, and stress. The included studies are RCTs aimed at reducing caregiver stress, depression, and other health issues.
While extensive research exists on interventions for family caregivers, studies on community-based interventions are relatively scarce. This study evaluates the impact of community interventions on the psychosocial well-being of family caregivers of individuals with dementia, analyzing the effects on mental health indicators such as depression, burden, and stress among informal caregivers. The review includes RCTs aimed at reducing caregiver stress, depression, and other physical and mental health issues. The objective of this systematic review is to assess the impact of community interventions on burden, anxiety, and depression among family caregivers of dementia patients living at home, identify types of intervention measures for informal caregivers, and report on the effectiveness of these measures in supporting family caregivers.
METHODS
Inclusion criteria
Studies must meet the following criteria to be included:
(1) The design of the study must be a RCT; (2) Subjects must be family caregivers of dementia patients residing at home, within community settings; (3) Intervention measures should primarily be implemented at the community level, including, but not limited to, educational courses, psychological support groups, and skill training; (4) Study results must include measurement data on mental health indicators such as caregiver burden (e.g., Zarit Burden Interview), depression (e.g., CES-D scale), and anxiety (e.g., HADS-A scale); (5) Studies must provide pre- and post-intervention data for assessing the effectiveness of the interventions.
Study selection
The criteria for study selection are identical to the inclusion criteria, ensuring consistency in the selection process.
Risk of bias in individual studies
Studies included in this review have assessed the risk of bias using methods recommended by the Cochrane Handbook for Systematic Reviews of Interventions. The risks are summarized in a risk of bias table, evaluating seven criteria: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, selective reporting, and other bias. Each criterion’s risk of bias is classified as ‘low risk’, ‘unclear’, or ‘high risk’ [14].
Data analysis
When studies use different scales to measure outcomes, SMDs with 95% CIs will be used. Heterogeneity will be assessed using I², with I²>50% indicating significant heterogeneity. If no significant heterogeneity is found, a fixed-effects model will be employed to calculate the pooled effect size; otherwise, a random-effects model will be used.
Search terms
Thisstudytargetsfamilycaregiversofelderlyindividuals with dementia, using keywords related to dementia such as ‘dementia,’ ‘Alzheimer’s disease,’ and ‘cognitive impairment,’ alongside terms from the Medical Subject Headings (MeSH) and EMBASE TREE index. Keywords for family caregivers include ‘informal caregiver’ and ‘family caregiver.’ In domestic contexts, terms such as ‘caregiving’ and ‘nursing’ are employed. This review includes English articles published between 2000 and 2025 that address the impact of community interventions on the burden, anxiety, and depression of these caregivers. The search strategy is (community intervention) AND (dementia OR Alzheimer’s disease) AND (informal caregiver or family caregiver) AND (burden or depression or anxiety).
Aim
The aim of this systematic review is to assess whether community interventions affect the burden, anxiety, and depression of family caregivers of dementia patients living at home. It seeks to (1) identify the types of interventions provided to these caregivers within the community and (2) evaluate the effectiveness of these interventions in supporting them.
RESULTS
Study selection
Initially, 2390 records were identified through database searches, with an additional 6 records found through references in the screened literature, totaling 2396 records. Duplicate records and clearly irrelevant documents were removed. Subsequently, 62 articles were assessed for eligibility, with reasons for exclusion, such as ‘lack of control trials’ and ‘incorrect population (e.g., incorrect intervention methods)’, clearly stated. Ultimately, 25 studies were included in this systematic review, as illustrated in Figure 1.
Figure 1: Figure showing the 25 studies which were included in this systematic review
Study characteristics
The studies varied in size, with participant numbers ranging from 30 to 299, and the duration of interventions extended from four weeks to eighteen months. Geographical distribution of the studies included ten in the United States [15-23] Table 1,
Table 1: Studies showing the Geographical distribution according to year, country, sample size.
Study Indicator (IG/CG) |
Year Data |
Sample size |
Country |
Mean age |
intervention measures |
Total time |
Outcome indicator |
Data Collection Points |
|
T |
C |
||||||||
Bruno Kajiyama |
2013 |
IG: n=75 CG: n=75 |
America |
57.02±12.53/ 55.22±11.31 |
iCare: A web-based training program featuring multiple action-oriented components, such as relaxation exercises, where participants sequentially complete modules and develop personal action plans. |
Accessed websites containing dementia information but lacking skill development content |
Three months |
burden: PSS depression: CES - D |
Baseline Three months |
Burcu Akpinar Soylemez |
2016 |
IG: n=35 CG:n=35 |
Turkey |
61.2 ±13.1/ 62.3 ±12.8 |
The PLST intervention includes four home visits, introducing PLST theory, along with subsequent telephone support and a care manual. |
Routine care |
six months |
burden (CBI) depression (BDI) |
Baseline Three months six months |
Cindy E.FRIAS |
2020 |
IG:n=86 CG:n=74 |
Spain |
64.7±11.5/ 62.4±14.3 |
INFOSA - DEM intervention, including 5 training sessions/ information courses; the intervention consists of five consecutive training sessions/ information courses held over one week, each session lasting approximately 90 minutes. |
Routine care |
six months |
burden (Zarit Burden Interview) |
Baseline Three months six months |
D.J.Done |
2001 |
IG:n=30 CG:n=15 |
England |
NA |
Participate in communication skills training workshops led by speech therapists |
Distribute a manual addressing communication issues and providing recommendations. |
Six weeks |
burden (relatives stress scale) |
Baseline Six weeks |
Franziska Meichsner |
2019 |
IG:n=15 CG:n=15 |
German |
63.00 ±9.40/ 61.17 ±10.14 |
8-week internet-based cognitive behavioral intervention |
Wait for 5 months before intervention |
Eight weeks |
Depressive symptoms (CES-D); caregiver burden (VAS); caregivers’ coping (CGS). |
Baseline Eight weeks Five months |
Geoffrey |
2008 |
IG:n=16 CG:n=17 |
America |
65.75±13.71/ 61.00±9.60 |
Participated in FITT-D intervention, |
Obtain documents containing information on local resources such as support group lists and adult day care centers, along with educational materials from the Alzheimer's Association. |
Twelve months |
burden (Zarit Burden Interview), depression (Geriatric Depression Scale) |
Baseline Twelve months |
Helen C. Kales |
2018 |
IG:n=27 CG:n=30 |
America |
total 65.9±14.0 |
Utilizing the WeCareAdvisor (WCA) tool, an innovative web-based instrument designed to assist family caregivers in assessing, managing, and tracking behavioral and psychological symptoms of dementia. |
No special intervention |
One months |
depression (CES - D) burden (Zarit burden scale) |
Baseline One months |
Hyejin Kim |
2022 |
IG:n=24 CG:n=11 |
America |
74.37±10.14/ 77.00±5.78 |
Participate in music interventions (listening, singing, playing instruments, etc.) conveniently at any time and place, with weekly telephone follow-ups by a research coordinator. |
No intervention before the study ends; information can be obtained after completion of the study |
Eight months |
Perceived stress and coping (Swedish version of the 14-item Perceived Stress Scale, calculating PSS-13 total score and subscale scores for stress and coping after removing item 12), depression (Patient Health Questionnaire - 9) |
Baseline Eight months |
Jeremy A Tanner |
2015 |
IG:n=106 CG:n=183 |
America |
66.3±14.1/ 67.5±13.0 |
Undergo a 18-month care coordination intervention, |
Accept the results of the written needs assessment, intervention recommendations, and resource guidelines. |
Eighteen months |
Burden (Zarit Burden Interview) Depression (Geriatric Depression Scale) |
Baseline nine months eighteen months |
Kenneth W. Hepburn |
2001 |
IG:n=72 CG:n=45 |
America |
total65±13.6 |
Undergo 14 hours of community training, which includes information provision, concept development, role clarification, belief clarification, and mastery-oriented coaching. |
Undergo training after waiting for 5 to 6 months |
Seven weeks |
Burden (Zarit Burden Interview)Depression (Center for Epidemiologic Studies Depression Scale) |
Baseline five months |
Kristine N. Williams |
2019 |
IG:n=42 CG:n=41 |
America |
64.6±12.2/ 63.9±13.7 |
IG?FamTechCare intervention |
Telephone support, providing guidance based on caregivers' recollections, with the expert team reviewing videos post-intervention and providing feedback. |
Three months |
Depression (Center for Epidemiologic Studies Depression scale} CES - D (Burden) Modified Zarit Burden Scale |
Baseline one months three months |
Laura N. Gitlin |
2010 |
IG:n=137 CG:n=135 |
America |
67.1±12.3/ 65.7±12.2 |
Up to 11 home and telephone contacts conducted by healthcare professionals |
No intervention |
Weeks 16-24 |
Burden (Zarit Burden 12 - item measure)Depression (Center for Epidemiologic Studies Depression Scale) |
Baseline 16 weeks 24 weeks |
Manuel Mart?´n- Carrasco |
2009 |
IG:n=60 CG:n=55 |
Spain |
55±13.3/ 61.6±13.8 |
Participate in a Psychological Education Intervention Program (PIP), which includes 8 individual sessions of 90 minutes each. |
Receive standard care, including information on AD progression, patient- specific information, informational brochures, and community resources. |
Four months |
Burden (Zarit Caregiver Burden Interview) |
Baseline four months ten months |
Marco M.Blom |
2015 |
IG:n=149 CG:n=96 |
Netherlands |
NA |
Enroll in the online course 'Mastery over Dementia' (MoD), which includes 8 lessons and 1 intensive session, with coaching guidance and feedback on assignments. |
Receive electronic newsletters (e-bulletins) containing practical information on dementia care. |
six months |
Depression (Center for Epidemiologic Studies Depression Scale)Anxity (Hospital Anxiety and Depression Scale)Burden (Self - Perceived Pressure from Informal Care scale) |
Baseline three months six months |
Martin Berwig |
2017 |
IG:n=47 CG:n=45 |
German |
72.3/73.98 |
Participate in the DE-REACH intervention, which includes 12 bi- weekly sessions (9 home visits and 3 telephone calls). |
Routine care |
six months |
Burden (Zarit Burden Inventory) |
Baseline six months nine months |
Miguel Madruga |
2020 |
IG:n=25 CG:n=23 |
Spain |
61.0±8.9/ 59.3±8.0 |
Engage in 60-minute home physical exercise sessions twice a week. |
Routine care |
Nine months |
Depression (Geriatric Depression Scale Short Form 15 - item version) Burden (Zarit Burden Interview) |
Baseline nine months |
Natasha Beauchamp |
2005 |
IG:n=150 CG:n=149 |
America |
46.9(12.2)/ 46,9(12.2) |
Dealing with Engage in 60-minute home physical exercise sessions twice a week. |
Routine care |
One months |
Burden (Caregiver Strain Instrument) Depression (CES - D) Anxity (State–Trait Anxiety Inventory) |
Baseline one months |
Saeed Pahlavanzadeh |
2010 |
IG:n=25 CG:n=25 |
Iran |
42.88±15.13/ 46.56±14.51 |
Participate in family education training programs, which include five 90-minute sessions per week conducted through lectures, group discussions, and Q&A sessions, covering knowledge related to dementia and care methods, with course CDs provided. |
No intervention |
Five weeks |
Burden (Zarit's caregiver burden scale) |
Baseline five weeks |
Sanford Finkel |
2007 |
IG:n=23 CG:n=23 |
America |
total64.6 |
A technology-based psychological education intervention, consisting of two home visits and twelve sessions conducted via a computer-telephone integration system (CTIS) |
Receive basic educational materials, two follow-up phone calls, and an invitation to attend a seminar after six months of evaluation. |
six months |
Depression (Centers for Epidemiologic Studies Depression Scale)Burden (Revised Memory and Behavior Problems Checklist) |
Baseline six months |
Su Jung Lee |
2022 |
IG:n=38 CG:n=40 |
Korean |
56.13±12.51/ 72.28±8.76 |
Community Dementia Caregiver Intervention (CDCI) includes training on dementia knowledge such as types, symptoms, and diagnosis, as well as caregiving skills like communication methods and patient ability identification. |
Only accepts standard medical care |
Eight weeks |
The primary outcome measure is caregiver burden, including personal stress and role stress, assessed using the Short Zarit Burden Interview (SZBI). Secondary outcome measures include depressive symptoms evaluated with the Korean version of the Patient Health Questionnaire-9 (PHQ-9) and attitudes towards caring for dementia assessed using the Dementia Attitudes Scale (DAS). |
Baseline Eight weeks |
Svetlana I. |
2009 |
IG:n=30 CG:n=30 |
Russia |
61.5±17.6/ 59.3±12.8 |
Undergo 10/66 caregiver intervention, which includes five half-hour sessions per week |
Only accepts standard medical care |
Five weeks |
Burden (Zarit Carer Burden Interview) Psychological distress (SRQ 20) Quality of life (WHOQOL - BREF) |
Baseline six months |
Timothy Kwok |
2013 |
IG:n=18 CG:n=20 |
Hong Kong, China |
61.0±8.9/ 59.3±8.0 |
Undergo 12 sessions of telephone- based psychological education intervention, each approximately 30 minutes long |
Provide DVDs containing information on dementia care education |
Three months |
Burden (Zarit Burden Interview) Self-care efficacy (Revised Scale for Caregiving Self - efficacy) |
Baseline three months |
Yi-Chien Liu |
2023 |
IG:n=137 CG:n=147 |
Tai Wan, China |
79.9±8.2/ 86.3±5.7 |
After receiving 3 hours of massage training, caregivers provide 30-minute full-body manual massages to patients three times a week at home. |
Caregivers learned the massage protocol after the study ended, while patients did not receive any intervention. |
Eight weeks |
Depressive symptoms (Cornell Scale for Depression in Dementia) Aggressive behavior (Cohen - Mansfield Agitation Inventory) Caregiver perceived stress (Perceived Stress Scale) |
Baseline four weeks Eight weeks |
three in Spain [24-26], two in German [27,28], two in China (one each in Taiwan [29], and Hong Kong[30]), and one each in Russia [31], Iran [32], England [33], the Netherlands [34], South Korea [35], and Turkey [36]. All studies provided clear inclusion and exclusion criteria and employed various intervention methods, including internet technology and skill training. All interventions were community-based, thus classified as community interventions.
Most studies featured control groups experiencing conditions similar to those of their respective intervention groups, with the experimental groups receiving additional community interventions. Some remaining studies involved control groups that received different interventions from those received by the intervention groups. These control groups were provided with DVDs [30], brochures [33], or documents [16], to ensure access to basic information on dementia care and local resources. For example, in studies by Hessel et al. and Williams et al., caregivers in the control group received telephone support, while Blom et al. provided electronic newsletters (e-bulletins) [34]. Kajiyama and colleagues offered caregivers in the control group access to websites containing dementia information, but notably, these did not include skill training [15]. All included studies assessed the impact of community interventions on improving the health outcomes of caregivers for elderly individuals with dementia.
Risk of bias assessment
Out of the 23 RCTs evaluated, most reported random allocation. However, only one study explicitly stated that the groups were not randomly assigned.[35]. Some studies [21], clearly outlined methods for random grouping, while others [32], did not provide details on group formation, potentially increasing bias risk. The nature of community interventions often prevents blinding of participants, affecting the quality of the experimental design. Only one study explicitly mentioned participant blinding [36]. About half of the studies ensured blinding of outcome assessors, thus reducing their risk of detection bias. Attrition bias was deemed high in only one study, due to inadequate explanation of dropout reasons and their potential impact on results [17, 24, 25,31,33]. Most studies showed no significant selective reporting bias, as primary and secondary outcome measures were clearly defined in the methods section and comprehensively reported in the results section. Other biases were rated as high risk due to small sample sizes [32]. The risk of bias for each study is depicted in Figure 2.
Figure 2: Figure showing the 25 studies which were included in this systematic review
Meta-Analysis Results of Interventions among Family Caregivers Burden
This analysis included nineteen community-based supportive interventions assessing the burden of family caregivers, involving 1,932 participants. Most burden measurements utilized the Zarit Burden Interview [16- 18,20,21,24-26,30-32,37], indicating a higher score corresponds to a greater caregiving burden. Additionally, the Caregiver Strain Instrument and PSS were employed [15,19,29]. Given the use of different scales, SMDs were employed to represent the pooled effect size. The meta-analysis revealed a statistically significant overall effect of the experimental intervention. Although the SMD was relatively small compared to depression, it still demonstrated a significant difference between the experimental and control groups, indicating the effectiveness of the intervention (n=1932; SMD=-0.3; 95%CI: -0.39 to -0.21; p<.001). A total of 13 studies involving 1132 participants were conducted offline, while the remaining seven studies involved online interventions. In the offline intervention studies, the results showed a significantly beneficial impact on the burden of caregivers (n=1132; SMD=-0.36; 95%CI: -0.48 to -0.24; P<0.001; I2=34, fixed-effects model). In studies on online interventions, it was also observed that community interventions have a positive impact on burden (n=878, SMD=–0.2; 95%CI –0.34 to –0.07; P=.003; I2=0%, fixed-effects model; Figure 3).
Figure 3: Meta-Analysis Results of Interventions among Family Caregivers Burden
Depressive symptoms
Ten studies assessed the impact of community interventions on family caregivers’ depressive symptoms using various methods: Center for Epidemiologic Studies Depression Scale [15,18,20,22,27,34], Cornell Scale for Depression in Dementia [29], Geriatric Depression Scale [17] (4), Geriatric Depression Scale Short Form 15-item version [26], and Self Reporting Questionnaire [31]. Due to the use of different scales for measurement, SMD was employed to represent the pooled effect size. The meta- analysis revealed that caregivers in the community-based intervention group showed significant improvement in depressive symptoms compared to the control group, indicating a highly statistically significant overall effect of the experimental intervention (n=942; SMD=-0.6; 95%CI- 0.75 to-0.47; p<.001). The direction ofthedifferencefavored the experimental group, suggesting the effectiveness of the intervention measures. Given the distinct nature of online and offline interventions, which can impact their effectiveness, community interventions were categorized by form into online and offline interventions for subgroup analysis. In the subgroup analysis of online interventions, results from six studies [15,18, 20,22,27,34] indicated that these digital approaches significantly alleviated caregivers’ depression (n=507; SMD=–0.27; 95% CI –0.44 to -0.09; P=.003; I2=0%). In the subgroup analysis of offline interventions, results from five studies [26,29,31,35,38], showed that these interventions also improved caregivers’ depressive symptoms (n=513; SMD=–0.94; 95% CI –1.67 to -0.22; P=.01; I2=0%; random-effects model; Figure. 4 & 5).
Figure 4: Assessment of the impact of community interventions on family caregivers’ depressive symptoms
Figure 5: Publication Bias and Sensitivity Analyses
Anxiety
Two studies examined anxiety symptoms using the Hospital Anxiety and Depression Scale [34], (Blom) and the State-Trait Anxiety Inventory [22], to assess changes in caregivers’ anxiety levels. The analysis revealed that, compared to standard care, community interventions significantly reduced anxiety among caregivers in the intervention group (n=474, SMD=-0.32, CI=-0.5to-0.14; p<.001, I²=0%).
Publication Bias and Sensitivity Analyses
Assessment of the impact on burden status in 19 studies was symmetrically distributed showing no outcome bias but indicating heterogeneity due to some studies falling outside the 95% CI. The visual inspection of the funnel plot did not reveal evidence of potential publication bias. The funnel plot is displayed as follows.
DISCUSSION
This article reviews 24 studies on the impact of community interventions on caregivers of dementia patients, excluding one study from the meta-analysis due to lack of specific numerical data. Unlike previous articles, this paper specifically focuses on the effects on family caregivers and examines various interventions from a community perspective. The meta-analysis of the included studies reveals that community interventions positively affect caregiver burden, depression, and anxiety. Both online and offline interventions effectively reduce caregiver burden, depressive symptoms, and anxiety.
This systematic review reveals that interventions at the community level yield substantial improvements in the mental well-being of dementia caregivers by significantly diminishing depression symptoms, burden stress, and anxiety. These enhancements likely originate from the supportive characteristics of such interventions, which offer improved access to resources that bolster caregivers’ understanding of dementia and enhance their caregiving capabilities. Consequently, this elevates their confidence in managing the condition and mitigates adverse emotional states. Within the community environment, caregivers engage with peers facing similar challenges, fostering an exchange of experiences, obstacles, and insights, which enhances emotional solidarity and collective support. Such interactions effectively reduce feelings of isolation and psychological distress among caregivers, thereby lessening depressive symptoms.
In the detailed subgroup analysis of this review, we assessed the effects of online versus offline interventions within the community-based approaches. Findings suggest that both modalities positively impact depression, stress perception, and anxiety levels. Nonetheless, offline interventions demonstrated greater effect sizes, indicating enhanced benefits for mental health. Such interventions facilitate more precise observation of caregivers’ behaviors and expressions, allowing for more accurate evaluations of their psychological conditions and offering tailored guidance. Tailored guidance is vital in caregiver interventions due to the broad variability in caregivers’ baseline understanding of the disease and coping mechanisms.
The American Geriatrics Society underscores that high-quality healthcare hinges on delivering services that respect and cater to the individual’s needs, preferences, and values—a principle crucial not only to medical care but also pivotal in boosting patient satisfaction and treatment outcomes [39]. Further, several guidelines [40-42], provide essential support and recommendations for managing dementia, advocating for highly personalized care that considers the patient’s interests, abilities, personal values, and previous life experiences. Plans should be adaptable based on the severity and nature of the symptoms to provide the most appropriate care.
Face-to-face interventions enable immediate responses to caregivers’ educational needs and on-the- spot corrections. For instance, in Kenneth W. Hepburn’s research, during the initial stages of concept development, professionals could elaborate on dementia’s effects on cognitive abilities and tailor coping strategies based on real-time caregiver feedback [37]. Cindy E. Frias’s research involved a series of five sequential training sessions, approximately 90 minutes each, utilizing audiovisual aids and promoting experience sharing among caregivers [24]. This setup allowed caregivers to pose questions and discuss their unique perspectives and circumstances, enabling professionals to provide more customized advice and support.
However, existing studies have not definitively proven the efficacy of community interventions. Dementia is a prolonged disease progression, and caregivers’ needs and psychological conditions continually evolve. Studies on community interventions often fail to monitor caregivers’ situations over extended periods post-implementation— such as one year or longer—thereby neglecting to evaluate sustained reductions in caregiving burdens or the stability of psychological states. This gap in understanding the long- term effects of interventions limits our ability to ascertain their continued effectiveness.
Community interventions, which target caregivers of dementia patients, constitute an emerging area of research. Nevertheless, these interventions vary widely across different communities due to the absence of standardized methods and guidelines. For instance, the measurement scales applied in such interventions are not consistent, which necessitates further exploration of these discrepancies.
In 23 studies, researchers investigated the effects of these interventions on caregivers. Martin Berwig reported that, six months after the interventions, caregivers in the intervention group exhibited statistically significant enhancements in the mental component of their quality of life, as measured by the SF-12, whereas improvements in the physical component showed a positive trend but were not statistically significant. In contrast, Svetlana I.’s findings revealed improvements in the quality of life for the intervention group, though these did not achieve statistical significance. On the other hand, research by Manuel Martín-Carrasco demonstrated that family caregivers in the intervention group noted a marked improvement in quality of life when compared to their counterparts in the control group. Despite the variability in outcomes among these studies, the overarching potential benefits of community interventions for caregivers are evident. Future research should focus on refining these interventions to enhance their effectiveness and address prevailing challenges.
Implications for Clinical Practice and Future Research
Our research findings indicate that community-based supportive interventions are beneficial for caregivers of dementia patients. Although this paper suggests that offline interventions may be more effective than online ones, the benefits of online interventions should not be underestimated. Therefore, when implementing community intervention measures, it is advantageous to integrate both online and offline interventions to leverage their respective strengths. Personalized interventions are recommended, tailored to users’ preferences, needs, personal circumstances, and the dementia severity. An online Q&A function is advisable on internet platforms to mitigate the lack of timely personalized feedback and guidance in online interventions. The primary aim of providing community support services to elderly family caregivers is to enhance the well-being of dementia caregivers. Consequently, future research should not only investigate the impact on family dementia caregivers but also examine its effects on various caregiver types. As dementia is a long-term condition, caregivers’ needs and psychological states evolve over time. Communities should establish long-term tracking mechanisms, consistently assess the impact of interventions on caregivers and patients, and promptly revise intervention plans to maintain long-term intervention efficacy.
Strengths and Limitations
This systematic review is notable for its focus on the impact of community interventions on family caregivers of dementia patients. The study is specifically targeted, examining Community Dementia Care Interventions (CDCI) and their effects on community support programs for these caregivers. The research question is clear and possesses substantial real-world relevance, addressing a crucial aspect of community intervention and family caregiving. Additionally, only studies with robust research designs were included, such as RCTs, quasi-experimental designs, and non-randomized control trials. Statistical methods, including analysis of covariance (ANCOVA), were employed to compare scores between the intervention and control groups in areas such as caregiving burden, depression, and attitudes towards dementia, offering a thorough assessment of the intervention’s effectiveness. The research process and data analysis methods are scientifically robust and logical, ensuring the production of high-quality evidence. However, the study does exhibit limitations. Firstly, since community interventions are not a uniform type of intervention, variations across different communities, based on available resources and population size, and the use of diverse measurement scales complicate the determination of the most effective intervention for family caregivers. Secondly, research on specific outcomes, like anxiety, is scarce, and no additional subgroup analyses were performed. Therefore, expanded research is essential to bolster the reliability of the conclusions.
CONCLUSIONS
This study, through a meta-analysis of 23 RCTs, established that: (1) Community interventions positively influence the burden, depression, and anxiety of family caregivers, significantly reducing caregiving stress (SMD =-0.3; 95% CI -0.39 to -0.21; p < .001), depressive symptoms (SMD = -0.6, 95% CI -0.75 to -0.47; p < .001), and anxiety (SMD = -0.32, CI -0.5 to -0.14; p < .001). (2) Community interventions have been effective, whether conducted online or offline, with evidence suggesting offline interventions may be marginally more effective than online ones. Future research could explore integrating online and offline community interventions. (3) Some studies show that post-intervention, caregivers’ psychological health- related quality of life improves, while physical health- related quality of life shows an upward trend or does not achieve significant levels, with outcomes varying across studies.
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