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      Tele-Health Intervention for Carers of Dementia Patients—A Systematic Review and Meta-Analysis of Randomized Controlled Trials


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          Objective: The purpose of this study is to evaluate the major mental health outcomes on dementia patient carers when using psychoeducational programs and psychotherapeutic interventions.

          Methods: A meta-analysis was performed with randomized controlled trials of carers' tele-health interventions from the literature inception to December 31, 2019, using PubMed, EMBASE, and CENTRAL databases for articles.

          Results: The meta-analysis identified 1,043 results, of which 11 were randomized control trials. Among all 11 randomized control trials, only one study addressed face-to-face contact with online modules of interventions, four studies addressed telephone-based interventions, two studies reported on combined face-to-face contact and phone call interventions, two studies focused on web-based interventions, one study used video and telephone interventions, and one study conducted a computer-telephone integration system of intervention. The updated evidence suggested that there was more efficacy via tele-health interventions in lowering depression for carers of people with dementia. We outlined the delivery formation of intervention to evaluate the effectiveness and processes of major mental health improvements, including depression, burden, anxiety, and quality of life.

          Conclusions: In this study, tele-health intervention was shown to significantly lower depression and also lower the risk of mental health impairment. Although there was a significant decrease of depression, there were no significant differences in burden, anxiety, and quality of life. Future researchers are encouraged to carry out larger-scale studies; also, further analysis using a standardized assessment tool is suggested for future multi-component tele-health interventions.

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          Most cited references44

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          The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

          Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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            Dementia and cognitive impairment: epidemiology, diagnosis, and treatment.

            Symptoms of memory loss are caused by a range of cognitive abilities or a general cognitive decline, and not just memory. Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. They can then diagnose the causal subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. Treatments are still mostly symptomatic. Copyright © 2014 Elsevier Inc. All rights reserved.
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              Internet-Based Interventions Aimed at Supporting Family Caregivers of People With Dementia: Systematic Review

              Background Caring for someone with dementia is one of the most challenging caring roles. The need for support for family caregivers has been recognized for some time but is often still lacking. With an aging population, demand on health and social care services is growing, and the population is increasingly looking to the internet for information and support. Objective In this review, we aimed to (1) identify the key components of existing internet-based interventions designed to support family caregivers of people with dementia, (2) develop an understanding of which components are most valued by caregivers, and (3) consider the evidence of effectiveness of internet-based interventions designed to support family caregivers of people with dementia. Methods We conducted a systematic search of online databases in April 2018. We searched reference lists and tracked citations. All study designs were included. We adopted a narrative synthesis approach with thematic analysis and tabulation as tools. Results We identified 2325 studies, of which we included 40. The interventions varied in the number and types of components, duration and dose, and outcomes used to measure effectiveness. The interventions focused on (1) contact with health or social care providers, (2) peer interaction, (3) provision of information, (4) decision support, and (5) psychological support. The overall quality of the studies was low, making interpretation and generalizability of the effectiveness findings difficult. However, most studies suggested that interventions may be beneficial to family caregiver well-being, including positive impacts on depression, anxiety, and burden. Particular benefit came from psychological support provided online, where several small randomized controlled trials suggested improvements in caregiver mental health. Provision of information online was most beneficial when tailored specifically for the individual and used as part of a multicomponent intervention. Peer support provided in online groups was appreciated by most participants and showed positive effects on stress. Finally, online contact with a professional was appreciated by caregivers, who valued easy access to personalized practical advice and emotional support, leading to a reduction in burden and strain. Conclusions Although mixed, the results indicate a positive response for the use of internet-based interventions by caregivers. More high-quality studies are required to identify the effectiveness of internet interventions aimed at supporting family caregivers, with particular focus on meeting the needs of caregivers during the different stages of dementia.

                Author and article information

                Front Aging Neurosci
                Front Aging Neurosci
                Front. Aging Neurosci.
                Frontiers in Aging Neuroscience
                Frontiers Media S.A.
                10 February 2021
                : 13
                [1] 1College of Nursing and Health Management, Shanghai University of Medicine and Health Sciences , Shanghai, China
                [2] 2Department of Nursing, Huadong Hospital Affiliated to Fudan University , Shanghai, China
                Author notes

                Edited by: Jiehui Jiang, Shanghai University, China

                Reviewed by: Po-Chun Hsieh, Taipei Tzu Chi Hospital, Taiwan; Can Sheng, Capital Medical University, China

                *Correspondence: Shu-Fen Chu zhusf@ 123456sumhs.edu.cn
                Copyright © 2021 Zhu, Cao, Zhou, Xie, Cheng and Chu.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 44, Pages: 10, Words: 6052
                Systematic Review

                tele-health,intervention,carers,dementia,systematic review,meta-analysis
                tele-health, intervention, carers, dementia, systematic review, meta-analysis


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