Caregiver-Provided Life Review: Increasing Access to Mental Health Care By Training Family Caregivers

Background and Purpose: Eleven percent of community-dwelling older adults (≥65 years) suffer from depression annually and 5.5 million older adults also live with Alzheimer’s disease in the U.S. To alleviate the impacts of these diseases, we developed an innovative six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for persons living with dementia (PWD) and their family caregivers in 2018. We pilot-tested with 19 caregiver (CG)-care recipient (CR) dyads and attained promising results. Encouraged by the outcomes, we expanded the sample and included long-term care facility (LTCF) residents because the prevalence of depression is higher in LTCFs (15%) and examined the effect of C-PLR since 2020.

Methods: The original C-PLR model involved in-person activities. Due to the COVID-19 pandemic, however, we adapted all modules to virtual and started sample dyads recruitment. The eligible CGs were family members who cared for their CRs for >8 hours/week and committed to a three-hour zoom training and six Life Review (LR) sessions. CRs’ eligibility included being community-dwellers or LTCF residents with mild depression and dementia. We collected dyads’ sociodemographic data and pre- and post-measures on CRs’ depression, life satisfaction and CG burden, positive aspects of caregiving, and dyad’s relationship quality.

Results: From August 2020 to March 2022, we contacted 196 LTCFs, 29 senior/community centers, 32 faith organizations, 97 clinical trial inquiries, and 385 community-dwellers by phone and emails, and recruited 21 dyads across the nation. Seventeen dyads completed the study and four dyads are currently undergoing it. The dyads were comprised of 5 LTCF residents (24%) and 16 (76%) community-dwellers. CGs were on average 50 years old, single (52%), working (71%), college-educated (95%), female (90%), and in good/excellent health (76%). CRs’ mean age was 82 years old, widowed (43%), female (81%) and in fair health (52%). After six LR sessions, CRs’ depression scores significantly improved (p=0.003) while their life satisfaction level remained the same (p=0.203). CGs’ burden scores worsened (p=0.002), however, their positive aspects of caregiving scores significantly improved (p=0.005). The change in the CG-CR relationship quality was insignificant (p=0.067).

Conclusion and Implications: The COVID-19 brought numerous recruitment challenges, especially among LTCFs: the facility closures, staff turnover, and technological disparities (i.e., shortages of cell phones and computers) made outreach extremely difficult resulting in the low number of LTCF dyads. Despite a small sample, the LR activities benefitted CRs by lowering their depression levels and providing them the opportunity to connect with their family regularly. On the contrary, CGs experienced more burden which may be due to COVID-19-related stressors and the additional caregiving responsibility that comes with conducting LR activities. By leveraging the schedule flexibility that C-PLR offers, we can encourage the dyads to conduct their LRs at their own pace so that CGs do not feel burdened. The C-PLR was developed to improve the health and depressive symptoms of vulnerable PWD and their caregivers. Thus, we need to consider the dyads’ physical and mental capacity to benefit both CRs and CGs.