Equipping Family Caregivers with the Tools to Conduct Depression Interventions at Home: Feasibility and Efficacy of Caregiver-Provided Life Review Sessions

Background and Purpose. Approximately 5-10% of community-dwelling older Americans (≥65 years) live with depression and more than 6.5 million of them live with Alzheimer’s dementia. To alleviate these conditions, we developed a novel six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for people living with dementia (PWD) and their family caregivers (CGs) as an in-person activity in 2018, and in 2020, adapted it to a virtual program due to the COVID-19 pandemic. C-PLR trains CGs virtually and teaches them how to conduct life review (LR) sessions in their homes without traveling to a therapist’s office or incurring additional costs. The training includes the theoretical background of LR therapy, interviewing techniques, probing skills, and ways to handle emotionally sensitive discussions. The objective of this study was to examine the feasibility of training family caregivers and the effect of C-PLR on PWD.

Methods. Eligible CGs were family members who cared for their care recipients (CRs) for ≥8 hours/week and completed virtual CG training (2-6 hours) and six weekly LR sessions. CRs were community-dwelling or long-term care facility (LTCF) residents with mild depressive symptoms (≥5 on Geriatric Depression Scale) and mild cognitive impairment (≥13 on Telephone-Montreal Cognitive Assessment). We collected sociodemographic data and pre- & post-measures on CRs’ depression (primary outcome), satisfaction with life, CGs’ burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared the results using paired t-tests. We compared sub-groups of CRs to evaluate whether the intervention effect differed by race/ethnicity, residential setting, or living alone.

Results. Out of 27 registered CG-CR dyads, 25 dyads completed the study. CGs were on average 52 years old, working (64%), college-educated (72%), female (88%), and in good-excellent health (72%). Most cared for their parent (80%). CRs’ mean age was 81 years old, and most were female (84%) and in poor-fair health (56%). Most CRs (68%) were community-dwelling while 32% were LTCF residents. Half of the CRs (48%) lived alone. CRs’ depression score significantly reduced from 4.2 at baseline to 2.4 at follow-up (p<0.001). This intervention effect was present among CRs who were non-Hispanic Asian (p=0.017), non-Hispanic White (p=0.040), community-dwelling (p<0.001), living alone (p=0.045), or living with others (p=0.002). No significant change in depression was found among CRs who were non-Hispanic Black (p=0.099) or living in an LTCF (p=0.15). There were no significant changes in any secondary outcomes.

Conclusions and Implications. Despite a small sample, we found a significant impact of C-PLR on depressive symptoms among PWD. We adapted the intervention training iteratively based on input from CGs and ended with the 2-hour training session. This study demonstrates that the C-PLR intervention can be successfully taught to CGs and appeared to be effective in reducing CR depressive symptoms without increasing CG burden. CGs showed high levels of fidelity and ability to implement the intervention, with implications that C-PLR could be implemented more broadly to improve symptoms among PWD in both community and residential settings, as well as among a diverse population of PWD.