Feasibility of Training and Efficacy of Life Review Depression Intervention Conducted By Asian and White Family Caregivers: A Mixed-Methods Comparative Study

Background and Purpose: Approximately 5% of community-dwelling older adults (≥65+ years) and 10% of older Americans living with Alzheimer’s dementias experience depression, yet behavioral interventions remain scarce. Life review therapy is an evidence-based depression intervention often used for older adults. We developed an innovative depression intervention, Caregiver-Provided Life Review (C-PLR) based on life review therapy, evaluated the feasibility of training family caregivers in life review skills, and examined the impact on care recipients’ depressive symptoms. The purposes of this study were to report the feasibility of training Asian and White family caregivers, compare the results of the primary and secondary outcomes quantitatively, and support them with qualitative interviews. We used this opportunity to focus on racial differences, using Asian dyads because Asians have not been included in many studies as a separate category due to the small size of the overall population. In addition, many Asian caregivers conducted the C-PLR in their native language despite the training being in English.

Methods: Using a mixed-methods design, Asian (n=15) and White (n=25) caregiver-care recipient dyads were trained. Eligible caregivers were family members (≥18 years), cared for people with dementia for ≥8 hours/week, completed virtual or online caregiver training, six weekly life review sessions, and five weekly fidelity check-in calls with the research team. Care recipients were 65+ years old and experienced depressive symptoms (≥5 on Geriatric Depression Scale) and were in early-stage dementia (≥13 on Telephone-Montreal Cognitive Assessment). We collected care recipients’ pre- and post-intervention depression scores (primary outcome), life satisfaction, caregivers’ caregiving burden, rewards of caregiving, and dyads’ relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated the feasibility of the caregivers’ training by fidelity check-in scores and adherence to the C-PLR training protocol.

Results: Forty dyads completed the study. Asian (mean age=52 years) and White (59 years) caregivers were working, female, and in good-excellent health. Their care recipients (mean age: Asian=82 and White=80 years) were female and in poor-fair health. Both Asian and White care recipients’ depressive symptoms and dyads’ relationship scores from baseline to post-intervention significantly improved (Asian=4.1 to 2.1, p<0.001; 12.5 to 13.4, p=0.029; White=4.0 to 3.0, p=0.034; 13.9 to 14.5, p=0.033, respectively). Asian (73%) and White (75%) caregivers’ fidelity scores were rated as good/excellent and similarly high (p=0.91). Qualitative interviews of both caregivers supported the sentiments of the quantitative results. Furthermore, 77% of Asian dyads conducted the C-PLR in their native languages (Chinese, Japanese, Tagalog, Vietnamese), however, that condition did not appear to influence any outcomes.

Conclusions and Implications: We examined the feasibility of Asian and White family caregivers delivering life reviews with their loved ones at home. The results showed a significant positive impact of the C-PLR interventions on care recipients’ depressive symptoms and dyads’ relationships quantitatively. These quantitative results were supported by qualitative interviews across racial groups, as well as languages. This study demonstrates that the C-PLR intervention can be added to a list of successful non-pharmaceutical interventions that are innovative, easily implemented, and cost-effective with flexible delivery methods and schedules.