Feasibility of Training Family Caregivers of People Living with Dementias Online and Delivering Life Review Depression Intervention at Home: A Mixed-Methods Study Results

Background and Purpose: Due to the high prevalence of depressive symptoms and dementia in older Americans (≥65 years), we developed a six-week depression intervention, Caregiver-Provided Life Review (C-PLR) based on an evidence-based life review therapy for care recipients with mild depressive symptoms and early-stage dementia. We trained family caregivers in life review skills via online video, evaluated the feasibility of online training, and examined the efficacy of the C-PLR intervention at home. The purpose of this study was to report the feasibility of training caregivers online, as well as the results of the primary and secondary outcomes quantitatively, and show how quantitative outcomes were supported by qualitative caregiver interviews.

Methods: A mixed-methods design was used for this study. Twenty caregiver-care recipient dyads were recruited and trained (N=20 dyads). Eligible caregivers were family members (≥18 years), who cared for their loved ones for ≥8 hours/week, completed online training, six weekly life review sessions, and five weekly fidelity check-in calls with the assigned Research Assistant. Care recipients were 65+ years old and were caregivers’ family members or close friends with mild depressive symptoms (≥5 on the Geriatric Depression Scale) and dementia (≥13 on the Telephone-Montreal Cognitive Assessment). We collected pre- and post-measures of care recipients’ depressive symptoms (primary outcome) and life satisfaction, caregivers’ caregiving burden, rewards of caregiving, and dyads’ relationship quality (secondary outcomes) and compared them using paired t-tests. We took fidelity scores to measure caregivers’ feasibility of delivering life reviews adhering to the intervention protocol. We used thematic analysis to interpret caregivers’ qualitative interviews to support quantitative outcomes.

Results: Caregivers were on average 64 years old (age range: 52-81), White (65%), married (65%), college-educated (70%), working or retired (40% each), and female (90%) in good-excellent health (100%). They assisted their spouses (45%), parents (30%), or others (25%), and lived together with their loved ones (65%). Their care recipients were 80 years old (mean) (age range: 68-99), married (45%) or widowed (40%), retired (95%), White (70%), female (50%) in poor-fair or good-excellent health (50% each). Caregivers’ average fidelity check-in score was 15.9±0.27 (out of 16), indicating excellent adherence. The C-PLR intervention significantly reduced care recipients’ depressive symptoms (4.2 at baseline to 3.0 at post-intervention, p=0.034) and increased caregivers’ rewards of caregiving (34.1 to 37.0, p=0.019). Caregivers’ interviews supported the quantitative results expressing that online-trained caregivers could deliver the intervention adhering to the C-PLR protocol.

Conclusions and Implications: We trained 20 family caregivers of people living with mild depressive symptoms and dementia the life review skills through an online video and examined the feasibility of training, as well as delivering life reviews with their loved ones at home. All dyads had positive experiences with high adherence to the C-PLR protocol. Furthermore, online-trained caregivers’ caregiving burden remained unchanged showing that the C-PLR intervention did not increase any intense caregiver burden on the caregivers’ daily tasks. This study demonstrated that the C-PLR, an innovative, cost-effective intervention with a flexible delivery schedule could make a positive impact on both caregivers’ and care recipients’ mental health.