Life Review Intervention Delivered By Caregivers of People Living with Dementia Improves Depression: A Mixed-Methods Study

Background: Depression rose from 6% to 23% in older Americans between the pre- and post-COVID-19 pandemic. Furthermore, 40% of them experience both depression and dementia as depression and dementia are the two most common neuropsychiatric disorders in older adults. Pharmacological depression interventions such as antidepressants often cause side effects and seeing a therapist is costly, stigmatizing, subject to therapists’ availability, and requires travel. Life review therapy, wherein participants discuss their lives in chronological order with a therapist, is a non-pharmacological evidence-based depression intervention for older adults. To alleviate these barriers, based on life review therapy, we developed an innovative depression intervention, Caregiver-Provided Life Review (C-PLR) for people with depression and dementia (PwDD) and their family caregivers. We trained caregivers in life review interview skills and caregivers conducted life reviews with their PwDD at home during the pandemic (2020-2023). This study reports the intervention results, along with their implications.

Methods: This six-week intervention used a mixed-methods design with a sample of 45 caregiver-PwDD dyads (N=90). Eligible PwDD were 65+ years old and lived with mild depressive symptoms (≥5 Geriatric Depression Scale) and early-stage dementia (≥13 Telephone-Montreal Cognitive Assessment). Caregivers were PwDD’s family members (≥18 years), cared for PwDD for ≥8 hours/week for ≥1 year, had no depression of their own, and no severe caregiver burden. We measured pre- and post-intervention levels of PwDD’s depression (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 caregivers’ training feasibility through weekly fidelity check-in scores for adherence to C-PLR training protocol and concluded with their interviews.

Results: PwDD were on average 81 years old (age range 67-99), widowed, retired, female, and in poor/fair health while caregivers were 58 years old (age range 25-81), married, college-educated, working, female, and in good/excellent health. PwDD’s depression scores (p<0.001), caregivers’ caregiving rewards (p=0.029), and relationship quality (p=0.041) significantly improved without increasing caregiver burden (p=0.519). Caregivers’ post-intervention interviews supported the quantitative results expressing the joy and excitement that both PwDD and caregivers experienced. All caregivers achieved high fidelity scores (15.9 out of 16) showing excellent adherence to C-PLR protocol and confirming the feasibility of virtual training and confidence in conducting the life reviews.

Conclusions: All 45 dyads completed the study as scheduled. Training family caregivers to conduct life reviews may be an acceptable and cost-effective way to improve depressive symptoms among PwDD while improving the caregiving experience. The online virtual training was convenient for caregivers because they could watch the video after taking care of their PwDD or when their caregiving duties ended for the day. Both caregivers and PwDD enjoyed C-PLR’s flexibility because they could set their own meeting times without the hassles of travel and incurring therapy costs. C-PLR appears to offer an easy and convenient depression intervention through its delivery method, while addressing barriers to existing interventions including delivery setting, delivery schedule, and delivery cost. C-PLR has the potential to reach a wider range of caregivers and PwDD than traditional clinical interventions.