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Effectiveness of START psychological intervention in reducing abuse by dementia family carers: randomized controlled trial

Published online by Cambridge University Press:  11 December 2015

Claudia Cooper*
Affiliation:
Division of Psychiatry, University College London, London, UK
Julie Barber
Affiliation:
Statistical Science UCL & PRIMENT clinical trials unit, UCL, London, UK
Mark Griffin
Affiliation:
Research Department of Primary Care and Population Health, UCL, London, UK
Penny Rapaport
Affiliation:
Division of Psychiatry, University College London, London, UK
Gill Livingston
Affiliation:
Division of Psychiatry, University College London, London, UK
*
Correspondence should be addressed to: Dr Claudia Cooper, Division of Psychiatry, University College London, Floor 6 Maple House, 149 Tottenham court Rd, London W1T 7NF, UK. Phone: 020 7679 9248. Email: [email protected].

Abstract

Background:

Family carers of people with dementia frequently report acting abusively toward them and carer psychological morbidity predicts this. We investigated whether START (STrAtegies for RelaTives), a psychological intervention which reduces depression and anxiety in family carers also reduces abusive behavior in carers of people living in their own homes. We also explored the longitudinal course of carer abusive behavior over two year.

Methods:

We included self-identified family carers who gave support at least weekly to people with dementia referred in the previous year to three UK mental health services and a neurological dementia service. We randomly assigned these carers to START, an eight-session, manual-based coping intervention, or treatment as usual (TAU). Carer abusive behavior (Modified Conflict Tactic Scale (MCTS) score ≥2 representing significant abuse) was assessed at baseline, 4, 8, 12, and 24 months.

Results:

We recruited 260 carers, 173 to START and 87 to TAU. There was no evidence that abusive behavior levels differed between randomization groups or changed over time. A quarter of carers still reported significant abuse after two years, but those not acting abusively at baseline did not become abusive.

Conclusion:

There was no evidence that START, which reduced carer anxiety and depression, reduced carer abusive behavior. For ethical reasons, we frequently intervened to manage concerning abuse reported in both groups, which may have disguised an intervention effect. Future dementia research should include elder abuse as an outcome, and consider carefully how to manage detected abuse.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Beach, S. R., Schulz, R., Williamson, G. M., Miller, L. S., Weiner, M. F. and Lance, C. E. (2005). Risk factors for potentially harmful informal caregiver behavior. Journal of the American Geriatrics Society, 53, 255261.Google Scholar
Cooper, C., Blanchard, M., Selwood, A., Walker, Z. and Livingston, G. (2010a). Family carers’ distress and abusive behaviour: longitudinal study. British Journal of Psychiatry, 196, 480485.Google Scholar
Cooper, C., Manela, M., Katona, C. and Livingston, G. (2008a). Screening for elder abuse in dementia in the LASER-AD study: prevalence, correlates and validation of instruments. International Journal of Geriatric Psychiatry, 23, 283288.Google Scholar
Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R. and Livingston, G. (2009). Abuse of people with dementia by family carers: representative cross sectional survey. British Medical Journal, 338, b155.CrossRefGoogle ScholarPubMed
Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R. and Livingston, G. (2010b). The determinants of family carers’ abusive behaviour to people with dementia: results of the CARD study. Journal of Affective Disorders, 121, 136142.CrossRefGoogle ScholarPubMed
Cooper, C., Selwood, A. and Livingston, G. (2008b). The prevalence of elder abuse and neglect: a systematic review. Age and Ageing, 37, 151160.CrossRefGoogle ScholarPubMed
Dong, X. and Simon, M. A. (2013). Elder abuse as a risk factor for hospitalization in older persons. Journal of the American Medical Association Internal Medicine, 173, 911917.Google ScholarPubMed
Dong, X. Q., Chen, R. J., Chang, E. S. and Simon, M. (2013). Elder abuse and psychological well-being: a systematic review and implications for research and policy - a mini review. Gerontology, 59, 132142.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D. et al. (2002). Coping with Caregiving: Reducing Stress and Improving Your Quality of Life. Stanford University School of Medicine and VA Palo Alto Healthcare System.Google Scholar
House of Commons Health Committee (2004). Elder Abuse. London: The Stationery Office Limited.Google Scholar
Hsieh, H. F., Wang, J. J., Yen, M. and Liu, T. T. (2009). Educational support group in changing caregivers’ psychological elder abuse behavior toward caring for institutionalized elders. Advances in Health Sciences Education: Theory and Practice, 14, 377386.CrossRefGoogle ScholarPubMed
Knapp, M. et al. (2013). Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. British Medical Journal, 347, f6342.Google Scholar
Livingston, G., Barber, J., Rapaport, P., Knapp, M. and Griffin, M. (2014a). START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Health Technology Assessment, 18, 1242.Google Scholar
Livingston, G. et al. (2013). Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial. British Medical Journal, 347, f6276.Google Scholar
Livingston, G. et al. (2014b). Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. Lancet Psychiatry, 1, 539548.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence and Social Care Institute for Excellence (NICE/SCIE) (2006). Dementia: Supporting People with Dementia and Their Carers in Health and Social Care. London: National Institute for Health and Clinical Excellence.Google Scholar
Ploeg, J., Hutchinson, B., MacMillan, H. and Bolan, G. (2009). A systematic review of interventions for elder abuse. Journal of Elder Abuse and Neglect, 21, 187210.Google Scholar
Rush Smith, G., Williamson, G., Miller, S. and Schulz, R. (2005). Depression and quality of informal care: a longitudinal investigation of caregiving stressors. Psychology and Aging, 26, 584591.CrossRefGoogle Scholar
Smith, G. R., Williamson, G. M., Miller, L. S. and Schulz, R. (2011). Depression and quality of informal care: a longitudinal investigation of caregiving stressors. Psychology and Aging, 26, 584591.Google Scholar