AIMS Medical Science, 2016, 3(1): 15-31. doi: 10.3934/medsci.2016.1.15 Research article Special Issues

Export file:

Format

RIS(for EndNote,Reference Manager,ProCite)
BibTex
Text

Content

Citation Only
Citation and Abstract

Impact of an Individualized Physical Activity Intervention on Improving Mental Health Outcomes in Family Caregivers of Persons with Dementia: A Randomized Controlled Trial

Carol J. Farran, Olimpia Paun, Fawn Cothran, Caryn D. Etkin, Kumar B. Rajan, Amy Eisenstein, and Maryam Navaie

1 Rush University Medical Center, College of Nursing, Chicago, IL, USA;
2 American Joint Replacement Registry, Rosemont, IL, USA;
3 Rush University Medical Center, Department of Internal Medicine, Chicago, IL USA;
4 CJE Senior Life, Chicago, IL, USA;
5 Meridian Health, Office of Research Services, Neptune, NJ, USA

Received: , Accepted: , Published:

Special Issues: Activity and Lifestyle factors in the elderly: Its relationship with Degenerative diseases and Depression

Abstract Full Text(HTML) Figure/Table Related pages

Purpose: This study examined secondary benefits of an individualized physical activity intervention on improving dementia family caregivers’ subjective burden, depressive symptoms and positive affect. Design and Methods: A community-based randomized controlled trial (RCT) was implemented with family caregivers of persons with dementia (N = 211) who received the Enhanced Physical Activity Intervention (EPAI: treatment intervention, n = 106) or the Caregiver Skill Building Intervention (CSBI: control intervention, n = 105). Interventions were delivered over 12 months, including a baseline home visit and regularly spaced telephone calls. Data were collected in person at baseline, 6 and 12-months; and telephonically at 3 and 9-months. The EPAI integrated physical activity and caregiving content while the CSBI focused only on caregiving content. Descriptive, bivariate and intention-to-treat analyses using generalized estimating equations (GEE) were performed to examine secondary benefits of the EPAI on family caregiver burden, depressive symptoms and positive affect. Results: Compared to caregivers in the CSBI group, caregivers in the EPAI significantly increased their overall and total moderate physical activity and showed a positive interaction between the intervention and time for positive affect at both six (p = 0.01) and 12-months (p = 0.03). The EPAI was significantly associated with improving burden at 3 months (p = 0.03) but had no significant effect on depressive symptoms. Implications: Caregiver involvement in an individualized physical activity intervention was associated with increased overall and total moderate physical activity and improved positive affect from baseline to 12 months. Improved positive affect may help caregivers to feel better about themselves and their situation, and better enable them to continue providing care for their family member for a longer time at lower risk to their own mental health.

Figure/Table

Supplementary

Article Metrics

References

1. Alzheimer's Association (2015) 2015 Alzheimer's disease facts and figures. Alzheimer’s Dement 11: 332-384.

2. Gitlin L, Marx K, Stanley I, et al. (2015) Translating evidence-based dementia caregiving interventions into practice: State-of-the-science and next steps. Gerontologist 55: 210-226.

3. Vernooij-Dassen J, Draskovic I, McCleery J, et al. (2011) Cognitive reframing for carers of people with dementia (Review). The Cochrane Collaboration, The Cochrane Library, 11, Available from: http://www.thecochranelibrary.com.

4. Sörensen S, Pinquart M, Duberstein P (2002) How effective are interventions with caregivers? An updated meta-analysis. Gerontologist 42: 356-372.

5. Schulz R, O’Brien A, Czaja S, et al. (2002) Dementia caregiver intervention research: In search of clinical significance. Gerontologist 42: 589-602.

6. Kim H, Chang M, Rose K, et al. (2012) Predictors of caregiver burden in caregivers of individuals with dementia.J Adv Nurs68: 846-855.

7. Adelman R, Tmanova L, Delgado D, et al. (2014) Caregiver burden: A clinical review.JAMA 311: 1052-1059.

8. Orgeta V, Sterzo E (2013) Sense of coherence, burden, and affective symptoms in family carers of people with dementia.Int Psychogeriatr 25: 973-980.

9. Varela G, Varona L, Anderson K, et al. (2011) Alzheimer's care at home: A focus on caregivers strain. [L'impegno dei caregivers nell'assistenza a casa ai pazienti con malati di Alzheimer.] Prof Inferm 64: 113-117.

10.Han J, Jeong H, Park J, et al. (2014) Effects of social supports on burden in caregivers of people with dementia.Int Psychogeriatr26: 1639-1648.

11.Rodakowski J, Skidmore E, Rogers J, et al. (2012) Role of social support in predicting caregiver burden.Arch Phys Med Rehabil93: 2229-2236.

12.Van der Lee J, Bakker T, Duivenvoorden H, et al. (2014) Multivariate models of subjective caregiver burden in dementia: A systematic review.Ageing Res Rev15: 76-93.

13.Ornstein K, Gaugler J (2012) The problem with "problem behaviors": A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad.Int Psychogeriatr 24: 1536-1552.

14.Givens J, Mezzacappa C, Heeren T, et al. (2014) Depressive symptoms among dementia caregivers: Role of mediating factors.Am J Geriatr Psychiatry22: 481-488.

15.Schulz R, Sherwood P (2008) Physical and mental health effects of family caregiving. Am J Nurs 108: 23-27.

16.Sörensen S, Pinquart M, Duberstein P (2002) How effective are interventions with caregivers? Gerontologist 42: 356-372.

17.Livingston G, Barber J, Rapaport P, et al. (2014) START (STrAtegies for RelaTives) study: A pragmatic randomized controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of careers of people with dementia. Hlth Tech Asst 18: 61.

18.Thompson C, Spilsbury K, Hill J, et al. (2007) Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatr 7:1-12.

19.de Labra C, Millán J, Buján A, et al. (2015) Predictors of caregiving satisfaction in informal caregivers of people with dementia. Arch Geront Geriat 60: 380-388.

20.Mittelman M, Haley W, Clay O, et al. (2006) Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurol 67: 1592-1599.

21.Roth D, Dilworth-Anderson P, Huang J, et al. (2015) Positive aspects of family caregiving for dementia: Differential item functioning by race. J Gerontol: PSS 1-7.

22.Fredman L, Gordon S, Heeren T, et al. (2013) Positive affect is associated with fewer sleep problems in older caregivers but not noncaregivers. Gerontologist 54: 559-569.

23.Lawton M, Kleban M, Moss M, et al. (1989) Measuring caregiving appraisal. J Gerontol 44: P61-71.

24.Bandura A (2002) Self-efficacy: The exercise of control. New York: WH Freeman.

25.Roth D, Fredman L, Haley W (2015) Informal caregiving and its impact on health: A reappraisal from population-based studies. Gerontologist 55: 309-319.

26.Zarit S, Kim K, Femia E, et al. (2013) The effects of adult day services on family caregivers’ daily stress, affect, and health: Outcomes from the daily stress and health (DaSH) Study. Gerontologist 54: 570-579.

27.Physical Activity Guidelines Advisory Committee (2008) Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S. Department of Health and Human Services.

28.Pinquart M, Sörensen S (2007) Correlates of physical health of informal caregivers: A meta-analysis. Gerontol B Psychol Sci Soc Sci 62: P126-137.

29.Connell C, Janevic M (2009) Effects of a telephone-based exercise intervention for dementia caregiving wives: A randomized controlled trial. J App Gerontol 28: 171-194.

30.King A, Baumann K, O'Sullivan P, et al. (2002) Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: A randomized controlled trial. J Gerontol A Biol Sci Med Sci 57: M26-36.

31.Castro C, Wilcox S, O'Sullivan P, et al. (2002) An exercise program for women who are caring for relatives with dementia. Psychosom Med 64: 458-468.

32.Orgeta V, Miranda-Castillo C (2014) Does physical activity reduce burden in carers of people with dementia? A literature review. Int J Geriatr Psychiatry 29: 771-783.

33.McAuley E, Elavsky S, Jerome G, et al. (2005) Physical activity-related well-being in older adults: Social cognitive influences. Psychol Aging 20: 295-302.

34.Elavsky S, McAuley E, Motl R, et al. (2005) Physical activity enhances long-term quality of life in older adults: Efficacy, esteem, and affective influences. Ann Behav Med 30:138-145.

35.Farran C, Staffileno B, Gilley D, et al. (2008) A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease. Am J Alzheimers Dis Other Demen 23: 132-142.

36.National Institutes of Health, Office of Behavioral and Social Sciences Research, Randomized Clinical Trials Involving Behavioral Interventions (2015, November 15) https://obssr.od.nih.gov/training_and_education/annual_Randomzied_Clinical_Trials_course/RCT_info.aspx

37.Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: The caregiver health effects study. JAMA 282: 2215-2219

38.Farran C, Gilley D, McCann J, et al. (2004) Psychosocial interventions to reduce depressive symptoms of dementia caregivers: A randomized clinical trial comparing two approaches. J Ment Health Aging 10: 337-350.

39.Cornoni-Huntley J, Brock D, Ostfeld A, et al. (1986) Established populations for epidemiologic studies of the elderly resource data book. (Rep. No. NIH Pub No. 86-2443). Washington, DC: U.S. Department of Health and Human Services.

40.Folstein M, Folstein S, McHugh P (1975) Mini-mental state: A practical method for grading the mental state of patients for the clinician. J Psychiatr Res 12: 188-189.

41.Stewart A, Mills K, King A, et al. (2001) CHAMPS physical activity questionnaire for older adults: Outcomes for interventions. Med Sci Sports and Exerc 33: 1126-1141.

42.Kohout F, Berkman L, Evans D, et al. (1993) Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health 5: 179-193.

43.Watson D, Clark L, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: The PANAS scales. J Pers Soc Psychol 54: 1063-1070.

44.SAS 9.3, SAS Institute, Cary, North Carolina.

45.Orgeta V, Miranda-Castillo C (2014) Does physical activity reduce burden in carers of people with dementia? A literature review. Int J Geriatr Psychiatry 29: 771-783.

46.Stromeyer E, Ward R (2012) Target populations, recruitment, retention, and optimal testing methods: Methodological issues for studies in the epidemiology of aging, In: Newman AB, Cauley JA (Eds), The Epidemiology of Aging, Springer, 49-68.

47.Samelson E, Kelsey J, Kiel D, et al. (2008) Issues in conducting epidemiologic research among elders: Lessons from the MOBILIZE Boston study. Am J Epidem 168: 1444-1451.

48.Hill K, Smith R, Fearn M, et al. (2007) Physical and psychological outcomes of a supported physical activity program for older carers. J Aging Phys Act 15: 257-271.

49.Hirano A, Suzuki Y, Kuzuya M, et al. (2011) Influence of regular exercise on subjective sense of burden and physical symptoms in community-dwelling caregivers of dementia patients: A randomized controlled trial. Arch Gerontol Geriatr 53: e158-163.

50.Dahlrup B, Nordell E, Carlsson KS, et al. (2014) Health economic analysis on a psychosocial intervention for family caregivers of persons with dementia. Dement Geriatr Cogn Disord 37: 181-195.

51.Forster A, Dickerson J, Young J, et al. (2013) A structured training programme for caregivers of inpatients after stroke (TRACS): A cluster randomised controlled trial and cost-effectiveness analysis. The Lancet 382: 2069-2076.

Copyright Info: © 2016, Carol J. Farran, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Article outline

Show full outline