Effectiveness of Interventions to Support Carers of People With Dementia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-02-27 DOI:10.1002/gps.70054

Frank Chen, Zhiwei Hu, Quan Li, Xuan Zheng, Meizhi Li, Maximilian Salcher-Konrad, Adelina Comas-Herrera, Martin Knapp, Cheng Shi, The STRiDE consortium

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引用次数: 0

Abstract

Objectives

Family and other carers of people with dementia can potentially benefit from training and support to reduce the negative impacts of caregiving and prevent harm to care recipients. While interventions for carers in low- and middle-income countries (LMICs) are emerging, their effectiveness is not well understood. Through a systematic review and meta-analysis, the objective was to evaluate the effectiveness of interventions to support carers of people with dementia in improving the well-being of carers and their care recipients in LMICs.

Methods

This review, registered with PROSPERO (CRD42018106206), built on a systematic mapping of dementia interventions in LMICs under the Strengthening Responses to Dementia (STRiDE) project. It analysed evidence on interventions to support carers in these regions. Title and abstract screening, full-text review, data extraction and risk of bias assessment were each conducted by two reviewers independently, with disagreements resolved through group discussion. Pairwise meta-analyses were conducted, with robustness tested via leave-one-out analysis. Heterogeneity was explored using subgroup analysis, meta-regression and MetaForest. Medline, Embase, Global Health and PsycINFO (via Ovid) and CINAHL (via EBSCO) databases were searched. We included randomised control trials focused on carer well-being in LMICs, 2008–2022. Primary outcomes were perceived burden and depression; other health-related quantitative outcomes were collected.

Results

From 5228 records, 48 studies in English and Chinese were identified as eligible, reporting on 67 carer outcomes and 36 care recipient outcomes. Forty-one studies were at high risk of bias. Meta-analysis revealed statistically significant medium-to-large intervention effects on three key carer outcomes—perceived burden, depression, and anxiety—and on four major outcomes for people with dementia—neuropsychiatric symptoms, cognitive function, quality of life (QoL), and activities of daily living (ADL). These effects were larger than those typically observed in previous studies in high-income countries (HICs).

Conclusions

This review provides a comparative overview and summarises the characteristics of published interventions to support carers in LMICs. It reveals medium-to-large beneficial effects of the interventions on several key outcomes for carers and care recipients in LMICs. Future research employing more rigorous methodologies is recommended, particularly for broader and more diverse populations.

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支持中低收入国家痴呆症患者照护者的干预措施的有效性：一项系统回顾和荟萃分析

痴呆症患者的家庭和其他照护者可能受益于培训和支持，以减少照护的负面影响，防止对照护者造成伤害。虽然针对低收入和中等收入国家护理人员的干预措施正在出现，但其有效性尚未得到很好的了解。通过系统回顾和荟萃分析，目的是评估干预措施的有效性，以支持痴呆症患者的护理人员改善中低收入国家护理人员及其护理对象的福祉。方法本综述在普洛斯彼罗注册（CRD42018106206），建立在加强痴呆症应对（STRiDE）项目下低收入国家痴呆症干预措施的系统映射基础上。它分析了支持这些地区护理人员的干预措施的证据。标题和摘要筛选、全文审查、数据提取和偏倚风险评估均由两位审稿人独立完成，分歧通过小组讨论解决。进行两两荟萃分析，通过留一分析检验稳健性。采用亚组分析、meta回归和MetaForest分析异质性。检索Medline、Embase、Global Health和PsycINFO（通过Ovid）和CINAHL（通过EBSCO）数据库。我们纳入了2008-2022年关注中低收入国家护理人员幸福感的随机对照试验。主要结局为感知负担和抑郁；收集了其他与健康相关的定量结果。从5228份记录中，48份中英文研究被确定为合格，报告了67个护理者结果和36个护理接受者结果。41项研究存在高偏倚风险。荟萃分析显示，统计上显著的中大型干预对三个关键护理结果（感知负担、抑郁和焦虑）和痴呆患者的四个主要结果（神经精神症状、认知功能、生活质量（QoL）和日常生活活动（ADL））有显著的影响。这些影响比以往在高收入国家（HICs）的研究中通常观察到的影响更大。本综述提供了一个比较的概述，并总结了已发表的支持中低收入国家照护者的干预措施的特点。它揭示了干预措施对中低收入国家护理人员和护理接受者的几个关键结果的中等到较大的有益影响。建议今后的研究采用更严格的方法，特别是针对更广泛和更多样化的人群。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.