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Mechanisms to Reduce the Burden on Dementia Caregivers

30 Pages Posted: 8 Oct 2019

See all articles by Hopin Lee

Hopin Lee

Centre for Pain, Health and Lifestyle; University of Oxford - Rheumatology and Musculoskeletal Sciences

Dipesh Mistry

University of Warwick - Warwick Medical School

Toby Smith

University of Oxford

Susanne Finnegan

University of Warwick - Warwick Medical School

Bethany Fordham

University of Oxford

Bart Sheehan

Warwickshire Partnership Trust

Sarah E Lamb

University of Oxford - Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)

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Abstract

Background: Caregiving for people with dementia is highly demanding. It is unclear which patient factors should be targeted to relieve caregiver burden. We aimed to identify potential mechanisms that could alleviate caregiver burden.

Methods: We conducted a causal mediation analysis of the Dementia And Physical Activity (DAPA) randomised controlled trial. DAPA was a pragmatic, investigator masked, randomised controlled trial conducted in 15 regions across England. DAPA recruited a sample of 494 people with mild to moderate dementia (DSM-IV) and their caregivers and compared a moderate to high intensity exercise programme (n=329) versus usual care (n=165). We estimated mediating effects of the intervention on caregiver burden at 12 months through the following mediators measured at six months, participants' social quality of life (Quality of Life in Alzheimer's Disease scale), physical function (Bristol Activities of Daily Living scale), behavioural symptoms (Neuropsychiatric Inventory), and cognitive function (Alzheimer disease assessment scale cognitive subscale).

Findings: The exercise programme had no effect on behavioural, cognitive, physical and social mediators. All mediators were significantly associated with less caregiver burden. Physical function had the strongest association with carer burden (0.20, 95%CI = 0.11 to 0.30), followed by behavioural symptoms (0.19, CI = 0.08 to 0.30).

Interpretation: Interventions that can improve physical function and reduce behavioural symptoms of people with dementia can reduce caregiver burden.

Funding Statement: National Institute of Health Research (NIHR) Health Technology Assessment Programme, NIHR Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust, and the NIHR Oxford Musculoskeletal Biomedical Research Unit.

Declaration of Interests: All authors declare no conflicts of interests.

Ethics Approval Statement: The national ethics review committees (REC No 11/SW/0232) and research governance departments in each organisation approved the original DAPA trial.

Keywords: Dementia, Caregiver, Caregiver burden, Mechanism, Mediation analysis

Suggested Citation

Lee, Hopin and Mistry, Dipesh and Smith, Toby and Finnegan, Susanne and Fordham, Bethany and Sheehan, Bart and Lamb, Sarah E, Mechanisms to Reduce the Burden on Dementia Caregivers (09/27/2019 14:57:39). Available at SSRN: https://ssrn.com/abstract=3463316 or http://dx.doi.org/10.2139/ssrn.3463316

Hopin Lee (Contact Author)

Centre for Pain, Health and Lifestyle

New Lambton Heights, NSW
Australia

University of Oxford - Rheumatology and Musculoskeletal Sciences

Oxford
United Kingdom

Dipesh Mistry

University of Warwick - Warwick Medical School ( email )

Gibbet Hill Rd.
Coventry, West Midlands CV4 8UW
United Kingdom

Toby Smith

University of Oxford ( email )

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Susanne Finnegan

University of Warwick - Warwick Medical School ( email )

Gibbet Hill Rd.
Coventry, West Midlands CV4 8UW
United Kingdom

Bethany Fordham

University of Oxford ( email )

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Bart Sheehan

Warwickshire Partnership Trust ( email )

Coventry, CV6 6NY
United Kingdom

Sarah E Lamb

University of Oxford - Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) ( email )

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