An experimental study on the effectiveness of a mutual support group for family caregivers of a relative with dementia in mainland China
Li-Qun Wang
School of Nursing, Jilin Medical College, Jilin, PR China
Wai Tong Chien
School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, PR China
Isabella Y M Lee
Ward Manager EDU, Tuen Mun Hospital; previously Department of Medical and Gerontology, Tuen Mun Hospital, Hospital Authority Hong Kong
PP: 210 - 224
Abstract
When caring for an older relative with dementia, family members experience considerable distress and burden. Literature reviews show that supportive group interventions for these caregivers have significant positive effects on improving their distress and quality of life, but not consistent and conclusive. Limited research is found in Asian populations. This study tested the effectiveness of a 12-session bi-weekly mutual support group program for Chinese family caregivers of a relative with dementia in Hong Kong, when compared with standard family support service. An experimental study with pretest and post-test, parallel groups design was conducted. A randomized sample of 78 family caregivers, 39 in each of the experimental and control groups, from one regional dementia care center participated in the study. A protocol was specifically designed by an advanced practice nurse to guide the mutual support group process and the facilitator and peer leader training, based on evidence from the literature on family support group intervention in Western countries. The results of ANOVA tests indicated that the mutual support group participants had significantly greater improvements in distress levels and quality of life than the control group. There were only mild changes in the demands for mental health services in both groups at post-test. These findings support the effectiveness of mutual support groups to offer psychosocial support to Chinese family caregivers in dementia care beyond routine community mental health care.
Keywords
experimental study, mutual support group, family caregivers, dementia, Chinese
Article Text
In developed countries, the prevalence rates of dementia are estimated to increase from 2% in persons aged 65 to 75 years to more than 30% in those aged 85 and older (Chien 2005; Cummings et al 2002). In 2009, the prevalence rate of dementia in Guangzhou was about 4.2% overall or about 320,000 persons aged 65 years and older (All China Data Center 2010). Dementia is characterized by progressive decline in cognitive and functional abilities, as well as psychological and behavioral disturbances such as psychotic and depressive symptoms and agitated and abnormal behaviors. People with dementia are increasingly dependent upon family members to provide daily care or fully depend on them at the latest illness stage (Heru, Ryan & Iqbal 2004).
Family members often experience a heavy burden and emotional distress in caring for a relative with dementia, which may also contribute psychosocial health problems and higher risks for mortality (Brodaty, Green & Koschera 2003). The negative outcomes associated with care-giving are well documented and involve a wide variety of health concerns. They include psychological disturbances (e.g., depression and anxiety), reduced physical functioning and immunological dysfunction, poor interpersonal relationships, and social activity restrictions (Belle et al 2006; Mitrani & Czaja 2000). An accumulation of these pressures can threaten caregivers' ability and self-efficacy in taking care of their relative with dementia at home.
To address the psychosocial health effects of dementia care, different psychosocial interventions were developed in the United States, such as the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program and the Program of All-Inclusive Care for the Elderly (PACE). These programs mainly consisted of supportive and educational strategies in helping these caregivers understand the illness and its care (Belle et al 2006). Some of them have indicated preliminary evidence of its effectiveness on improving caregivers' overall health condition and delaying clients' institutionalization (Schultz, Martire & Klinger 2005; Brodaty et al 2003). However, only few indicated significant effect on reducing clients' behavioral problems and thus improving caregivers' distress or quality of life (Schultz & Martire 2004). In addition, most family intervention studies have focused on Caucasian populations and few studies have been carried out with Chinese and Asian populations where great importance is attached to intimate interpersonal relationships with and a need for social support from family members (Chien & Lee 2011). Therefore, this study was to test the effect of a family mutual support group program that incorporated educational, supportive and community mental health care components in a group of family members caring for a relative with dementia at home.
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