背景:随着西班牙裔/拉丁裔(HL)人口的增长,痴呆症患者对HL家庭护理人员的需求也是如此。HL护理人员往往受的教育较少,健康素养较低,收入较低,每个独特的复合负担。需要进行研究以适当地为该人群定制干预措施。
目的:进行了系统评价和荟萃分析,以1)提供对HL痴呆照顾者的非药物干预研究的最新评价,2)表征有希望的干预措施,3)突出未来研究的机会。
方法:在数据库中搜索评估HL痴呆照顾者非药物干预措施的文章。如果目标人群不包括HLs或没有干预措施,则排除研究。提取数据并对两个主要结局进行随机效应荟萃分析:照顾者抑郁和负担。效果大小计算为干预前后标准化平均差(SMD),并进一步进行抑郁亚组meta分析。其他次要结果指标(例如,感知到的社会支持,照顾者知识,焦虑)进行定性评估。
结果:确定了23项研究。大多数包括与心理社会支持有关的多个组成部分,照顾者教育,和社区资源便利化。许多研究成功地改善了照顾者的结果,虽然干预设计各不相同。荟萃分析显示,在改善抑郁症状(SMD=-0.31,95%CI-0.46至-0.16;I2=50.16%)和负担(SMD=-0.28,95%CI-0.37至-0.18;I2=11.06%)方面具有最小至中度异质性和小效应。
结论:尽管干预成分各不相同,许多报告结果有所改善。未来的研究可能会受益于针对身体健康,解决护理人员的社会文化和经济环境,和利用技术。
As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population.
A systematic
review and meta-analysis was conducted to 1) provide an updated
review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research.
Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively.
Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = -0.31, 95% CI -0.46 to -0.16; I2 = 50.16%) and burden (SMD = -0.28, 95% CI -0.37 to -0.18; I2 = 11.06%).
Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.