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Researchers used an optimizing strategy to determine the most effective psychosocial components of educational interventions for caregivers of patients with dementia.

An approach that integrates mindfulness with support groups or behavioral problem management components could be an efficient way to improve well-being in distressed informal caregivers of people with dementia, according to a study published in JAMA Network Open.

In a 2020 meta-analysis that spanned 131 randomized clinical trials, multicomponent interventions were found to have a marked effect on reducing stress and enhancing well-being in informal caregivers of patients with dementia, the researchers explained. This study used a multiphase optimization strategy to investigate the effects of five components of a dementia caregiving education intervention created to support informal caregivers.

The five components evaluated were self-care skills, behavioral problem management, behavioral activation, mindfulness-based intervention, and support group. For each component, the primary outcomes were physical health, caregiver burden and stress, psychological well-being, anxiety, depressive symptoms, and social support, which were measured using established scales. Several proximal outcomes were also measured.

The assessor-blinded randomized clinical trial included 250 Chinese adults who were informal caregivers of patients with dementia. Participants had elevated depressive symptoms or caregiving burden and were randomly assigned to 1 of 16 experimental conditions, each with different intervention components.

At 12 months, the mindfulness component of the intervention was associated with significantly improved caregiver outcomes including depressive symptoms, mindfulness, perceived social support, and active dementia care management, researchers reported. The support group component significantly improved perceived social support.

Meanwhile, behavioral problem management showed mixed results. At 6 months, it was associated with worsening caregiver anxiety and self-care risk. At 12 months, however, it was linked with improved dementia care strategies including encouragement, active management, and psychological well-being.

Mindfulness also showed interaction effects, according to the study. Specifically, mindfulness enhanced the beneficial effects that self-care skills and behavioral problem management had on depression. Mindfulness and support group components synergistically benefited perceived social support.

Combining mindfulness with self-care, support group, or behavioral problem management components “was an effective multi-component approach to support caregivers in this study, although ongoing support was needed to mitigate potential short-term risks,” wrote corresponding author Jojo Yan Yan Kwok, MPH, PhD, RN, and colleagues. “Further research is required to validate the efficacy of this optimized intervention package.”