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Randomized Controlled Trial
. 2008 Jun 4;3(6):e2333.
doi: 10.1371/journal.pone.0002333.

The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India

Amit Dias  1 , Michael E Dewey, Jean D'Souza, Rajesh Dhume, Dilip D Motghare, K S Shaji, Rajiv Menon, Martin Prince, Vikram Patel
Affiliations
Randomized Controlled Trial

The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India

Amit Dias et al. PLoS One. .

Abstract

Objectives: To develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden, promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia.

Methodology and principal findings: This was a randomised controlled trial in which the person with dementia-caregiver dyad was randomly allocated either to receive the intervention immediately or to a waiting list group which received the intervention after 6 months. It was carried out in communities based in two talukas (administrative blocks) in Goa, India. Mild to moderate cases with dementia (diagnosed using the DSM IV criteria and graded using the Clinical Dementia Rating scale) and their caregivers were included in the trial. Community based intervention provided by a team consisting of Home Care Advisors who were supervised by a counselor and a psychiatrist, focusing on supporting the caregiver through information on dementia, guidance on behaviour management, a single psychiatric assessment and psychotropic medication if needed. We measured caregiver mental health (General Health Questionnaire), caregiver burden (Zarit Burden Score), distress due to behavioural disturbances (NPI-D), behavioural problems in the subject (NPI-S) and activities of daily living in the elder with dementia (EASI). Outcome evaluations were masked to the allocation status. We analysed each outcome with a mixed effects model. 81 families enrolled in the trial; 41 were randomly allocated to the intervention. 59 completed the trial and 18 died during the trial. The intervention led to a significant reduction of GHQ (-1.12, 95% CI -2.07 to -0.17) and NPI-D scores (-1.96, 95%CI -3.51 to -0.41) and non-significant reductions in the ZBS, EASI and NPI-S scores. We also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm (OR 0.34, 95% CI 0.01 to 1.03).

Conclusion: Home based support for caregivers of persons with dementia, which emphasizes the use of locally available, low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring. ClinicalTrials.gov NCT00479271.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Dementia Trial Flow Chart
See this image and copyright information in PMC

References

    1. Prince M, Graham N, Brodaty H, Rimmer E, Varghese M, et al. Alzheimer Disease International's 10/66 Dementia Research Group - one model for action research in developing countries. Int J Geriatr Psychiatry. 2004;19(2):178–81. - PubMed
    1. Prince M. Dementia in developing countries. Int Psychogeriatr. 2001;13(4):389–93. - PubMed
    1. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, et al. Global prevalance of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112–7. - PMC - PubMed
    1. Patel V, Prince M. Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India. Psychol Med. 2001;31(1):29–38. - PubMed
    1. Prince M. Care arrangements for people with dementia in developing countries. Int J Geriatr Psychiatry. 2004;19(2):170–7. - PubMed

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