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Correspondence |
Department of Psychiatry, Medical College, Thrissur-680596 Kerala, India
Marriott et al (2000) have shown the usefulness of focused interventions in reducing the burden on caregivers of patients with Alzheimer's disease. The authors did not specify the kind of information provided to the carers in the control groups. We presume that they did not receive the kind of detailed information that was given to the caregivers in the study group. Thus, this study was not designed to compare the effects of giving information alone with an intervention programme, where giving information was only one of its components. Despite this, the authors had come to the conclusion that "providing information alone to the carer had no effect on burden".
If one control group had received the initial three sessions of the intervention and was compared to the study group, then we would have known the efficacy of that component of the intervention. The study design does not allow us to come to conclusions about the relative efficacy of the different components of the intervention programme. So one could speculate that the first three sessions were crucial and mostly responsible for the improvement.
By dismissing the possibility that information alone could have desirable effects, the authors have underestimated its therapeutic value. We disagree with the assertion of the authors that they found little evidence that information alone significantly reduced burden or had an impact on the patient. We are of the opinion that neither the study design nor their findings allow such conclusions. Effects of single-component interventions, like giving information and educating the caregiver, have to be evaluated thoroughly considering the potential for widespread application in the community, especially in developing regions of the world. There is an urgent need for developing and evaluating services that can be of use in developing countries (10/66 Dementia Research Group, 2000). Interventions that are costly and need highly trained professionals for implementation have serious limitations in such settings.
REFERENCES
Marriott, A., Donaldson, C., Tarrier, N., et al
(2000) Effectiveness of cognitive-behavioural family
intervention in reducing the burden of care in carers of patients with
Alzheimer's disease. British Journal of Psychiatry,
176,
557-562.
10/66 Dementia Research Group (2000) Dementia in developing countries. A Consensus Statement from the 10/66 Dementia Research Group. International Journal of Geriatric Psychiatry, 15, 14-20.[CrossRef][Medline]
Carisbrooke Resource Centre, Wenlock Way, Gorton, Manchester M12 5LF
School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR
Dr Shaji et al raise an important point in relation to the interpretation of trials of interventions with carers of people with dementia. In relation to our own study, information was provided in three 45-minute sessions by an experienced clinician, and supplemented by four written information booklets entitled "What are dementia and Alzheimer's disease", "Stress and the person with Alzheimer's disease", "Coping with caring" and "Advice about services". The control group did not receive the information and education sessions. We carried out an analysis after the three sessions of information, which occurred at the beginning of the intervention, and there was no difference between the intervention and control groups at that time on any outcome variable. This finding has also been reported in trials of family intervention with the carers of patients with serious mental illness (Tarrier et al, 1988). This is perhaps not surprising, as providing information and advice is notoriously poor at changing people's behaviour.
With regard to the method of the intervention, we utilised an integrated model described previously in relation to schizophrenia (Barrowclough & Tarrier, 1992). This takes an individualised approach and includes an assessment of the carer's own model of coping. It is recognised that there are significant individual differences in the impact of education on carers managing older people with dementia. It may be that the information provided will enable those in the intervention group to utilise the later sessions more effectively.
We agree entirely with Dr Shaji et al that simple, straightforward strategies should be evaluated in carers of people with dementia, and that costly interventions should not be adopted unless they have been shown to be effective.
REFERENCES
Barrowclough, C. & Tarrier, N. (1992) Families of Schizophrenic Patients: A Cognitive—Behavioural Intervention. London: Chapman & Hall.
Tarrier, N., Barrowclough, C., Vaughn, C., et al
(1988) The community management of schizophrenia. A
controlled trial of a behavioural intervention with families to reduce
relapse. British Journal of Psychiatry,
153,
532-542.
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