G. Warner, S. Hutchinson, R.
Genoe and N. Geddes,
Special thanks to….
Robin Parker from Kellogg
Library for assistance in
conducting the database
searches
Funded by…
Nova Scotia Health
Research Foundation
through a REDI team
development grant
What is known from the existing
literature about the delivery and
effectiveness of self-management
interventions for family
caregivers of older adults?
What self-management
components were included in
the identified programs?
What did these programs look
like? (e.g. participants,
duration, group versus
individual)
How effective were the
programs?
What types of selfmanagement programs are
feasible?
Self-management programs
teach individuals not only to
medically manage their
condition, but also to manage
the psychological, social and
lifestyle dimensions
associated with living with the
condition. (Barlow, 2002)
 What is self-management for
unpaid caregivers who care for
a spouse/parent or friend with
a debilitating condition.
Where is the
unpaid
caregiver?
1. Action planning, goal setting &
follow-up
2. Caregiver self care & stress reduction
3. Decision support tools
4. Group education, coaching session
5. Individual education, coaching
session
6. Information via computer or
7. telephone or 8. video/audio or 9.
written
10. Peer group support
11. Problem solving
Must be an intervention
Must include family
caregivers, either alone or as
a caregiver /care receiver
dyad
Participant caring for
someone with an ongoing
condition (or limitations due
to aging)
Intervention described as a
self-management/selfcare/patient education
/empowerment program
Study published prior to the
year 2000
Intervention only delivered
psychotherapy or exercise
Delivered primarily as
inpatient/resident program
Care recipients ≤55
Databases Searched: Central,
Cinahl, Medline, Embase,
Cochrane from 2000 to 2012
Located 2227 sources
2 stages: Two individuals
reviewed 1) abstracts then 2)
full manuscripts
Conflicts discussed and
consensus decision
Extracted information using
NVivo and Excel
32 studies met inclusion
criteria
Number of Abstracts reviewed =2227
Included/Reviewed= 130 Excluded= 2097
Included after manuscript review= 42
After cross referencing by study = 32
Excluded after manuscript review= 88
Reasons: Study Design= 31
Participants= 31
Intervention= 21
Language= 5
Of the 32 studies examined:
Study Design:
 RCTs = 18
Participants:
 Caregiver only = 17
 Dyads = 15
Delivery format:
 Individual/dyad = 17
 Group = 9
 Combination = 6
29 out of the 32 interventions
were disease specific
Conditions:
Alz Dis/Dementia = 17
Stroke = 5
Osteoarthritis = 2
Heart failure=2
Cancer = 2
Parkinson’s Disease=1
1. Won Won, 2008:Powerful tools for
caregiving (PTC)
2. Ducharme, 2011:Learning to be a
caregiver
3. van den Heuvel ,2000: Group and
individual support program for caregivers
of stroke patients
4. Johnston, 2007: Workbook intervention
for stroke patients and carers
5. Gitlin, 2010: Advancing Caregiver Training
(ACT)
6. Glueckauf, 2007: Telephone-based
cognitive-behavioral intervention
 Self-management programs are most
commonly provided to only the
caregiver who is caring for someone
with dementia
 There are some care partner/dyad
interventions for persons with stroke
or chronic heart failure that look
interesting
 The sample size for some of the
studies was too small to see if the
intervention is effective, many were
pilots of planned RCTs
All 32 interventions had an education/
coaching component
Other components included were:
• Information delivered (written,
telephone, computer or video) = 28
• Addressed caregiver self-care or
stress reduction = 28
• Involved problem solving = 25
• Had action planning or goal setting
with follow-up = 18
• Included a peer group support = 9
Not possible to conduct a
meta-analysis because of
clinical heterogeneity:
Diverse conditions
161 outcome measures
used, of these 42 were
developed for the study
only ~50% had an RCT
design
1) Grouped individual
outcome measures by
general categories,
three most prevalent
categories were
 Psycho-social
 Self-care
 Physical health/fitness
2) Ranked results by:
 Statistically significant
difference
 Positive results but not
statically significant
 No effect
The number of studies with
statistically results was not
substantially difference by :
 Delivery method – (in-person,
telephone, computer)
 Format – (group, individual, both)
 Location – (home, community)
 Duration of intervention – (< 6
weeks, 6-11 weeks, 12-20 weeks,
>21 weeks)
 Number of sessions – (< 5, 6 -10,
11-20, > 20)
 Number of self management
components (range 3 – 10)
In-person = 9
• Pros:
• If in home, convenient for caregivers
• Better for communication
• Cons:
• Time consuming for staff
• High cost to provider
• If in community not convenient for
caregivers
Telephone = 6
Computer = 3
• Pros:
• Less disruption to care duties
• Low cost to caregivers and providers
• Easy to organise and participate in
• Can reach rural populations
• Cons:
• Can hinder communication
• Requires equipment and a connection
In-person +
telephone = 13
• Pros:
• More flexible for individually tailoring
the intervention
• Allows participants opportunity to
meet facilitator but convenience of
telephone access
• Cost effective
• Cons:
• None reported
 Self management programs had two
common objectives;
 teach caregivers self-care or selfmanagement principles and;
 provide information or education tailored to
caregiver concerns, usually related to the care
recipients health condition
Self-management programs are diverse –
conditions, change they hope to effect in the
participant, sometimes in conjunction with
exercise, outcomes
What is feasible?
 one-to-one in person can be high resources
 outside the home may be hard for caregivers
to access
 Telephone is cost efficient but may not be
acceptable for caregivers
 Combo of phone/in person may work the
best
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Self-Management for Older Adults & Their Caregivers