[ { "id": "CI-001", "intervention_name": "REACH II (Resources for Enhancing Alzheimer's Caregiver Health II)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "6 months; 12 in-home and telephone sessions", "study_name": "Belle et al., Annals of Internal Medicine 2006 (REACH II RCT)", "study_design": "randomized controlled trial, 5 US sites, stratified by race/ethnicity", "n_participants": 642, "outcomes_measured": [ "quality-of-life", "depression", "burden", "institutionalization-delay", "social-support" ], "effect_size": "Clinical depression prevalence 12.6% intervention vs 22.7% control at 6 months; QoL composite improved significantly for Hispanic/Latino (P<0.001), White (P=0.037) and Black spouse caregivers (P=0.003)", "effect_size_type": "prevalence difference / composite score change", "p_value": "0.001 (clinical depression)", "direction": "benefit", "year": 2006, "url": "https://pubmed.ncbi.nlm.nih.gov/17116917/", "pubmed_id": "17116917", "evidence_strength": "high (multi-site RCT, n=642; primary outcome met)", "limitations": "Single 6-month follow-up; no significant difference in institutionalization at 6 months; heterogeneous ethnic groups pooled; some ethnic groups excluded", "notes": "212 Hispanic/Latino, 219 White, 211 Black caregivers. NCT00177489. Basis for REACH VA and REACH Community translations." }, { "id": "CI-002", "intervention_name": "NYU Caregiver Intervention (NYUCI) - counseling and support for spouse caregivers", "type": "multicomponent", "target": "caregiver", "delivery": "in-person", "duration": "6 individual/family counseling sessions within 4 months, plus required support group and ad hoc phone counseling (ongoing)", "study_name": "Mittelman et al., JAMA 1996", "study_design": "randomized controlled trial, single site (New York)", "n_participants": 206, "outcomes_measured": [ "institutionalization-delay" ], "effect_size": "Median time to nursing home placement 329 days longer in treatment group; adjusted relative risk of placement 0.65 (95% CI 0.45-0.94)", "effect_size_type": "relative risk (Cox model), median survival difference (days)", "p_value": "0.02", "direction": "benefit", "year": 1996, "url": "https://pubmed.ncbi.nlm.nih.gov/8940320/", "pubmed_id": "8940320", "evidence_strength": "high (RCT; long follow-up); single site limits generalizability", "limitations": "Referred volunteer sample of spouse caregivers only; single site; enrolment over 3.5 years", "notes": "Effect strongest for mild (RR 0.18) and moderate (RR 0.38) dementia." }, { "id": "CI-003", "intervention_name": "NYU Caregiver Intervention (NYUCI) - enhanced counseling and support, long-term follow-up", "type": "multicomponent", "target": "caregiver", "delivery": "in-person", "duration": "6 sessions individual and family counseling, support group participation, continuous ad hoc telephone counseling; follow-up over 9.5 years of enrolment", "study_name": "Mittelman et al., Neurology 2006", "study_design": "randomized controlled trial vs usual care, single site", "n_participants": 406, "outcomes_measured": [ "institutionalization-delay", "depression", "social-support" ], "effect_size": "Hazard ratio for nursing home placement 0.717 (28.3% reduction in placement rate); model-predicted median time to placement 557 days longer", "effect_size_type": "hazard ratio (Cox model, covariate adjusted)", "p_value": "0.025", "direction": "benefit", "year": 2006, "url": "https://pubmed.ncbi.nlm.nih.gov/17101889/", "pubmed_id": "17101889", "evidence_strength": "high (RCT, long follow-up)", "limitations": "Spouse caregivers only; referred volunteer sample; single metropolitan area", "notes": "Improvements in caregiver social support satisfaction, response to behaviour problems and depressive symptoms accounted for 61.2% of the placement effect." }, { "id": "CI-004", "intervention_name": "START (STrAtegies for RelaTives) manual-based coping programme", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "8 sessions delivered by supervised psychology graduates", "study_name": "Livingston et al., BMJ 2013 (START pragmatic RCT)", "study_design": "pragmatic randomised controlled trial, 2:1 randomisation vs treatment as usual, UK", "n_participants": 260, "outcomes_measured": [ "depression", "anxiety", "quality-of-life", "abusive-behaviour" ], "effect_size": "HADS total adjusted mean difference -1.80 points (95% CI -3.29 to -0.31) over 8 months; case-level depression OR 0.24 (95% CI 0.07-0.76); carer QoL (HSQ mental health) +4.09 (95% CI 0.34-7.83)", "effect_size_type": "adjusted mean difference; odds ratio", "p_value": "0.02 (HADS-T)", "direction": "benefit", "year": 2013, "url": "https://pubmed.ncbi.nlm.nih.gov/24162942/", "pubmed_id": "24162942", "evidence_strength": "high (pragmatic RCT; effects sustained at 6 years; cost-effective)", "limitations": "Self-identified carers from UK memory services; unblinded participants; no effect on care recipient QoL", "notes": "Companion cost-effectiveness paper (Knapp et al., BMJ 2013, PMID 24162943): >99% probability of cost-effectiveness at GBP 30,000/QALY. ISRCTN70017938." }, { "id": "CI-005", "intervention_name": "START (STrAtegies for RelaTives) - 6-year follow-up", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "8 sessions; outcomes at 72 months", "study_name": "Livingston et al., British Journal of Psychiatry 2020", "study_design": "randomised controlled trial, 6-year follow-up", "n_participants": 260, "outcomes_measured": [ "depression", "anxiety", "institutionalization-delay", "cost" ], "effect_size": "HADS-T adjusted mean difference -2.00 points (95% CI -3.38 to -0.63) over 72 months; time to care home intensity ratio 0.88 (95% CI 0.58-1.35, not significant)", "effect_size_type": "adjusted mean difference; intensity ratio", "p_value": "", "direction": "benefit (affective symptoms); null (care home admission, costs)", "year": 2020, "url": "https://pubmed.ncbi.nlm.nih.gov/31298169/", "pubmed_id": "31298169", "evidence_strength": "high for durability of mental-health effect", "limitations": "222 of 260 carers analysed at 6 years; care-home and cost differences not statistically significant", "notes": "Described by authors as the first carer intervention with a 6-year clinical benefit without increased cost." }, { "id": "CI-006", "intervention_name": "REACH VA (national clinical translation of REACH II in VA Home-Based Primary Care)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "6 months; 12 individual in-home/telephone sessions and 5 telephone support-group sessions", "study_name": "Nichols et al., Archives of Internal Medicine 2011", "study_design": "pre-post clinical translation (no control group), 24 VA medical centers in 15 states", "n_participants": "", "outcomes_measured": [ "burden", "depression", "caregiving-frustration", "problem-behaviours", "hours-on-duty" ], "effect_size": "Significant decreases in burden, depression, impact of depression on daily life, caregiving frustrations and number of troubling dementia-related behaviours from baseline to 6 months; ~2-hour/day decrease in time on duty approached significance", "effect_size_type": "within-group pre-post change (magnitudes not stated in abstract)", "p_value": "", "direction": "benefit", "year": 2011, "url": "https://pubmed.ncbi.nlm.nih.gov/21357811/", "pubmed_id": "21357811", "evidence_strength": "moderate (uncontrolled translation study; consistent with REACH II RCT)", "limitations": "No control group; sample size not given in abstract; VA-specific population", "notes": "96% of caregivers believed VA should provide the program. Ran Sept 2007-Aug 2009." }, { "id": "CI-007", "intervention_name": "COPE (Care of Persons with Dementia in their Environments)", "type": "skill-training", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "Up to 12 home or telephone contacts over 4 months (OT and nurse)", "study_name": "Gitlin et al., JAMA 2010 (COPE randomized trial)", "study_design": "prospective 2-group randomized trial, Pennsylvania", "n_participants": 237, "outcomes_measured": [ "patient-functional-dependence", "patient-engagement", "caregiver-well-being", "caregiver-confidence", "quality-of-life" ], "effect_size": "Caregiver well-being (Perceived Change Index) adjusted mean difference 0.22 (95% CI 0.08-0.36), Cohen d 0.30; caregiver confidence using activities +0.81 (95% CI 0.30-1.32), d 0.54; patient functional dependence d 0.21; IADL dependence d 0.43", "effect_size_type": "adjusted mean difference; Cohen d", "p_value": "0.002 (caregiver well-being)", "direction": "benefit at 4 months; no patient group differences at 9 months", "year": 2010, "url": "https://pubmed.ncbi.nlm.nih.gov/20810376/", "pubmed_id": "20810376", "evidence_strength": "high (RCT, JAMA)", "limitations": "Single state; effects on patients not sustained at 9 months; control received 3 phone calls and educational materials", "notes": "NCT00259454. 237 dyads randomized; 209 assessed at 4 months." }, { "id": "CI-008", "intervention_name": "Tailored Activity Program (TAP)", "type": "skill-training", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "8 occupational therapy sessions over 4 months", "study_name": "Gitlin et al., American Journal of Geriatric Psychiatry 2008 (pilot RCT)", "study_design": "randomized controlled pilot study with wait-list control", "n_participants": 60, "outcomes_measured": [ "problem-behaviours", "activity-engagement", "burden", "caregiver-mastery", "self-efficacy", "hours-on-duty" ], "effect_size": "Reduced frequency of problem behaviours (especially shadowing and repetitive questioning); fewer caregiver hours doing things/being on duty; greater mastery and self-efficacy (magnitudes not given in abstract)", "effect_size_type": "between-group difference (not quantified in abstract)", "p_value": "", "direction": "benefit", "year": 2008, "url": "https://pubmed.ncbi.nlm.nih.gov/18310553/", "pubmed_id": "18310553", "evidence_strength": "low-moderate (pilot, n=60)", "limitations": "Small pilot; wait-list design; single site", "notes": "Depressed caregivers derived similar benefit to non-depressed caregivers." }, { "id": "CI-009", "intervention_name": "Advancing Caregiver Training (ACT) - targeting and managing behavioural symptoms", "type": "skill-training", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "Up to 11 home and telephone contacts over 16 weeks, plus 3 reinforcement calls to 24 weeks", "study_name": "Gitlin et al., Journal of the American Geriatrics Society 2010", "study_design": "two-group randomized trial vs no-treatment control", "n_participants": 272, "outcomes_measured": [ "problem-behaviours", "caregiver-upset", "caregiver-confidence", "burden", "depression", "well-being" ], "effect_size": "67.5% of intervention caregivers reported improvement in targeted problem behaviour vs 45.8% of controls (P=0.002); fewer intervention caregivers with depressive symptoms (53.0% vs 67.8%, P=0.02); less burden (P=0.05); better well-being (P=0.001)", "effect_size_type": "proportion difference", "p_value": "0.002 (primary behaviour outcome)", "direction": "benefit", "year": 2010, "url": "https://pubmed.ncbi.nlm.nih.gov/20662955/", "pubmed_id": "20662955", "evidence_strength": "high (RCT, n=272)", "limitations": "No-treatment control (no attention control); single region", "notes": "34.1% of intervention patients had undiagnosed illnesses requiring physician follow-up identified via blood/urine testing." }, { "id": "CI-010", "intervention_name": "MIND at Home (Maximizing Independence at Home) care coordination - patient outcomes", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "18 months; delivered by non-clinical community workers with interdisciplinary team oversight", "study_name": "Samus et al., American Journal of Geriatric Psychiatry 2014 (MIND pilot RCT)", "study_design": "18-month randomized controlled trial, Baltimore, MD", "n_participants": 303, "outcomes_measured": [ "institutionalization-delay", "unmet-needs", "quality-of-life", "depression", "neuropsychiatric-symptoms" ], "effect_size": "Adjusted hazard of leaving home (all-cause transition) reduced 37%: HR 0.63 (95% CI 0.42-0.94); significant improvement in self-reported QoL; no group difference in total unmet needs, proxy QoL, NPS or depression", "effect_size_type": "hazard ratio", "p_value": "", "direction": "benefit (time at home, self-rated QoL); null (other outcomes)", "year": 2014, "url": "https://pubmed.ncbi.nlm.nih.gov/24502822/", "pubmed_id": "24502822", "evidence_strength": "moderate (pilot RCT, single city)", "limitations": "Pilot; single urban area; no significant reduction in total unmet needs", "notes": "Companion caregiver-outcome paper: CI-011." }, { "id": "CI-011", "intervention_name": "MIND at Home care coordination - caregiver outcomes", "type": "care-coordination", "target": "caregiver", "delivery": "in-person", "duration": "18 months", "study_name": "Tanner et al., American Journal of Geriatric Psychiatry 2015", "study_design": "18-month randomized controlled trial (dyads)", "n_participants": 289, "outcomes_measured": [ "unmet-needs", "burden", "quality-of-life", "depression", "hours-of-care" ], "effect_size": "No statistically significant between-group differences in unmet caregiver needs, burden, depression or QoL after multiple-comparison adjustment; potentially clinically relevant reduction in caregiver hours spent with care recipient", "effect_size_type": "between-group difference (not significant)", "p_value": "", "direction": "null (primary); possible benefit (caregiver time)", "year": 2015, "url": "https://pubmed.ncbi.nlm.nih.gov/25260557/", "pubmed_id": "25260557", "evidence_strength": "moderate (RCT) - null caregiver findings", "limitations": "Both groups received written needs-assessment results, diluting contrast; single city", "notes": "Honest null: included so users see that care coordination did not move caregiver burden/depression in this trial." }, { "id": "CI-012", "intervention_name": "Care Ecosystem (telephone/internet collaborative dementia care with care team navigator)", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "12 months", "study_name": "Possin et al., JAMA Internal Medicine 2019 (Care Ecosystem RCT)", "study_design": "single-blind pragmatic randomized clinical trial, California/Nebraska/Iowa, 2:1 randomization vs usual care", "n_participants": 780, "outcomes_measured": [ "quality-of-life", "emergency-department-use", "depression", "burden" ], "effect_size": "PWD quality of life B 0.53 (95% CI 0.25-1.30, P=0.04); ED visits B -0.14 (95% CI -0.29 to -0.01, P=0.04); caregiver depression (PHQ-9) B -1.14 (95% CI -2.15 to -0.13, P=0.03); caregiver burden (ZBI-12) B -1.90 (95% CI -3.89 to -0.08, P=0.046)", "effect_size_type": "regression coefficient (B), intention-to-treat", "p_value": "0.04 (primary QoL); 0.03 (depression); 0.046 (burden)", "direction": "benefit", "year": 2019, "url": "https://pubmed.ncbi.nlm.nih.gov/31566651/", "pubmed_id": "31566651", "evidence_strength": "high (large pragmatic RCT)", "limitations": "Caregiver-rated primary outcome; 571 of 780 completed 12-month survey; small absolute effects", "notes": "NCT02213458. Delivered from centralized hubs by telephone and internet; English, Spanish and Cantonese." }, { "id": "CI-013", "intervention_name": "Savvy Caregiver (transportable psychoeducation program)", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "6 sessions", "study_name": "Hepburn et al., Journal of Gerontological Nursing 2007", "study_design": "randomized trial with wait-list control, agencies in 3 states", "n_participants": 52, "outcomes_measured": [ "caregiver-mastery", "distress" ], "effect_size": "Experimental participants' mastery and distress scores significantly better than control at 5-6 month follow-up (magnitudes not given in abstract)", "effect_size_type": "between-group difference", "p_value": "", "direction": "benefit", "year": 2007, "url": "https://pubmed.ncbi.nlm.nih.gov/17378189/", "pubmed_id": "17378189", "evidence_strength": "low-moderate (small trial; 52 completers)", "limitations": "Small completer sample; wait-list design", "notes": "Widely disseminated; online adaptation Tele-Savvy tested later (CI-014)." }, { "id": "CI-014", "intervention_name": "Tele-Savvy (online synchronous/asynchronous adaptation of Savvy Caregiver)", "type": "psychoeducation", "target": "caregiver", "delivery": "telehealth", "duration": "43 days: 7 weekly synchronous group video sessions plus 36 brief asynchronous video lessons", "study_name": "Hepburn et al., The Gerontologist 2022 (Tele-Savvy RCT)", "study_design": "three-arm randomized trial (active, attention control, usual-care waitlist), 2:2:1", "n_participants": 261, "outcomes_measured": [ "depression", "perceived-stress", "reaction-to-behaviours", "caregiver-mastery", "burden", "anxiety" ], "effect_size": "Statistically and clinically significant benefits with moderate to large effect sizes for depression, perceived stress, reaction to care-recipient behaviours and mastery (numeric values not in abstract); no benefit for burden or anxiety", "effect_size_type": "multilevel model group-by-time effects", "p_value": "", "direction": "benefit (depression, stress, mastery); null (burden, anxiety)", "year": 2022, "url": "https://pubmed.ncbi.nlm.nih.gov/33640979/", "pubmed_id": "33640979", "evidence_strength": "moderate-high (RCT with attention control; truncated by COVID-19)", "limitations": "Trial truncated because of COVID-19 confounding; secondary analysis found benefit mainly in White, not Black, caregivers (PMID 37067896)", "notes": "NCT03033875. Secondary analysis (PMID 38111602, n=137) found combined Tele-Savvy effect on insomnia severity d=0.31." }, { "id": "CI-015", "intervention_name": "Partners in Dementia Care (PDC) - VA/Alzheimer's Association care coordination", "type": "care-coordination", "target": "caregiver", "delivery": "mixed", "duration": "outcomes at 6 and 12 months; telephone and e-mail delivery, caseloads 100-125", "study_name": "Bass et al., Journal of the American Geriatrics Society 2013", "study_design": "controlled trial (intervention vs comparison VA sites); 6- and 12-month follow-up", "n_participants": 486, "outcomes_measured": [ "unmet-needs", "caregiver-strain", "depression", "social-support" ], "effect_size": "Significant improvements in unmet needs, three types of caregiver strain, depression and two support resources; most improvements evident at 6 months (magnitudes not in abstract)", "effect_size_type": "between-group difference", "p_value": "", "direction": "benefit", "year": 2013, "url": "https://pubmed.ncbi.nlm.nih.gov/23869899/", "pubmed_id": "23869899", "evidence_strength": "moderate (non-randomized comparison-site design)", "limitations": "Not individually randomized; 394 and 324 caregivers completed 6- and 12-month follow-up; VA-specific", "notes": "Some outcomes improved only for caregivers with more initial difficulties." }, { "id": "CI-016", "intervention_name": "Dementia Care Management (DelpHi-MV), nurse-delivered in German primary care", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "6 months of home-based care management; 12-month follow-up", "study_name": "Thyrian et al., JAMA Psychiatry 2017 (DelpHi-MV cluster RCT)", "study_design": "pragmatic GP-based cluster-randomized trial, Germany", "n_participants": 634, "outcomes_measured": [ "burden", "neuropsychiatric-symptoms", "quality-of-life", "antidementia-drug-treatment" ], "effect_size": "Caregiver burden b = -0.50 (95% CI -1.09 to 0.08, P=0.045); BPSD b = -7.45 (95% CI -11.08 to -3.81, P<0.001); patient QoL improved only for those not living alone", "effect_size_type": "regression coefficient (b)", "p_value": "0.045 (caregiver burden)", "direction": "benefit (small for burden)", "year": 2017, "url": "https://pubmed.ncbi.nlm.nih.gov/28746708/", "pubmed_id": "28746708", "evidence_strength": "moderate-high (cluster RCT; but 407 of 634 available for primary outcome)", "limitations": "Burden CI crosses zero despite reported P=0.045; substantial attrition; German health system", "notes": "NCT01401582." }, { "id": "CI-017", "intervention_name": "Collaborative care for Alzheimer disease in primary care (Indiana, PREVENT)", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "12 months of care management by advanced practice nurse; outcomes to 18 months", "study_name": "Callahan et al., JAMA 2006", "study_design": "controlled clinical trial randomized by physician", "n_participants": 153, "outcomes_measured": [ "neuropsychiatric-symptoms", "caregiver-distress", "depression", "institutionalization-delay", "hospitalization" ], "effect_size": "Total NPI mean difference -5.6 at 12 months (P=0.01) and -5.4 at 18 months (P=0.01); caregiver NPI distress improved at 12 months; caregiver PHQ-9 depression improved at 18 months; no differences in nursing home placement, hospitalization or death", "effect_size_type": "mean difference", "p_value": "0.01 (NPI)", "direction": "benefit (symptoms, caregiver distress/depression); null (placement)", "year": 2006, "url": "https://pubmed.ncbi.nlm.nih.gov/16684985/", "pubmed_id": "16684985", "evidence_strength": "moderate-high (RCT, small)", "limitations": "n=153; two university-affiliated systems; caregiver outcomes secondary", "notes": "NCT00246896." }, { "id": "CI-018", "intervention_name": "Dementia guideline-based disease management program (ACCESS), southern California", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": ">12 months, care managers in 9 intervention clinics", "study_name": "Vickrey et al., Annals of Internal Medicine 2006", "study_design": "clinic-level cluster randomized controlled trial, 18 primary care clinics", "n_participants": 408, "outcomes_measured": [ "guideline-adherence", "quality-of-life", "caregiving-quality", "social-support", "unmet-needs" ], "effect_size": "Guideline adherence 63.9% vs 32.9% (adjusted difference 30.1%, 95% CI 25.2-34.9); caregiving quality, social support and unmet caregiving needs better in intervention (P<0.05); caregiver health-related QoL did not differ", "effect_size_type": "adjusted percentage-point difference", "p_value": "<0.001 (adherence)", "direction": "benefit (care quality, caregiver support); null (caregiver HRQoL)", "year": 2006, "url": "https://pubmed.ncbi.nlm.nih.gov/17116916/", "pubmed_id": "17116916", "evidence_strength": "high (cluster RCT)", "limitations": "Well-educated, predominantly White participants with usual source of care; fee-for-service cost concerns", "notes": "ISRCTN72577751. 408 patient-caregiver pairs." }, { "id": "CI-019", "intervention_name": "UCLA Alzheimer's and Dementia Care (ADC) program - nurse practitioner dementia care managers", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "1 year (observational)", "study_name": "Reuben et al., Journal of the American Geriatrics Society 2019", "study_design": "observational pre-post, single academic medical center", "n_participants": 554, "outcomes_measured": [ "caregiver-strain", "depression", "caregiver-distress", "burden", "neuropsychiatric-symptoms" ], "effect_size": "63% of caregivers (282/447) demonstrated clinical benefit at 1 year (improved or maintained low symptoms by MCID); caregivers improved on all scales (Modified Caregiver Strain Index, PHQ-9, NPI-Q distress, Dementia Burden Scale)", "effect_size_type": "proportion achieving clinical benefit", "p_value": "", "direction": "benefit", "year": 2019, "url": "https://pubmed.ncbi.nlm.nih.gov/31355423/", "pubmed_id": "31355423", "evidence_strength": "low-moderate (no control group)", "limitations": "Observational; regression to mean possible; single urban academic center", "notes": "Health-system model later tested against community-based care in D-CARE (CI-020)." }, { "id": "CI-020", "intervention_name": "D-CARE: health system-based vs community-based dementia care vs usual care", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "18 months", "study_name": "Reuben et al., JAMA 2025 (D-CARE randomized clinical trial)", "study_design": "pragmatic randomized clinical trial, 4 US sites, 7:7:1 randomization", "n_participants": 2176, "outcomes_measured": [ "caregiver-strain", "neuropsychiatric-symptoms", "caregiver-self-efficacy" ], "effect_size": "No significant differences on primary outcomes: Modified Caregiver Strain Index LSM 10.7 (health system) vs 10.5 (community) vs 10.6 (usual care); NPI-Q 9.8 vs 9.5 vs 10.1. Caregiver self-efficacy higher for both interventions vs usual care (differences 0.70 [95% CI 0.26-1.14] and 0.85 [0.42-1.29])", "effect_size_type": "least-squares mean difference", "p_value": "", "direction": "null (primary outcomes); small benefit (self-efficacy)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/39878968/", "pubmed_id": "39878968", "evidence_strength": "high (large pragmatic RCT) - null result", "limitations": "Usual-care arm small (n=144); 62% completed 18 months; enrolment spanned COVID-19", "notes": "NCT03786471. Important honest null for care-management models similar to those in the CMS GUIDE model." }, { "id": "CI-021", "intervention_name": "Psychosocial interventions for dementia caregivers (meta-analysis, 30 studies/34 interventions, 1985-2001)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Brodaty, Green & Koschera, Journal of the American Geriatrics Society 2003", "study_design": "meta-analysis of controlled trials", "n_participants": "", "outcomes_measured": [ "psychological-distress", "burden", "knowledge", "patient-mood", "institutionalization-delay" ], "effect_size": "Caregiver psychological distress ES 0.31 (95% CI 0.13-0.50); caregiver knowledge ES 0.51 (0.05-0.98); any main caregiver outcome ES 0.32 (0.15-0.48); patient mood ES 0.68 (0.30-1.06); caregiver burden ES 0.09 (-0.09 to 0.26, not significant)", "effect_size_type": "random-effects standardized effect size", "p_value": "", "direction": "benefit (distress, knowledge); null (burden)", "year": 2003, "url": "https://pubmed.ncbi.nlm.nih.gov/12752841/", "pubmed_id": "12752841", "evidence_strength": "moderate (older literature; heterogeneous)", "limitations": "Excludes respite care; English-language studies 1985-2001; considerable outcome variability", "notes": "4 of 7 studies indicated delayed nursing home admission; success more likely when patients were involved alongside caregivers." }, { "id": "CI-022", "intervention_name": "Interventions with family caregivers of older adults (meta-analysis, 78 studies, six intervention types)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Sorensen, Pinquart & Duberstein, The Gerontologist 2002", "study_design": "meta-analysis", "n_participants": "", "outcomes_measured": [ "burden", "depression", "subjective-well-being", "caregiver-satisfaction", "ability-knowledge", "care-receiver-symptoms" ], "effect_size": "Combined interventions improved outcomes by 0.14 to 0.41 SD units on average across the six outcomes; effects larger for ability/knowledge than for burden or depression; effects for dementia caregivers smaller than for other groups", "effect_size_type": "standardized mean difference (range across outcomes)", "p_value": "", "direction": "benefit (small)", "year": 2002, "url": "https://pubmed.ncbi.nlm.nih.gov/12040138/", "pubmed_id": "12040138", "evidence_strength": "moderate", "limitations": "Not dementia-specific (dementia caregivers a subgroup with smaller effects); older literature", "notes": "Psychoeducational and psychotherapeutic interventions showed the most consistent short-term effects." }, { "id": "CI-023", "intervention_name": "Interventions for dementia caregivers (meta-analysis, 127 studies, 1982-2005)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Pinquart & Sorensen, International Psychogeriatrics 2006", "study_design": "meta-analysis", "n_participants": "", "outcomes_measured": [ "burden", "depression", "subjective-well-being", "ability-knowledge", "care-recipient-symptoms", "institutionalization-delay" ], "effect_size": "Significant but small average effects on burden, depression, subjective well-being, ability/knowledge and care-recipient symptoms (numeric values not in abstract); only multicomponent interventions reduced risk of institutionalization", "effect_size_type": "standardized effect sizes (abstract gives qualitative summary)", "p_value": "", "direction": "benefit (small; domain-specific)", "year": 2006, "url": "https://pubmed.ncbi.nlm.nih.gov/16686964/", "pubmed_id": "16686964", "evidence_strength": "moderate-high (largest meta-analysis of its era)", "limitations": "Effect magnitudes not reported in abstract; heterogeneity by caregiver gender and publication year", "notes": "Psychoeducational interventions requiring active caregiver participation had the broadest effects." }, { "id": "CI-024", "intervention_name": "Meta-review of 60 systematic reviews/meta-analyses of nonpharmacological interventions for informal dementia caregivers (2006-2018)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Cheng & Zhang, BMC Geriatrics 2020", "study_design": "meta-review (umbrella review) appraised with AMSTAR II", "n_participants": "", "outcomes_measured": [ "depression", "quality-of-life", "mastery", "communication-skills", "anxiety", "social-support", "burden" ], "effect_size": "Depression most modifiable across psychoeducation, counseling/psychotherapy, occupational therapy, mindfulness and multicomponent programs; evidence for QoL (psychoeducation), mastery and communication skills; null or weak results for anxiety, social support and burden; support groups and respite generally ineffective", "effect_size_type": "qualitative synthesis of review-level effects", "p_value": "", "direction": "benefit (depression); null/weak (burden, anxiety)", "year": 2020, "url": "https://pubmed.ncbi.nlm.nih.gov/32293325/", "pubmed_id": "32293325", "evidence_strength": "moderate (most included reviews low quality per AMSTAR II)", "limitations": "Review-level evidence; inconsistent intervention classification across reviews", "notes": ">500 primary intervention studies covered. No evidence that dyadic programs beat caregiver-only programs or that multicomponent programs have broader impacts." }, { "id": "CI-025", "intervention_name": "Nonpharmacological interventions for informal dementia caregivers (meta-analysis of 131 RCTs, 2006-mid 2018)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Cheng, Li, Losada et al., Psychology and Aging 2020", "study_design": "systematic review and meta-analysis of RCTs (350 post-intervention effect sizes)", "n_participants": "", "outcomes_measured": [ "depression", "burden", "subjective-well-being", "physical-health", "positive-aspects-of-caregiving" ], "effect_size": "Post-intervention effects significant for all outcomes when pooled; educational programs with psychotherapeutic components, counseling/psychotherapy and mindfulness had strongest effects on depressive symptoms; multicomponent interventions had largest effects on burden/stress (numeric pooled values not in abstract)", "effect_size_type": "pooled effect sizes by intervention class (values not in abstract)", "p_value": "", "direction": "benefit", "year": 2020, "url": "https://pubmed.ncbi.nlm.nih.gov/31985249/", "pubmed_id": "31985249", "evidence_strength": "moderate-high", "limitations": "Smaller-sample studies (mindfulness, psychotherapy) reported larger effects; follow-up effects absent for physical health and positive aspects", "notes": "Meta-regression: younger caregivers benefited more." }, { "id": "CI-026", "intervention_name": "Caregiver support groups (mutual support, psychoeducational and educational groups) - meta-analysis of 30 controlled trials", "type": "support-group", "target": "caregiver", "delivery": "in-person", "duration": "varied", "study_name": "Chien et al., International Journal of Geriatric Psychiatry 2011", "study_design": "meta-analysis of true and quasi-experimental controlled trials (1998-2009)", "n_participants": "", "outcomes_measured": [ "psychological-well-being", "depression", "burden", "social-outcomes" ], "effect_size": "Psychological well-being Hedges g -0.44 (95% CI -0.73 to -0.15); depression g -0.40 (-0.72 to -0.08); burden g -0.23 (-0.33 to -0.13); social outcomes g 0.40 (0.09-0.71)", "effect_size_type": "Hedges g", "p_value": "", "direction": "benefit (small to moderate)", "year": 2011, "url": "https://pubmed.ncbi.nlm.nih.gov/21308785/", "pubmed_id": "21308785", "evidence_strength": "moderate (includes quasi-experimental designs; 'support group' includes psychoeducational groups)", "limitations": "Mixes mutual-support with psychoeducational groups; quasi-experimental studies included; contrasts with Cheng 2020 meta-review finding support groups generally ineffective", "notes": "Effect sizes moderated by theoretical model use and session length/intensity." }, { "id": "CI-027", "intervention_name": "Respite care for people with dementia and their carers (Cochrane review)", "type": "respite", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "varied", "study_name": "Maayan, Soares-Weiser & Lee, Cochrane Database of Systematic Reviews 2014 (CD004396)", "study_design": "Cochrane systematic review of RCTs (4 trials)", "n_participants": 753, "outcomes_measured": [ "burden", "psychological-health", "institutionalization-delay" ], "effect_size": "No significant effects of respite care vs no respite on any caregiver variable; vs polarity therapy, caregiver perceived stress favoured polarity therapy (MD 5.80, 95% CI 1.43-10.17, n=38); no evaluable data on people with dementia", "effect_size_type": "mean difference (single comparison); otherwise no pooled estimate possible", "p_value": "", "direction": "null / insufficient evidence", "year": 2014, "url": "https://pubmed.ncbi.nlm.nih.gov/24435941/", "pubmed_id": "24435941", "evidence_strength": "very low (Cochrane GRADE rating)", "limitations": "Only 4 heterogeneous trials; pooling impossible; authors caution results may reflect lack of high-quality research rather than lack of benefit", "notes": "Key honest finding: despite wide advocacy, RCT evidence for respite is absent, not negative." }, { "id": "CI-028", "intervention_name": "Respite care (day care, temporary residential admission, community/in-home respite) - systematic review of 17 papers", "type": "respite", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "varied", "study_name": "Vandepitte et al., International Journal of Geriatric Psychiatry 2016", "study_design": "systematic review (RCTs, quasi-experimental, pre-post and cohort studies)", "n_participants": "", "outcomes_measured": [ "burden", "problem-behaviours", "institutionalization-delay" ], "effect_size": "Day care services effective in decreasing caregiver burden and behavioural problems but accelerate time to nursing home admission; temporary residential admission results mixed with unexpected adverse effects; high-quality evidence on community-based/in-home respite lacking", "effect_size_type": "narrative synthesis", "p_value": "", "direction": "mixed (benefit for burden; possible harm for time to institutionalization)", "year": 2016, "url": "https://pubmed.ncbi.nlm.nih.gov/27245986/", "pubmed_id": "27245986", "evidence_strength": "low-moderate (non-randomized designs included)", "limitations": "Few comparable studies; methodological quality variable", "notes": "Companion general review of 53 caregiver-support papers (PMID 27079704) found comparative research on respite 'very rare'." }, { "id": "CI-029", "intervention_name": "Adult day services (ADS) - daily stress exposure on ADS vs non-ADS days", "type": "respite", "target": "caregiver", "delivery": "in-person", "duration": "Daily assessments before first ADS use and after 1 and 2 months of attendance", "study_name": "Zarit et al., Journals of Gerontology Series B 2011", "study_design": "within-person withdrawal design (A-B-A-B), no randomized control", "n_participants": 121, "outcomes_measured": [ "stressor-exposure", "stress-appraisal", "behaviour-problems", "care-recipient-sleep" ], "effect_size": "Total exposure to stressors and stress appraisals decreased significantly on ADS days vs non-ADS days; reductions in evening behaviour problems and improved care-recipient sleep after ADS days (magnitudes not in abstract)", "effect_size_type": "within-person difference", "p_value": "", "direction": "benefit (day-level)", "year": 2011, "url": "https://pubmed.ncbi.nlm.nih.gov/21642593/", "pubmed_id": "21642593", "evidence_strength": "low-moderate (within-person design; no control group)", "limitations": "Non-randomized; caregivers self-selected into ADS; short follow-up", "notes": "Companion quasi-experimental analysis (Kim et al. 2012, PMID 21322030, n=341): both wives and daughters using ADS had lower depressive symptoms and overload over 12 months vs non-ADS controls; wives' positive affect declined." }, { "id": "CI-030", "intervention_name": "STAR-C (Staff Training in Assisted living Residences - Caregivers): behavioural approach taught by community consultants", "type": "skill-training", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "not stated in abstract (assessments at baseline, post-treatment and 6 months)", "study_name": "Teri et al., The Gerontologist 2005", "study_design": "randomized controlled trial", "n_participants": 95, "outcomes_measured": [ "depression", "burden", "reactivity-to-behaviours", "care-recipient-behaviour-problems", "quality-of-life" ], "effect_size": "Significant improvements in caregiver depression, burden and reactivity to behaviour problems; reduced frequency/severity of care-recipient behaviour problems and improved QoL; maintained at 6 months (magnitudes not in abstract)", "effect_size_type": "between-group difference", "p_value": "", "direction": "benefit", "year": 2005, "url": "https://pubmed.ncbi.nlm.nih.gov/16326662/", "pubmed_id": "16326662", "evidence_strength": "moderate (small RCT)", "limitations": "n=95 dyads; single region; session schedule not given in abstract", "notes": "Demonstrated that master's-level community consultants can deliver the protocol with adherence." }, { "id": "CI-031", "intervention_name": "RDAD (Reducing Disability in Alzheimer Disease): home exercise plus caregiver behavioural-management training", "type": "skill-training", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "3 months, in-home; follow-up to 24 months", "study_name": "Teri et al., JAMA 2003", "study_design": "randomized controlled trial vs routine medical care", "n_participants": 153, "outcomes_measured": [ "patient-physical-function", "patient-depression", "institutionalization-delay" ], "effect_size": "Patients exercising >=60 min/wk OR 2.82 (95% CI 1.25-6.39); SF-36 physical role functioning mean difference 19.29 (95% CI 8.75-29.83) at 3 months and 10.89 (3.62-18.16) at 2 years; Cornell depression mean difference -1.03; trend toward less institutionalization for behavioural disturbance (19% vs 50%)", "effect_size_type": "odds ratio; mean difference", "p_value": "<0.001 (physical role functioning)", "direction": "benefit (patient outcomes); trend (institutionalization)", "year": 2003, "url": "https://pubmed.ncbi.nlm.nih.gov/14559955/", "pubmed_id": "14559955", "evidence_strength": "high (RCT)", "limitations": "Caregiver outcomes not primary; institutionalization difference only a trend; single site (Seattle)", "notes": "Included as a dyadic caregiver-training program with patient-level outcomes." }, { "id": "CI-032", "intervention_name": "Remotely delivered information, training and support for informal dementia caregivers (Cochrane review, 26 RCTs)", "type": "technology", "target": "caregiver", "delivery": "telehealth", "duration": "varied (printed materials, telephone, internet; no face-to-face professional contact)", "study_name": "Gonzalez-Fraile et al., Cochrane Database of Systematic Reviews 2021 (CD006440.pub3)", "study_design": "Cochrane systematic review and meta-analysis of RCTs", "n_participants": 2367, "outcomes_measured": [ "burden", "depression", "quality-of-life", "dropout" ], "effect_size": "Vs usual care/waitlist/attention control: burden SMD -0.06 (95% CI -0.35 to 0.23; 9 studies); depression SMD -0.05 (-0.22 to 0.12; 8 studies); HRQoL SMD 0.10 (-0.13 to 0.32). Vs information alone: burden SMD -0.24 (-0.51 to 0.04); depression SMD -0.25 (-0.43 to -0.06; 11 studies, 1100 participants); dropout RR 1.51 (1.04-2.20)", "effect_size_type": "standardized mean difference; risk ratio", "p_value": "", "direction": "null vs usual care; slight benefit vs information-only (depression)", "year": 2021, "url": "https://pubmed.ncbi.nlm.nih.gov/33417236/", "pubmed_id": "33417236", "evidence_strength": "moderate to low certainty (GRADE)", "limitations": "Self-rated outcomes by unblinded participants; attrition; remote delivery increased dropout vs information-only", "notes": "Searches to 10 April 2020; motivated in part by COVID-19 isolation." }, { "id": "CI-033", "intervention_name": "Cognitive reframing for carers of people with dementia (Cochrane review)", "type": "psychoeducation", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Vernooij-Dassen et al., Cochrane Database of Systematic Reviews 2011 (CD005318.pub2)", "study_design": "Cochrane systematic review and meta-analysis of RCTs", "n_participants": "", "outcomes_measured": [ "anxiety", "depression", "subjective-stress", "coping", "burden", "institutionalization-delay" ], "effect_size": "Anxiety SMD -0.21 (95% CI -0.39 to -0.04); depression SMD -0.66 (-1.27 to -0.05); subjective stress SMD -0.23 (-0.43 to -0.04); no effects on coping, burden appraisal, reactions to behaviours or institutionalization", "effect_size_type": "standardized mean difference", "p_value": "", "direction": "benefit (psychological morbidity); null (burden, institutionalization)", "year": 2011, "url": "https://pubmed.ncbi.nlm.nih.gov/22071821/", "pubmed_id": "22071821", "evidence_strength": "moderate", "limitations": "Number of included trials/participants not stated in abstract; search date 5 April 2009; identifying relevant interventions was difficult", "notes": "Cognitive reframing is a CBT component; authors suggest it is best used within tailored multicomponent interventions." }, { "id": "CI-034", "intervention_name": "Mastery over Dementia (guided self-help internet course, Netherlands)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "8 lessons with online feedback (guided self-help)", "study_name": "Blom et al., PLoS One 2015", "study_design": "randomized controlled trial vs minimal intervention (e-bulletins)", "n_participants": 245, "outcomes_measured": [ "depression", "anxiety" ], "effect_size": "Post-intervention symptoms lower in intervention group: depression (CES-D) P=0.034, effect size 0.26; anxiety (HADS-A) P=0.007, effect size 0.48", "effect_size_type": "standardized effect size (adjusted for baseline)", "p_value": "0.034 (depression); 0.007 (anxiety)", "direction": "benefit", "year": 2015, "url": "https://pubmed.ncbi.nlm.nih.gov/25679228/", "pubmed_id": "25679228", "evidence_strength": "moderate (RCT; internet-recruited, well-educated sample)", "limitations": "Non-completion high: 55.7% did not finish all 8 lessons (Pot et al. 2015, PMID 25648589); all data collected online", "notes": "149 intervention vs 96 control analysed (251 randomized, 6 lost at baseline). Dutch Trial Register NTR-2051." }, { "id": "CI-035", "intervention_name": "Mindfulness-based stress reduction (MBSR) for family carers of people with dementia (Cochrane review, 5 RCTs)", "type": "other", "target": "caregiver", "delivery": "in-person", "duration": "varied (not stated in abstract)", "study_name": "Liu et al., Cochrane Database of Systematic Reviews 2018 (CD012791.pub2)", "study_design": "Cochrane systematic review and meta-analysis of RCTs", "n_participants": 201, "outcomes_measured": [ "depression", "anxiety", "burden", "coping", "dropout" ], "effect_size": "Vs active controls: depressive symptoms SMD -0.63 (95% CI -0.98 to -0.28; 3 trials, 135 participants); anxiety MD -7.50 (-13.11 to -1.89; 1 trial); burden SMD 0.24 (-0.11 to 0.58, possible slight increase). Vs inactive controls: depression MD -1.97 (-6.89 to 2.95, not significant)", "effect_size_type": "standardized mean difference; mean difference", "p_value": "<0.001 (depression vs active control)", "direction": "benefit (short-term depression/anxiety); uncertain (burden)", "year": 2018, "url": "https://pubmed.ncbi.nlm.nih.gov/30106471/", "pubmed_id": "30106471", "evidence_strength": "low to very low quality (GRADE)", "limitations": "Only 5 small trials; high risk of detection bias; no data on QoL or institutionalization", "notes": "Searches to September 2017." }, { "id": "CI-036", "intervention_name": "Case management approaches to home support for people with dementia (Cochrane review, 13 RCTs)", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "varied", "study_name": "Reilly et al., Cochrane Database of Systematic Reviews 2015 (CD008345)", "study_design": "Cochrane systematic review and meta-analysis of RCTs", "n_participants": 9615, "outcomes_measured": [ "institutionalization-delay", "hospitalization", "burden", "depression", "quality-of-life", "cost" ], "effect_size": "Institutionalization OR 0.82 (95% CI 0.69-0.98) at 6 months and OR 0.25 (0.10-0.61) at 18 months, but uncertain at 10-12 months (OR 0.95) and 24 months; carer burden SMD -0.07 (-0.12 to -0.01) at 6 months; carer depression SMD -0.08 (-0.16 to -0.01) at 18 months; total service cost SMD -0.07 (-0.12 to -0.02) at 12 months", "effect_size_type": "odds ratio; standardized mean difference", "p_value": "0.02 (institutionalization 6 mo); 0.03 (burden 6 mo)", "direction": "benefit (small, time-point dependent)", "year": 2015, "url": "https://pubmed.ncbi.nlm.nih.gov/25560977/", "pubmed_id": "25560977", "evidence_strength": "moderate (low-moderate risk of bias; considerable heterogeneity)", "limitations": "69% of studies at high risk of performance bias; effects inconsistent across time points; searches to Dec 2013", "notes": "Caregiver effect sizes are very small (SMD ~ -0.07)." }, { "id": "CI-037", "intervention_name": "Internet-based interventions supporting family caregivers of people with dementia (systematic review, 40 studies)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "varied", "study_name": "Hopwood et al., Journal of Medical Internet Research 2018", "study_design": "systematic review with narrative synthesis (all study designs)", "n_participants": "", "outcomes_measured": [ "depression", "anxiety", "burden", "stress", "well-being" ], "effect_size": "Most studies suggested benefit to caregiver well-being including depression, anxiety and burden; strongest signal for online psychological support in several small RCTs; overall study quality low", "effect_size_type": "narrative synthesis (no pooled estimate)", "p_value": "", "direction": "benefit (tentative)", "year": 2018, "url": "https://pubmed.ncbi.nlm.nih.gov/29895512/", "pubmed_id": "29895512", "evidence_strength": "low (mixed designs, low quality)", "limitations": "Heterogeneous interventions and outcomes; no meta-analysis; search April 2018", "notes": "Five component types identified: professional contact, peer interaction, information, decision support, psychological support." }, { "id": "CI-038", "intervention_name": "Draw-Care (culturally adapted WHO iSupport Lite: six animated films and tipsheets in 10 languages)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "Online, follow-up at 6 and 12 weeks", "study_name": "Brijnath et al., Age and Ageing 2026 (Draw-Care RCT, Australia)", "study_design": "single-blind parallel-group randomised clinical trial vs waitlist, multilingual carers", "n_participants": 93, "outcomes_measured": [ "burden", "depression", "quality-of-life", "work-productivity" ], "effect_size": "No significant differences on Zarit Burden Interview, CES-D, WHOQOL-Bref or WPAI:CG; CarerQoL-VAS higher in intervention (mean difference 0.75, 95% CI 0.25-1.24, P=0.003)", "effect_size_type": "mean difference", "p_value": "0.003 (CarerQoL-VAS only)", "direction": "null (burden, mood); small benefit (one QoL measure)", "year": 2026, "url": "https://pubmed.ncbi.nlm.nih.gov/41719424/", "pubmed_id": "41719424", "evidence_strength": "low-moderate (under-recruited: 93 analysed vs 194 target)", "limitations": "Recruitment shortfall; possible ceiling effects; short follow-up", "notes": "Conducted 1 Aug 2023 to 8 Nov 2024. 116 consented, 93 analysed." }, { "id": "CI-039", "intervention_name": "iSupport (WHO online self-help e-health programme) - UK multi-centre RCT", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "Self-guided online modules; outcomes at 6 months", "study_name": "iSupport UK RCT: cost-consequence analysis (Anthony et al., BMJ Open 2025) and process evaluation (Masterson-Algar et al., Behavioral Sciences 2025)", "study_design": "multi-centre single-blind randomised controlled trial vs usual care (England, Wales, Scotland)", "n_participants": 352, "outcomes_measured": [ "distress", "quality-of-life", "health-and-social-care-costs", "engagement" ], "effect_size": "Main trial reported no measurable benefits to carer well-being (per process evaluation); EQ-5D-5L no difference (P=0.67); mean change in public-sector resource-use costs favoured intervention (difference GBP 146 per participant, P=0.003)", "effect_size_type": "cost difference; QoL difference (null)", "p_value": "0.67 (EQ-5D-5L); 0.003 (cost change)", "direction": "null (well-being); possible benefit (costs)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/40379340/", "pubmed_id": "40379340", "evidence_strength": "moderate (RCT) - null primary result; primary-outcome paper not loaded here", "limitations": "8.3% never used the platform and 54% spent 30-90 minutes total; primary clinical-outcome paper not retrieved in this pass", "notes": "ISRCTN17420703. 175 iSupport vs 177 usual care; recruitment 12 Nov 2021-31 Mar 2023. Process evaluation PMID 40867464." }, { "id": "CI-040", "intervention_name": "Facilitator-enabled flexible iSupport for Dementia (Australia) - internal pilot RCT", "type": "technology", "target": "caregiver", "delivery": "mixed", "duration": "6 months (manual, online peer meetings, WhatsApp, one-to-one facilitator support)", "study_name": "Yu et al., Nursing Open 2026 (internal pilot of multi-centre RCT)", "study_design": "multi-centre internal block-pilot randomised controlled trial with embedded qualitative study", "n_participants": 84, "outcomes_measured": [ "behavioural-problems", "carer-distress", "quality-of-life", "social-support", "self-efficacy" ], "effect_size": "Possible trend toward lower behavioural problems and lower carer distress responses; no clear evidence of effect on carer QoL, social support, self-efficacy or PLWD QoL", "effect_size_type": "preliminary estimates (pilot)", "p_value": "", "direction": "inconclusive (pilot)", "year": 2026, "url": "https://pubmed.ncbi.nlm.nih.gov/42634407/", "pubmed_id": "42634407", "evidence_strength": "very low (pilot; 10% recruitment rate, 70% retention)", "limitations": "Not powered for effectiveness; informs main trial only", "notes": "ACTRN12622000199718. Recruitment June 2022-April 2023." }, { "id": "CI-041", "intervention_name": "Tele-Savvy - secondary outcomes: sleep quality and insomnia", "type": "psychoeducation", "target": "caregiver", "delivery": "telehealth", "duration": "7-week virtual programme; 6-month follow-up", "study_name": "Brewster et al., Clinical Interventions in Aging 2023 (secondary analysis of Tele-Savvy RCT)", "study_design": "secondary analysis of 3-arm RCT", "n_participants": 137, "outcomes_measured": [ "sleep-quality", "insomnia" ], "effect_size": "No initial group-by-time effects for PSQI or ISI; combined Tele-Savvy group showed significant improvement in ISI over time (P=0.050); effect sizes PSQI d=0.126, ISI d=0.310", "effect_size_type": "Cohen d", "p_value": "0.050 (ISI)", "direction": "small benefit (insomnia); null (sleep quality)", "year": 2023, "url": "https://pubmed.ncbi.nlm.nih.gov/38111602/", "pubmed_id": "38111602", "evidence_strength": "low (secondary analysis; borderline P)", "limitations": "Not designed for sleep; sample predominantly White (68.6%) and female", "notes": "Relevant to burden dataset's sleep-disruption items." }, { "id": "CI-042", "intervention_name": "Tele-Savvy - secondary outcomes: dyadic relationship quality", "type": "psychoeducation", "target": "caregiver", "delivery": "telehealth", "duration": "7 weeks; 6-month follow-up", "study_name": "Bonds Johnson et al., The Gerontologist 2026 (secondary analysis)", "study_design": "secondary analysis of 3-arm RCT (active n=96, attention control n=111, waitlist n=54)", "n_participants": 261, "outcomes_measured": [ "positive-dyadic-interaction", "dyadic-strain" ], "effect_size": "Tele-Savvy group reported significant improvements in positive interactions and reduction in dyadic strain over time vs both control groups (magnitudes not in abstract)", "effect_size_type": "mixed-model group-by-time effect", "p_value": "", "direction": "benefit", "year": 2026, "url": "https://pubmed.ncbi.nlm.nih.gov/41734283/", "pubmed_id": "41734283", "evidence_strength": "low-moderate (secondary analysis)", "limitations": "Care-partner-reported only; secondary outcome", "notes": "NCT03033875." }, { "id": "CI-043", "intervention_name": "CMS GUIDE (Guiding an Improved Dementia Experience) Model - Medicare alternative payment model with care navigation, caregiver education and respite benefit", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "8-year model test beginning July 1, 2024 (established track); new-program track began delivering services July 1, 2025", "study_name": "CMS Innovation Center GUIDE Model (no outcome results published as of Sept 2026)", "study_design": "voluntary nationwide payment-and-delivery model test under Section 1115A; formal CMS evaluation pending", "n_participants": "", "outcomes_measured": [ "institutionalization-delay", "hospitalization", "emergency-department-use", "burden", "quality-of-life", "expenditures" ], "effect_size": "", "effect_size_type": "", "p_value": "", "direction": "not yet reported", "year": 2024, "url": "https://www.cms.gov/priorities/innovation/innovation-models/guide", "pubmed_id": "", "evidence_strength": "none yet (model in progress; outcomes are stated aims, not results)", "limitations": "No evaluation results released; the closest RCT evidence for similar care-management models is mixed (Care Ecosystem positive, D-CARE null)", "notes": "Structure: tiered per-beneficiary-per-month care-management payment adjusted by patient complexity and caregiver strain; respite services reimbursed up to $2,500 per eligible patient per year (in-home, adult day, facility-based); 24/7 support line; interdisciplinary team with care navigator; health-related social needs screening; one-time infrastructure payment to safety-net providers in new-program track. CMS page lists 292 participants (page modified 08/11/2026). See burden dataset for enrolment/participant figures." }, { "id": "CI-044", "intervention_name": "National Family Caregiver Support Program (NFCSP) respite - 4+ hours/week", "type": "respite", "target": "caregiver", "delivery": "in-person", "duration": "ongoing programme services (Older Americans Act Title III-E)", "study_name": "NFCSP outcome evaluation as summarized by ARCH National Respite Network ('Respite Facts and Talking Points')", "study_design": "programme evaluation with comparison group (design details not on the loaded page)", "n_participants": "", "outcomes_measured": [ "burden", "ability-to-continue-caregiving" ], "effect_size": "Caregivers receiving 4 or more hours of respite per week had a decrease in self-reported burden over time while comparison caregivers experienced an increase; more respite hours per week increased probability of reporting that services helped them continue caregiving (no numeric effect on loaded page)", "effect_size_type": "qualitative direction only", "p_value": "", "direction": "benefit", "year": "", "url": "https://archrespite.org/policy/respite-facts-and-talking-points/", "pubmed_id": "", "evidence_strength": "low (secondary summary of a non-randomized evaluation; primary report not loaded)", "limitations": "Not dementia-specific; primary evaluation report not retrieved; numeric values absent on loaded page", "notes": "Recorded because respite effectiveness evidence is otherwise thin; treat as advocacy-organization summary." }, { "id": "CI-045", "intervention_name": "Cognitive behavioural therapy (CBT) for dementia caregivers - depression, anxiety and stress (meta-analysis of 25 studies)", "type": "other", "target": "caregiver", "delivery": "mixed", "duration": "varied; subgroup analysis compared <=8 vs >8 sessions", "study_name": "Hopkinson, Reavell, Lane & Mallikarjun, The Gerontologist 2019", "study_design": "systematic review and meta-analysis of CBT trials (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, grey literature)", "n_participants": "", "outcomes_measured": [ "depression", "anxiety", "stress", "quality-of-life" ], "effect_size": "Depression SMD -0.34 (95% CI -0.47 to -0.21); stress SMD -0.36 (-0.52 to -0.20); anxiety SMD 0.10 (-0.18 to 0.39), not significant. Significant reductions limited to group (not individual) formats; <=8 sessions as effective as >8 (depression MD 0.79, 95% CI -0.45 to 2.03, P=.21 between dose groups)", "effect_size_type": "standardized mean difference", "p_value": "<.001 (depression, stress); .47 (anxiety)", "direction": "benefit (depression, stress; small); null (anxiety)", "year": 2019, "url": "https://pubmed.ncbi.nlm.nih.gov/29529290/", "pubmed_id": "29529290", "evidence_strength": "moderate (25 pooled studies; small effects; heterogeneity in formats)", "limitations": "Abstract gives no pooled N; format subgroup findings (group better than individual) conflict with the 2022 network meta-analysis of CBT delivery formats (CI record on Sun et al. 2022)", "notes": "DOI 10.1093/geront/gnx217. Authors suggest cost-effectiveness could improve by limiting CBT to group format and eight sessions." }, { "id": "CI-046", "intervention_name": "CBT vs acceptance and commitment therapy (ACT) for caregivers with significant depressive symptoms (Spain)", "type": "other", "target": "caregiver", "delivery": "in-person", "duration": "not stated in abstract; post-intervention and follow-up assessments", "study_name": "Losada et al., Journal of Consulting and Clinical Psychology 2015", "study_design": "three-arm randomized clinical trial (CBT vs ACT vs control), caregivers with high depressive symptomatology", "n_participants": 135, "outcomes_measured": [ "depression", "anxiety", "leisure", "dysfunctional-thoughts", "experiential-avoidance" ], "effect_size": "Depression at post-intervention vs control: CBT d=0.98 (NNT 3.61), ACT d=1.17 (NNT 3.53), both P<.001; maintained at follow-up only for CBT (d=0.74, NNT 9.71, P=.02). Clinically significant change 26.7% CBT, 24.2% ACT, 0% control. Anxiety at post: ACT lower than CBT (d=0.50) and control (d=0.79, NNT 3.86), no follow-up effect", "effect_size_type": "Cohen d; number needed to treat", "p_value": "<.001 (depression, both arms, post-intervention)", "direction": "benefit (depression, both therapies; large at post-intervention); CBT effect persisted at follow-up, ACT did not", "year": 2015, "url": "https://pubmed.ncbi.nlm.nih.gov/26075381/", "pubmed_id": "26075381", "evidence_strength": "moderate (single-site RCT, n=135; large post-treatment effects, attenuated at follow-up)", "limitations": "Recovery at follow-up modest (10.53% CBT, 4% ACT, 0% control for depression); follow-up length not in abstract; Spanish sample", "notes": "DOI 10.1037/ccp0000028. Authors conclude ACT is 'a viable and effective treatment' with results similar to CBT." }, { "id": "CI-047", "intervention_name": "Tele.TAnDem - telephone-delivered individual CBT for family caregivers (Germany)", "type": "other", "target": "caregiver", "delivery": "telehealth", "duration": "12 x 50-minute telephone CBT sessions within 6 months; 6-month follow-up", "study_name": "Wilz, Reder, Meichsner & Soellner, The Gerontologist 2018", "study_design": "randomized controlled trial vs usual care (unrestricted community resources), intention-to-treat latent change models", "n_participants": 273, "outcomes_measured": [ "depression", "emotional-well-being", "physical-health", "burden", "coping", "problem-behaviours" ], "effect_size": "Post-intervention vs usual care: emotional well-being gamma=9.59 (p=.001); depression gamma=-0.23 (p=.043); physical health symptoms gamma=-0.25 (p=.019); coping with care situation gamma=0.25 (p=.005); care-recipient behaviour gamma=0.23 (p=.034). At 6-month follow-up: coping gamma=0.28 (p=.006) and 0.39 (p<.001), emotional well-being gamma=7.61 (p=.007)", "effect_size_type": "latent change model coefficients (gamma)", "p_value": ".001 (emotional well-being, post-intervention)", "direction": "benefit (well-being, depression, physical symptoms, coping); well-being and coping sustained at 6 months", "year": 2018, "url": "https://pubmed.ncbi.nlm.nih.gov/29190357/", "pubmed_id": "29190357", "evidence_strength": "moderate (RCT n=273 embedded in routine care; multiple outcomes, some marginal)", "limitations": "Burden of care listed as an outcome but no significant effect reported in abstract; depression effect small and marginal (p=.043)", "notes": "DOI 10.1093/geront/gnx183. Delivered by qualified CBT therapists after an 8-hour training session within existing German health-care structures." }, { "id": "CI-048", "intervention_name": "CBT delivery formats for caregiver depressive symptoms - internet, telephone, individual, group, combined (network meta-analysis)", "type": "other", "target": "caregiver", "delivery": "mixed", "duration": "varied across 37 RCTs", "study_name": "Sun, Ji, Leng & Wang, Journal of Affective Disorders 2022", "study_design": "systematic review with pairwise and network meta-analysis of RCTs to 15 January 2022 (English and Chinese databases)", "n_participants": 4191, "outcomes_measured": [ "depression" ], "effect_size": "vs controls: internet CBT SMD -1.33 (95% CI -2.18 to -0.66; GRADE low); telephone CBT SMD -1.29 (-1.89 to -0.61; GRADE moderate); individual CBT SMD -1.04 (-2.01 to -0.07; GRADE very low); group and combined formats not significantly effective; no statistically significant differences between the five formats", "effect_size_type": "standardized mean difference (network meta-analysis)", "p_value": "", "direction": "benefit (internet, telephone, individual formats); null (group, combined formats)", "year": 2022, "url": "https://pubmed.ncbi.nlm.nih.gov/35429541/", "pubmed_id": "35429541", "evidence_strength": "low to moderate (GRADE ratings low to very low for most comparisons; 37 RCTs, 4,191 caregivers)", "limitations": "Effect sizes implausibly large relative to pairwise meta-analyses (e.g., Hopkinson 2019 SMD -0.34); formats did not differ significantly from each other; authors advise cautious interpretation", "notes": "DOI 10.1016/j.jad.2022.04.055. Contradicts Hopkinson et al. 2019, where only group formats reached significance; see also the Fossey 2021 RCT in which online CBT without support underperformed psychoeducation." }, { "id": "CI-049", "intervention_name": "Interventions for caregiver depressive symptoms by type: CBT, mindfulness, psychoeducation, emotional support, cognitive rehabilitation, multicomponent (meta-analysis of 31 RCTs, 2007-2017)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Lee et al., Dementia (London) 2020", "study_design": "systematic review and meta-analysis of RCTs published 2007-2017 (MEDLINE, CINAHL, PsycINFO)", "n_participants": "", "outcomes_measured": [ "depression" ], "effect_size": "CBT (838 participants) SMD -0.905 (95% CI -1.622 to -0.187; p=0.013); mindfulness (186 participants) SMD -0.578 (-0.881 to -0.275; p<0.001); psychoeducation SMD -0.244 (-0.395 to -0.092; p=0.002); emotional support, cognitive rehabilitation and multicomponent interventions: less than small or non-significant", "effect_size_type": "standardized mean difference by intervention class", "p_value": "0.013 (CBT); <0.001 (mindfulness); 0.002 (psychoeducation)", "direction": "benefit (CBT large, mindfulness moderate, psychoeducation small); null/negligible (emotional support, cognitive rehabilitation, multicomponent)", "year": 2020, "url": "https://pubmed.ncbi.nlm.nih.gov/30638044/", "pubmed_id": "30638044", "evidence_strength": "moderate (31 RCTs; wide CI for CBT estimate)", "limitations": "CBT confidence interval very wide (-1.62 to -0.19); search limited to 2007-2017 and three databases; multicomponent null contrasts with REACH II and other trials", "notes": "DOI 10.1177/1471301218822640." }, { "id": "CI-050", "intervention_name": "Comparative ranking of 11 non-pharmacological caregiver interventions (network meta-analysis of 85 RCTs)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied", "study_name": "Sun, Ji, Leng, Li et al., International Journal of Nursing Studies 2022", "study_design": "systematic review and network meta-analysis of 85 RCTs from seven databases; Cochrane risk-of-bias tool", "n_participants": "", "outcomes_measured": [ "depression", "anxiety", "quality-of-life", "burden" ], "effect_size": "Depression: ACT, behavioural activation, mindfulness, multicomponent, psychoeducation and CBT 'might reduce' depression. Anxiety: psychoeducation was the only effective intervention. Quality of life: only support groups had a statistically significant effect. Burden: case management, psychoeducation and multicomponent interventions effective (numeric estimates not in abstract)", "effect_size_type": "network meta-analysis rankings (values not in abstract)", "p_value": "", "direction": "benefit (outcome-specific by intervention class)", "year": 2022, "url": "https://pubmed.ncbi.nlm.nih.gov/35247788/", "pubmed_id": "35247788", "evidence_strength": "moderate (85 RCTs; ranking evidence, magnitudes not reported in abstract)", "limitations": "Abstract reports which interventions were effective without effect sizes; network meta-analysis assumptions (transitivity) across heterogeneous caregiver programmes", "notes": "DOI 10.1016/j.ijnurstu.2022.104204. Useful for matching intervention class to the outcome a carer most needs (e.g., support groups for QoL, psychoeducation for anxiety)." }, { "id": "CI-051", "intervention_name": "Online CBT with or without telephone support vs online psychoeducation for caregivers with mild anxiety/depression (UK)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "26 weeks", "study_name": "Fossey et al., JAMDA 2021", "study_design": "three-arm parallel-group online RCT; primary outcome GHQ-12 at 26 weeks; completer analysis (ANCOVA)", "n_participants": 638, "outcomes_measured": [ "psychological-distress", "depression", "anxiety", "caregiver-strain", "competence" ], "effect_size": "All three arms improved from baseline on GHQ-12 (P<.001) but neither CBT arm was better than psychoeducation. CBT without telephone support was worse than psychoeducation on HADS depression (mean difference 1.86, 95% CI 0.61-3.11; P=.004) and Relative Stress Scale (MD 3.11, 95% CI 0.13-6.09; P=.04)", "effect_size_type": "mean difference (ANCOVA)", "p_value": ".004 (HADS depression, unsupported CBT vs psychoeducation)", "direction": "null (CBT vs psychoeducation); harm-direction for unsupported online CBT vs psychoeducation on mood", "year": 2021, "url": "https://pubmed.ncbi.nlm.nih.gov/33288467/", "pubmed_id": "33288467", "evidence_strength": "moderate (large randomization, but only 208 of 638 in the analysis population)", "limitations": "Only 208 of 638 randomized (33%) contributed to the primary analysis; no untreated control, so within-arm improvement cannot be attributed to the programmes", "notes": "DOI 10.1016/j.jamda.2020.10.009. Authors: unsupported online CBT 'should not be recommended based on current evidence'. Recorded as a null/negative finding." }, { "id": "CI-052", "intervention_name": "iCare Stress Management e-Training Program (internet-based; adapted from Coping with Caregiving)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "3 months", "study_name": "Kajiyama et al., Aging & Mental Health 2013", "study_design": "RCT vs education/information-only online condition", "n_participants": 150, "outcomes_measured": [ "perceived-stress", "caregiver-upset", "depression", "quality-of-life" ], "effect_size": "Perceived stress (PSS, primary) improved significantly in the iCare arm but not the information-only arm (p=.017); no significant change in bother (RMBPC), depression (CES-D) or quality of life; roughly one-third of enrolled caregivers dropped out before completion", "effect_size_type": "mixed ANOVA group-by-time effect (magnitude not in abstract)", "p_value": ".017 (perceived stress)", "direction": "benefit (perceived stress); null (depression, bother, QoL)", "year": 2013, "url": "https://pubmed.ncbi.nlm.nih.gov/23461355/", "pubmed_id": "23461355", "evidence_strength": "low (single outcome significant; ~33% attrition)", "limitations": "High dropout; effect size not reported in abstract; comparison arm received information so absolute effect unknown", "notes": "DOI 10.1080/13607863.2013.775641; PMC3695021. Described by the authors as the first attempt to deliver an evidence-based caregiver intervention via the Internet." }, { "id": "CI-053", "intervention_name": "Online support programmes for family caregivers (meta-analysis of 10 RCTs/quasi-experimental studies, 2014-2018)", "type": "technology", "target": "caregiver", "delivery": "self-guided", "duration": "varied", "study_name": "Etxeberria, Salaberria & Gorostiaga, Aging & Mental Health 2021", "study_design": "systematic review and meta-analysis (PubMed, PsycInfo, CINAHL, Web of Science, Cochrane), studies Jan 2014-Jul 2018", "n_participants": "", "outcomes_measured": [ "depression", "anxiety", "burden", "competence" ], "effect_size": "Depression Hedges g = -0.21 (95% CI -0.410 to -0.025; z=-2.216; p=0.027) favouring intervention; no significant differences for anxiety, burden or competence. Best results for multicomponent online programmes (psychoeducation + psychological skills training + professional support + online forums/support groups)", "effect_size_type": "Hedges g", "p_value": "0.027 (depression)", "direction": "benefit (depression, small); null (anxiety, burden, competence)", "year": 2021, "url": "https://pubmed.ncbi.nlm.nih.gov/32363901/", "pubmed_id": "32363901", "evidence_strength": "moderate (10 studies; small pooled effect)", "limitations": "Only 10 heterogeneous studies including quasi-experimental designs; medium-small effects despite high study quality", "notes": "DOI 10.1080/13607863.2020.1758900." }, { "id": "CI-054", "intervention_name": "Telehealth interventions (internet- or telephone-based) for caregiver burden and mental health (meta-analysis of 22 RCTs)", "type": "technology", "target": "caregiver", "delivery": "telehealth", "duration": "varied", "study_name": "Zhu et al., Aging & Mental Health 2024", "study_design": "systematic review and meta-analysis of RCTs from nine databases (incl. Chinese) to 26 July 2023", "n_participants": 2132, "outcomes_measured": [ "burden", "depression", "stress", "anxiety" ], "effect_size": "Burden SMD -0.14 (95% CI -0.25 to -0.02; p=0.02); depression SMD -0.17 (-0.27 to -0.07; p<0.001); stress SMD -0.20 (-0.37 to -0.04; p=0.01); anxiety SMD -0.12 (-0.27 to 0.03; p=0.12, not significant). Tailored interventions: depression SMD -0.26 (-0.40 to -0.13) vs standardized SMD -0.08 (-0.22 to 0.06; p=0.25). Internet-based SMD -0.17 and telephone-based SMD -0.18 both effective for depression", "effect_size_type": "standardized mean difference", "p_value": "<0.001 (depression); 0.02 (burden); 0.01 (stress); 0.12 (anxiety)", "direction": "benefit (burden, depression, stress; small); null (anxiety)", "year": 2024, "url": "https://pubmed.ncbi.nlm.nih.gov/38946249/", "pubmed_id": "38946249", "evidence_strength": "moderate (22 RCTs, n=2,132; consistent small effects)", "limitations": "Effects small; tailored vs standardized subgroup difference is observational across trials", "notes": "DOI 10.1080/13607863.2024.2371480. Standardized (non-tailored) telehealth programmes showed no significant depression benefit." }, { "id": "CI-055", "intervention_name": "Facilitator-enabled online multicomponent Chinese iSupport (WHO iSupport psychoeducation + facilitated online carer support groups + care-service access), Australia and greater China", "type": "technology", "target": "patient-caregiver-dyad", "delivery": "telehealth", "duration": "6 months; outcomes at 6 (T1) and 9 months (T2)", "study_name": "Xiao et al., International Journal of Nursing Studies 2024 (multicentre RCT)", "study_design": "multicentre RCT vs usual care; multivariate mixed-effects linear regression; recruited 1 Nov 2021-30 Jun 2022", "n_participants": 266, "outcomes_measured": [ "quality-of-life", "self-efficacy", "social-support", "distress", "care-recipient-behaviour-problems", "hospitalization", "emergency-department-use", "institutionalization-delay" ], "effect_size": "At 6 months vs usual care: mental-health-related QoL mean difference 4.1 (95% CI 1.5-6.8; p=0.002); self-efficacy in controlling upsetting thoughts MD 7.1 (2.2-12.0; p=0.005); distress reactions to changed behaviours MD -0.1 (-0.3 to -0.03; p=0.012)", "effect_size_type": "mean difference (mixed-effects model)", "p_value": "0.002 (mental-health QoL)", "direction": "benefit (carer mental-health QoL, self-efficacy, distress reactions)", "year": 2024, "url": "https://pubmed.ncbi.nlm.nih.gov/39163682/", "pubmed_id": "39163682", "evidence_strength": "moderate (multicentre RCT, n=266; primary outcome met)", "limitations": "Care-recipient outcomes (behaviour frequency, QoL, admissions, nursing-home placement) not reported as significant in abstract; Chinese-language carers only", "notes": "DOI 10.1016/j.ijnurstu.2024.104868; ACTRN12621000276853. Intervention n=131, usual care n=135; mostly women, mean age 53." }, { "id": "CI-056", "intervention_name": "Virtual iSupport Program (skills training, peer support, access to care services) delivered by four Australian organisations", "type": "technology", "target": "patient-caregiver-dyad", "delivery": "telehealth", "duration": "12 months", "study_name": "Xiao et al., Alzheimer's & Dementia 2025 (pragmatic RCT)", "study_design": "pragmatic randomized controlled trial vs usual care, July 2022-December 2024", "n_participants": 149, "outcomes_measured": [ "quality-of-life", "self-efficacy", "social-support", "reactivity-to-behaviours", "hospitalization", "emergency-department-use" ], "effect_size": "At 12 months vs usual care: carer mental-health-related QoL +12.0 points (p<0.001); self-efficacy +14.8 to +18.5 points (p<0.001); social support +0.25 (p<0.028); reactions to behaviour -0.25 (p<0.028); 60% lower hospital admission rate for people with dementia (p=0.045)", "effect_size_type": "between-group difference at 12 months", "p_value": "<0.001 (mental-health QoL)", "direction": "benefit (carer QoL, self-efficacy, social support; care-recipient hospital admissions)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/41023309/", "pubmed_id": "41023309", "evidence_strength": "moderate (pragmatic RCT, n=149; multiple significant outcomes)", "limitations": "Small trial; hospital-admission finding borderline (p=0.045); QoL of people with dementia (co-primary) not reported as significant in abstract", "notes": "DOI 10.1002/alz.70747; PMC12479211; ACTRN12622000199718." }, { "id": "CI-057", "intervention_name": "iSupport web programme integrated with family-physician contract services in Beijing primary care (hybrid effectiveness-implementation trial)", "type": "technology", "target": "caregiver", "delivery": "mixed", "duration": "not stated in abstract (baseline to post-intervention)", "study_name": "Yuan et al., Journal of Medical Internet Research 2025", "study_design": "cluster randomized controlled trial (family-physician-team-guided iSupport + usual care vs usual care + iSupport registration only); intention-to-treat; CFIR implementation analysis", "n_participants": 120, "outcomes_measured": [ "burden", "quality-of-life", "social-support", "learning-behaviours" ], "effect_size": "No significant between-group differences in caregiver burden (beta=-3.80, 95% CI -11.25 to 3.65; P=.32), quality of life (beta=-1.55; P=.55) or social support (beta=0.85; P=.65); learning behaviours improved (beta=2.35, 95% CI 1.03-3.67; P<.001)", "effect_size_type": "regression coefficient (linear mixed model)", "p_value": ".32 (burden, primary)", "direction": "null (burden, QoL, social support); benefit (learning behaviours only)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/40925598/", "pubmed_id": "40925598", "evidence_strength": "low (small cluster RCT, n=120; primary outcome null)", "limitations": "Control arm also had iSupport access (registration), diluting contrast; implementation barriers included digital gaps for older users and lack of primary-care incentives", "notes": "DOI 10.2196/77688; PMC12457867; ChiCTR2400084788. Recorded as a null finding for an unfacilitated/lightly facilitated iSupport model." }, { "id": "CI-058", "intervention_name": "WeCareAdvisor web app (DICE-based problem-solving 'prescriptions' for behavioural symptoms)", "type": "technology", "target": "patient-caregiver-dyad", "delivery": "self-guided", "duration": "3 months (main endpoint) vs 3-month delayed access", "study_name": "Gitlin, McClure, Webster, Lyketsos & Kales, Journal of the American Geriatrics Society 2026", "study_design": "two-group randomized trial, immediate vs 3-month delayed app access; masked interviewers", "n_participants": 262, "outcomes_measured": [ "caregiver-distress", "caregiver-confidence", "behaviour-problems", "patient-functional-dependence", "caregiver-upset", "well-being" ], "effect_size": "No treatment differences at 3 months on the three primary outcomes (behavioural symptoms, caregiver distress, confidence); time-by-intervention interaction for distress significant (Bonferroni-corrected p=0.012). Secondary: immediate users reported fewer behaviours (p=0.02), less functional dependence (p=0.05), less associated upset (p=0.005) and better well-being (p<0.001)", "effect_size_type": "group-by-time effects (magnitudes not in abstract)", "p_value": "0.012 (distress time-by-intervention interaction)", "direction": "null (primary outcomes at 3 months); benefit (secondary outcomes, distress trajectory)", "year": 2026, "url": "https://pubmed.ncbi.nlm.nih.gov/42561014/", "pubmed_id": "42561014", "evidence_strength": "moderate (RCT n=262; primary endpoints not met)", "limitations": "Sample 83% White, 93% some college; 3-month endpoint only; effect magnitudes not in abstract", "notes": "DOI 10.1111/jgs.70637; NCT05012410. Caregivers mean age 63.8, 82% female, 65% spouses; care recipients 62% moderate-severe dementia, mean 6.4 behaviours." }, { "id": "CI-059", "intervention_name": "Powerful Tools for Caregivers (PTC) - 6-week community psychoeducation class, as delivered in practice (Florida)", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "6 weekly 2-hour group classes; 6-week follow-up", "study_name": "Terracciano et al., JAMDA 2020", "study_design": "pragmatic two-arm RCT vs usual care (wait-list then PTC); intent-to-treat", "n_participants": 60, "outcomes_measured": [ "burden", "neuropsychiatric-symptoms", "depression", "self-efficacy", "self-rated-health", "life-satisfaction" ], "effect_size": "Caregiver burden d=-0.48; depressive symptoms d=-0.53; self-confidence d=0.68; no significant benefit for care-recipient behavioural and psychological symptoms of dementia. 94% completed at least 4 of 6 classes", "effect_size_type": "Cohen d", "p_value": "", "direction": "benefit (burden, depression, confidence); null (care-recipient BPSD)", "year": 2020, "url": "https://pubmed.ncbi.nlm.nih.gov/31866419/", "pubmed_id": "31866419", "evidence_strength": "low (small pragmatic RCT, n=60; 44 at follow-up)", "limitations": "Small sample; usual-care arm crossed over after the trial; p-values not in abstract", "notes": "DOI 10.1016/j.jamda.2019.11.011; PMC7302999. PTC is delivered by two trained, certified leaders through stakeholder organizations." }, { "id": "CI-060", "intervention_name": "ADS Plus - staff-delivered caregiver support embedded in adult day services (education, validation, referrals, care strategies, self-care)", "type": "respite", "target": "caregiver", "delivery": "mixed", "duration": "12 months", "study_name": "Gitlin et al., The Gerontologist 2024 (ADS Plus multisite cluster-randomized trial)", "study_design": "cluster-randomized trial in 34 adult day service sites (16 ADS Plus, 18 ADS-only controls)", "n_participants": 203, "outcomes_measured": [ "depression", "well-being", "adult-day-service-attendance" ], "effect_size": "6 months: 43.6% control vs 34.2% ADS Plus caregivers with CES-D >=16 (OR 0.38, p=.072). 12 months: ADS Plus reduced total depression (p=.013) and depressed affect (p=.015) after covariate adjustment. Client attendance 126.05 vs 78.49 days at 9 intervention vs 9 control sites (p=.079; +60.6%)", "effect_size_type": "odds ratio; adjusted between-group difference", "p_value": ".013 (total depression, 12 months)", "direction": "benefit (caregiver depression at 12 months); trend (attendance, 6-month depression)", "year": 2024, "url": "https://pubmed.ncbi.nlm.nih.gov/37549428/", "pubmed_id": "37549428", "evidence_strength": "moderate (multisite cluster RCT; 12-month effect significant, 6-month not)", "limitations": "22.7% lost to follow-up at 12 months; caregivers 76.4% White and 88.2% college-educated; attendance data from only 18 of 34 sites", "notes": "DOI 10.1093/geront/gnad107; PMC10943495; NCT02927821. Complements the Zarit adult-day-service record by testing an add-on caregiver programme rather than day care itself." }, { "id": "CI-061", "intervention_name": "Volunteer befriending scheme for family carers (access to a befriender facilitator and trained lay befriender), UK", "type": "other", "target": "caregiver", "delivery": "in-person", "duration": "15 months post-randomisation follow-up", "study_name": "Charlesworth et al., BMJ 2008 (BECCA trial)", "study_design": "single-blind RCT, community settings in East Anglia and London; intention-to-treat", "n_participants": 236, "outcomes_measured": [ "depression", "quality-of-life" ], "effect_size": "No benefit of access to a befriender facilitator on the primary outcome (HADS depression) or any secondary outcome (EuroQoL) at 15 months", "effect_size_type": "between-group difference (not significant; values not in abstract)", "p_value": "", "direction": "null", "year": 2008, "url": "https://pubmed.ncbi.nlm.nih.gov/18505757/", "pubmed_id": "18505757", "evidence_strength": "moderate (RCT n=236; clear null)", "limitations": "Uptake of befriending was incomplete, so this tests offering the scheme rather than receiving befriending", "notes": "DOI 10.1136/bmj.39549.548831.AE; PMC2413394; ISRCTN08130075. Recorded as a null finding: 'providing access to a befriending scheme is not effective in improving wellbeing'." }, { "id": "CI-062", "intervention_name": "REMCARE - joint reminiscence groups for people with dementia and their family carers (UK)", "type": "other", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "12 weekly sessions then monthly maintenance for 7 months; 10-month primary endpoint", "study_name": "Woods et al., Health Technology Assessment 2012 (REMCARE pragmatic multicentre RCT)", "study_design": "multicentre pragmatic RCT vs usual care; blinded assessment at 3 and 10 months; intention-to-treat", "n_participants": 488, "outcomes_measured": [ "quality-of-life", "psychological-distress", "caregiver-strain", "cost" ], "effect_size": "No differences on primary or secondary outcomes (QoL-AD mean difference 0.07, SE 0.65; F=0.48; p=0.53). Carers in the reminiscence arm reported significantly higher anxiety on a GHQ-28 subscale at 10 months (mean difference 1.25, SE 0.5; F=8.28; p=0.04); carers attending more groups showed increased caregiving stress. Economic analysis curtailed because QALY differences were negligible", "effect_size_type": "mean difference", "p_value": "0.53 (primary QoL-AD); 0.04 (carer anxiety, adverse direction)", "direction": "null (primary); harm (carer anxiety, stress with higher attendance)", "year": 2012, "url": "https://pubmed.ncbi.nlm.nih.gov/23211271/", "pubmed_id": "23211271", "evidence_strength": "high (large pragmatic multicentre RCT; consistent null)", "limitations": "350 of 488 dyads completed; compliance analyses are non-randomized comparisons", "notes": "DOI 10.3310/hta16480; ISRCTN42430123. NIHR HTA-funded. Recorded deliberately as a null-with-possible-harm result for joint dyadic reminiscence groups." }, { "id": "CI-063", "intervention_name": "10/66 'Helping Carers to Care' brief caregiver education and training (5 weekly half-hour sessions), Moscow, Russia", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "5 weekly 30-minute sessions; 6-month follow-up", "study_name": "Gavrilova et al., International Journal of Geriatric Psychiatry 2009 (10/66 Russia RCT)", "study_design": "single-blind parallel-group RCT vs medical care as usual", "n_participants": 60, "outcomes_measured": [ "burden", "psychological-distress", "quality-of-life", "neuropsychiatric-symptoms" ], "effect_size": "Large, statistically significant net improvement in Zarit burden at 6 months vs controls; no group differences in caregiver psychological distress (SRQ-20), caregiver QoL (WHOQOL-BREF) or patient QoL (DEMQOL) (values not in abstract)", "effect_size_type": "between-group difference (magnitude not in abstract)", "p_value": "", "direction": "benefit (burden); null (distress, QoL)", "year": 2009, "url": "https://pubmed.ncbi.nlm.nih.gov/18814197/", "pubmed_id": "18814197", "evidence_strength": "low (small RCT, n=60; single outcome significant)", "limitations": "Small sample; magnitudes not in abstract; one site", "notes": "DOI 10.1002/gps.2126; ISRCTN41039907. Three modules: assessment (1 session), basic dementia education (2), training on specific problem behaviours (2)." }, { "id": "CI-064", "intervention_name": "10/66 'Helping Carers to Care' brief caregiver education and training, Lima, Peru", "type": "psychoeducation", "target": "caregiver", "delivery": "in-person", "duration": "5 sessions (1 assessment, 2 education, 2 behaviour training); 6-month follow-up", "study_name": "Guerra et al., Revista Brasileira de Psiquiatria 2011 (10/66 Peru RCT)", "study_design": "RCT, immediate intervention vs 6-month wait-list", "n_participants": 58, "outcomes_measured": [ "caregiver-strain", "psychological-distress", "quality-of-life", "neuropsychiatric-symptoms" ], "effect_size": "Significantly decreased caregiver strain (Zarit Burden Interview) at 6 months vs controls; no group differences in caregiver psychological distress (SRQ-20) or in caregiver or patient quality of life (values not in abstract)", "effect_size_type": "between-group difference (magnitude not in abstract)", "p_value": "", "direction": "benefit (strain); null (distress, QoL)", "year": 2011, "url": "https://pubmed.ncbi.nlm.nih.gov/20602013/", "pubmed_id": "20602013", "evidence_strength": "low (small RCT, n=58)", "limitations": "Small; wait-list control; magnitudes not in abstract", "notes": "DOI 10.1590/s1516-44462010005000017. Same 10/66 manual as the Russia trial; authors conclude it is 'as effective as similar interventions used in more developed countries'." }, { "id": "CI-065", "intervention_name": "Home Care Advisor programme - home-based caregiver support with lay Home Care Advisors supervised by a counsellor and psychiatrist, Goa, India", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "in-person", "duration": "6 months (wait-list received intervention after 6 months)", "study_name": "Dias et al., PLoS One 2008 (Goa RCT)", "study_design": "RCT, immediate intervention vs 6-month wait-list; masked outcome evaluation; mixed-effects models", "n_participants": 81, "outcomes_measured": [ "psychological-distress", "burden", "caregiver-distress", "neuropsychiatric-symptoms", "patient-functional-dependence", "mortality" ], "effect_size": "GHQ caregiver mental health -1.12 (95% CI -2.07 to -0.17); NPI-D caregiver distress -1.96 (-3.51 to -0.41); non-significant reductions in Zarit burden, EASI and NPI-S; non-significant reduction in deaths of people with dementia (OR 0.34, 95% CI 0.01-1.03)", "effect_size_type": "mean difference (mixed-effects model); odds ratio", "p_value": "", "direction": "benefit (caregiver mental health, distress from behaviours); null/trend (burden, behaviours, mortality)", "year": 2008, "url": "https://pubmed.ncbi.nlm.nih.gov/18523642/", "pubmed_id": "18523642", "evidence_strength": "low (small RCT, n=81; 18 deaths during trial)", "limitations": "59 of 81 completed; 18 care recipients died; mild-moderate dementia only", "notes": "DOI 10.1371/journal.pone.0002333; PMC2396286; NCT00479271. Emphasises locally available, low-cost human resources; included psychiatric assessment and medication if needed." }, { "id": "CI-066", "intervention_name": "Non-pharmacological interventions for informal dementia caregivers in low- and middle-income countries (meta-analysis of 32 RCTs, 13 LMICs)", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "varied; in-person (10 studies), remote (2), hybrid (2) in the burden meta-analysis", "study_name": "Craig et al., BMJ Global Health 2026", "study_design": "systematic review and meta-analysis of RCTs to July 2025 (17 global and 12 regional databases); RoB 2", "n_participants": "", "outcomes_measured": [ "burden", "distress", "depression" ], "effect_size": "Post-intervention improvement: caregiver burden MD 8.7 (95% CI 4.1-13.3; I2=89.9%); distress MD 4.3 (0.5-8.2; I2=66.5%); depression MD 5.9 (1.7-10.1; I2=67.0%). Burden by delivery: in-person MD 6.4 (1.4-11.5), remote MD 8.0 (1.9-14.1), hybrid MD 20.9 (5.8-36.0)", "effect_size_type": "mean difference (scale units unspecified in abstract)", "p_value": "", "direction": "benefit (burden, distress, depression)", "year": 2026, "url": "https://pubmed.ncbi.nlm.nih.gov/41506756/", "pubmed_id": "41506756", "evidence_strength": "moderate (24 of 32 RCTs pooled; very high heterogeneity; sensitivity analyses excluding high-risk studies unchanged)", "limitations": "Mean differences pooled across different scales; I2 up to 90%; authors could not identify an optimal component combination", "notes": "DOI 10.1136/bmjgh-2024-016028; PMC13059920; PROSPERO CRD42021283611. Complements the 10/66 and Goa trial records." }, { "id": "CI-067", "intervention_name": "Non-pharmacological support programmes to delay institutionalization of people with dementia (meta-analysis of 13 programmes)", "type": "multicomponent", "target": "patient-caregiver-dyad", "delivery": "mixed", "duration": "varied", "study_name": "Spijker et al., Journal of the American Geriatrics Society 2008", "study_design": "systematic review and meta-analysis of support programmes with institutionalization outcomes", "n_participants": 9043, "outcomes_measured": [ "institutionalization-delay" ], "effect_size": "Odds of institutionalization OR 0.66 (95% CI 0.43-0.99; P=.05); time to institutionalization SMD 1.44 (0.07-2.81; P=.04). Best-quality studies: OR 0.60 (0.43-0.85; P=.004) but time to institutionalization no longer significant (SMD 1.55, -0.35 to 3.45; P=.11). Actively involving caregivers in treatment choices distinguished effective from ineffective programmes", "effect_size_type": "odds ratio; standardized mean difference", "p_value": ".05 (odds); .004 (best-quality studies)", "direction": "benefit (odds of institutionalization); uncertain (time to institutionalization)", "year": 2008, "url": "https://pubmed.ncbi.nlm.nih.gov/18410323/", "pubmed_id": "18410323", "evidence_strength": "moderate (13 programmes, 9,043 patients; borderline pooled significance)", "limitations": "Wide confidence intervals; older literature (pre-2008); heterogeneous programmes", "notes": "DOI 10.1111/j.1532-5415.2008.01705.x." }, { "id": "CI-068", "intervention_name": "Optimised multicomponent caregiver intervention (education core + self-care, behaviour management, behavioural activation, mindfulness, support group) - MOST fractional factorial trial, Hong Kong", "type": "multicomponent", "target": "caregiver", "delivery": "mixed", "duration": "components tested over 6 months; 12-month follow-up", "study_name": "Kwok et al., JAMA Network Open 2025", "study_design": "assessor-blinded RCT with 2^5 fractional factorial design (16 conditions); multiphase optimization strategy", "n_participants": 250, "outcomes_measured": [ "physical-health", "burden", "perceived-stress", "psychological-well-being", "anxiety", "depression", "social-support" ], "effect_size": "Mindfulness component at 12 months: depressive symptoms beta=-2.13 (95% CI -2.85 to -1.38; P<.001), social support beta=4.76 (1.28-8.15; P=.007). Support-group component: social support beta=4.63 (1.32-7.85; P=.006). Behaviour-management component initially increased anxiety (beta=1.43, 0.43-2.42; P=.005) at 6 months but improved psychological well-being (beta=3.52; P=.008) at 12 months. Mindfulness enhanced the depression benefit of self-care (beta=-1.70; P=.01) and behaviour management (beta=-1.40; P=.04)", "effect_size_type": "regression coefficient (beta), component main and interaction effects", "p_value": "<.001 (mindfulness on depression, 12 months)", "direction": "benefit (mindfulness, support group); mixed (behaviour management: short-term harm, later benefit)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/40094667/", "pubmed_id": "40094667", "evidence_strength": "moderate (factorial RCT n=250; component-level inference; not yet validated as a package)", "limitations": "Chinese caregivers in Hong Kong, mean age 48.9; short-term anxiety increase with behaviour-management training; optimized package not yet tested against control", "notes": "DOI 10.1001/jamanetworkopen.2025.0069; PMC11915064; ChiCTR2300071235." }, { "id": "CI-069", "intervention_name": "IN-PEACE - integrated dementia palliative care (monthly nurse/social-worker calls, protocols for neuropsychiatric symptoms, caregiver distress, advance care planning, hospice) for moderate-to-severe dementia", "type": "care-coordination", "target": "patient-caregiver-dyad", "delivery": "telehealth", "duration": "24 months (quarterly assessments)", "study_name": "Sachs et al., JAMA 2025 (IN-PEACE RCT)", "study_design": "randomized clinical trial vs usual care, two sites in central Indiana, enrolled March 2019-December 2020", "n_participants": 201, "outcomes_measured": [ "neuropsychiatric-symptoms", "depression", "caregiver-distress", "emergency-department-use", "hospitalization" ], "effect_size": "Primary NPI-Q severity: between-group difference at 24 months -0.24 (95% CI -2.33 to 1.84), P=.87 for group-by-time. No significant differences in caregiver depression (PHQ-8) or distress. Combined ED visits and hospitalizations 1.06 vs 2.37 events per patient (difference -1.31, 95% CI -1.93 to -0.69; relative risk 0.45, 95% CI 0.31-0.65)", "effect_size_type": "between-group difference; relative risk", "p_value": ".87 (primary outcome)", "direction": "null (patient symptoms, caregiver depression/distress); benefit (ED visits and hospitalizations)", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/39878993/", "pubmed_id": "39878993", "evidence_strength": "high (RCT n=201 dyads, 43.3% African American, >=90% assessment completion; primary outcome null)", "limitations": "83 patients died during follow-up; two sites in one state", "notes": "DOI 10.1001/jama.2024.25845; PMC11780502; NCT03773757. Recorded for its null caregiver-outcome result alongside a 55% reduction in acute-care events." }, { "id": "CI-070", "intervention_name": "Telephone-based acceptance and commitment therapy (tbACT) for family caregivers (Germany)", "type": "other", "target": "caregiver", "delivery": "telehealth", "duration": "8 weekly telephone sessions; 6-month follow-up", "study_name": "Risch, Lechner-Meichsner & Wilz, Clinical Gerontologist 2025", "study_design": "RCT vs untreated control", "n_participants": 81, "outcomes_measured": [ "depression", "anxiety", "physical-health", "pre-death-grief", "coping", "emotional-well-being" ], "effect_size": "At post-assessment vs control: significantly lower depressive symptoms, fewer physical symptoms, better physical health, more resource utilization, better coping and emotional well-being (magnitudes not in abstract). At 6 months: less pre-death grief, fewer physical symptoms, more resource use; most other effects not maintained", "effect_size_type": "between-group differences (values not in abstract)", "p_value": "", "direction": "benefit (short-term, multiple outcomes); mostly not maintained at 6 months", "year": 2025, "url": "https://pubmed.ncbi.nlm.nih.gov/39169671/", "pubmed_id": "39169671", "evidence_strength": "low (small RCT, n=81; authors call results preliminary)", "limitations": "Untreated control; small sample; anxiety (co-primary) not reported as significant in abstract; effects faded by 6 months", "notes": "DOI 10.1080/07317115.2024.2393307. Authors suggest booster sessions." } ]