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Geriatric Nursing 37 (2016) 426e433

Contents lists available at ScienceDirect

Geriatric Nursing
journal homepage: www.gnjournal.com

Feature Article

INFOSA intervention for caregivers of the elderly, an experimental
study
Adelaida Zabalegui, RN, PhD, FEANS a, Maria Galisteo, RN, Msc c, *,
Maria Montserrat Navarro, RN, PhD c, Esther Cabrera, RN, MSc, PhD b
a
Hospital Clinic of Barcelona. Villarroel, 170, Es 1, pl 8, 08036 Barcelona, Spain
b
Tecno Campus Mataró-Maresme, Mataró, Spain
c
Hospital Clinic of Barcelona. Villarroel, Barcelona, Spain

a r t i c l e i n f o a b s t r a c t

Article history: An experimental study was carried out in a geriatric hospital unit (pre-discharge at home) with repeated
Received 21 November 2015 observations taken at baseline, on study completion and six months post-intervention to analyze the
Received in revised form impact of a psychoeducational intervention INFOSA addressed to caregivers who support dependent
29 May 2016
elderly people, on burden, psychological distress and perceived support. Univariate regression models
Accepted 6 June 2016
Available online 29 July 2016
showed that the participants in the experimental group had less burden (OR 35, IC 95% 7.47e163.99) and
emotional distress (OR 149.5, IC 95% 15. 57e1435.52) than participants in the control group. Odds ratios
effect were statistically significant at post-test and six-month follow-up. The INFOSA intervention
Keywords:
Caregivers
reduced burden and emotional distress and enhanced caregivers’ perceived social support in the short-
Older people term, suggesting that applying the intervention for an extended period could maintain the positive effect
Elderly in the long-term.
Psychoeducational intervention Ó 2016 Elsevier Inc. All rights reserved.
Educational program

Introduction These care recipients increase their degree of dependence
because of their worsening health status until full-time care is
Aging in developed countries is mainly due to drops in fertility required from their caregivers. As dependence grows, caregivers
rates and increases in life expectancy.1 These factors lead to a rise in may refuse to continue taking care of their dependent relatives at
the number of dependent individuals and, consequently, a growing home; mainly because they do not feel they have the training to
need for prolonged care provision. Declining health status is the cope with their care needs.9 Thus, the development of resources to
most important factor that contributes to dependence in elderly support caregivers is essential10 for the maintenance of long-term
people.2 It is forecast that the number of elderly people without homecare and to lessen demand for institutional care.11 In fact, it
physical functionality and autonomy to carry out the activities of has been shown that caregivers express a need for further infor-
daily living (ADL) will double by 2050.3 mation, training and support from health and other professionals to
Aging may cause progressive loss of autonomy, leaving them continue with their homecare duties.12,13
dependent on others when performing ADL. In Spain, most care of In the last 20 years, several studies have been performed to
dependent elderly people is carried out voluntarily and informally develop or demonstrate the efficacy of various support measures
by family members in the home environment.4 Occasionally, this addressed to the main caregivers of people with diverse chronic
situation leads to a co-dependent relationship between the care- dependent conditions such as dementia and cancer.14,15 In a sys-
giver and the person being looked after, leading to further negative tematic review Zabalegui et al. (2008),13 classified these different
effects on caregivers such as deterioration of physical and mental types of measures into counselling, educational, psychoeduca-
health, economic difficulties and a breakdown of the caregivers’ tional, multicomponent or breather. Content and educational
social relationships.5e7 Caregiver depression, stress or exhaustion methods vary from study to study with psychotherapeutic and
increases the risk of institutionalization of the care recipient.8 psychoeducational programs implemented most frequently.16 The
majority of these interventions are designed to ameliorate the
emotional and physical consequences of care provision such as
Conflict of interest: None. levels of burden, anxiety and depression, and have shown moder-
* Corresponding author. Tel.: þ34 932275400. ate or significant results.17
E-mail address: galisteo@clinic.ub.es (M. Galisteo).

0197-4572/$ e see front matter Ó 2016 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.gerinurse.2016.06.001

terventions and care of dependent elderly people. who needed help for activities of daily living (ADLs). including caregivers’ self-care. were consecutively selected at The INFOSA intervention the time of the patient’s admission to a hospital geriatric unit be- tween 2008 and 2009 and randomly assigned to an experimental or The psychoeducational intervention. Zabalegui et al.1%) agreed to participate. psychiatrists and psychologists recognized by Unit. 32 in the experimental caregivers do not have time to attend psychoeducational programs group and 24 in the control group. A total of 56 informal caregivers of elderly dependent adults over 65. 2). The intervention turn home or enter another long-term care facility (LTCF) following was specifically designed for caregivers of individuals with or referral from the reference hospitals’ acute units.19 with an error of 5% and a power of 90%. physicians. In addition. 96 taken care of at home and institutionalization is considered to (43%) caregivers were identified as candidates to participate in the be caregivers’ last resort. individuals who had been discharged from La tion techniques and how to deal with aggressive or irritable Albada Socio-health Unit or those with a life expectancy of less than behavior by care recipients. min sessions that took place over 8 weeks (Fig. toileting. 20 participants did not complete the psychoeducational population.and long-stay Funding and Research (Agencia de Gestió de Ajuts Universitaris i de patients who need rehabilitation before being discharged to re. without cognitive impairment and can be adapted to distinct terviews were carried out to ensure that candidates met all the educational and training levels. anyone who shops various aspects were covered. Care. A. it was signed by their surrogate decision comparing efficacy at baseline assessment with efficacy post. We included caregivers The INFOSA content was delivered in small groups of ICs in older than 18 years who took care of elderly patients (above 65 workshops led by a nurse with expertise in educational in- years) at home following discharge from an acute hospital.19 the most difficult insomnia. intervention and at six-month follow-up. / Geriatric Nursing 37 (2016) 426e433 427 During intervention Post I Post II n=20 n=20 n=25 Nursing home discharge: n=3 Care recipient death: n=6 Care recipient death: n=23 Employee with no free-time: n=13 Discharged to home: n=11 Nursing Home discharge: n=2 Unwilling to participate: n=2 Caregiver mental disease: n=2 No reason: n=1 No reason: n=1 Familial problem with caregiver: n=1 Not want to leave patient alone: n=1 Fig. In these work- givers with any physical illness or mental disability. inclusion and none of the exclusion criteria. cognitive impairment. development of effective communica- who lived in an LTCF. the con- The main informal caregiver was defined as the person tent and reliability of the intervention was validated by the responsible for providing homecare who received no financial Dependent Elderly Persons Care Group (CGGD). Recerca de la Generalitat de Catalunya. anxiety and considered to be. givers. The setting was La Albada Socio-health nurses. 2008. Reasons for withdrawal. providing specific Participants were assigned to the experimental group (39) and the information and education on the care of the dependent elderly control group (37) by simple randomization. the study was approved by the Methods Research and Ethics Committee at Corporación Sanitaria Parc Taulí. Psychoeducational programs focused on caregiving have to be A total of 223 interviews were carried out to identify the care- adapted to Mediterranean countries where patients want to be givers that met the selection criteria. which is part of the Corporación Sanitaria Parc Taulí de the Generalitat de Catalunya Agency for Management of University Sabadell (Barcelona). All participants provided written informed consent. of tailored programs for this (Fig. givers. The aim of this study was to assess the efficacy of a psycho. designed to provide: (i) information aimed at improving the care- giver’s knowledge. (iii) emotional support. . 23 care- to be implemented before the patient is discharged from hospital. Personal in. was control group through simple randomization. had previously taken part in a similar study and those with literacy medication in patients with dysphagia. problems were excluded from the study. In An experimental. Following the interviews. according to the literature. called INFOSA. makers. there are difficulties in implementing the program in the sessions could not complete the questionnaires. 1. as far as we know. Therefore.17 More. INFOSA has post-intervention assessment carried out 6-months later. respond to the cultural values of these countries. Following the recommendations of the World Medical Associ- ation Declaration of Helsinki. social dysfunction. following a literature review.18 The INFOSA program was designed to INFOSA program. (ii) training intended to develop practical skills for the care of frail. convenience-sampling study was used to cases where those receiving care were unable to sign due to assess the efficacy of the INFOSA psychoeducational program. 10 from the experimental and 13 from the control group. Caregivers of individuals hygiene. The program consisted of weekly 90- six months were also excluded from the study. Design Care recipients also provided signed informed consent in case the caregiver agreed to participate at the INFOSA intervention. although only 76 (34. Subsequently. the experimental group who completed the psychoeducational over. The Participants program was developed. mobility. leaving 56 caregivers in the study. AGAUR). elderly persons and. This centre admits medium. 1). educational program with respect to degree of psychological Sample size calculation was performed based on what is burden. abandoned the study. nutrition for the elderly. 2 participants from while they are taking care of the elderly person at home. consisting of compensation for this role. The Informal Caregivers (ICs) report showed that sessions. For diverse reasons person and the lack. During the community due to limited social resources. psychological distress (somatic symptoms. and depression) and perceived social variable to modify which is the degree of burden among care- support in the main caregivers of elderly dependent individuals. by expert nurses with relevant expertise in the field.

428 A. The degree of depen- dence was classified as minor (scores from 60 to 95). The Barthel Index.00 collected at the beginning of the study. For care recipients.47 to 1. The cut-off was set at 3 errors to differentiate cognitive impairment from no cognitive Measures impairment with a sensitivity of 55% and specificity of 96%.21 on the following variables were collected: age. Regarding caregivers. TAU consisted interviewer. completed by the personnel while the control group received TAU only. validated instruments suited to the study The Zarit Burden Interview population. All sessions were led by the same nurse to control possible variability between groups. The experimental group met in the geriatric unit in sessions Barthel index of ADL attended by a maximum of 5 caregivers. Zabalegui et al. and general knowledge. Psychoeducational program contents. degree of physical dependence based on the Barthel Index.23 The efficacy of the INFOSA psychoeducational program was assessed through reliable. data and intrarater values range from 0. consists of 10 ADL related to self-care and mobility of traditional care activities. A score of 100 indicates that the individual is totally independent. the original version by Mahoney addition to treatment as usual (TAU) from the unit’s health and Barthel (1965)20 was used. The Pfeiffer’s score records the number of errors. The care Socio-demographic variables recipient was considered to be totally dependent when the BI score was below 20. 2. and mental status The cognitive level of care recipients was evaluated using the measured using the Pfeiffer Test. of 5e15 depending on the item measured. / Geriatric Nursing 37 (2016) 426e433 Fig. civil status and employment situation. gender. moderate (scores from 40 to 55) and severe (scores from 20 to 35). and information provided on patient with scores ranging from 0 (total dependence) to a maximum score or IC demand. and information on the Pfeiffer questionnaire reason for admission to the geriatric rehabilitation centre. Pfeiffer questionnaire. on completion of the INFOSA program and at 6-month follow-up in The degree of caregiver burden was evaluated through the both the experimental and the control groups. remote memory. Measurements were taken prior to the intervention. educational level. The To assess the degree of physical functionality and autonomy of experimental group received the INFOSA intervention program in the care recipient to carry out ADL.97. the variables recorded were: age. Socio-demographic variables associated with care were Interrater reliability mean Kappa values range from 0.84e0. gender.22 This consists of 10 questions covering orien- tation in time and place. Zarit Burden Interview (ZBI) using the adapted Spanish version .

5: Characteristics and impact of caregiving. with a sensitivity of 77% and Impact on health 5.9  8. More than half of the care recipients were men with a mean age the second immediately post-intervention (post-test I). the INFOSA program in the experimental group and included.5) Perception of health 5.23 Social dysfunction 3.6) Data analysis No burden 9 (16.0.27 The Duke-UNK is self-administered and has 11 items Yes 15 (26. the majority had primary education.8) used. 46.71  11.25 No 7 (12. the first at baseline (pre-test). The care re.3 years. The scale has two dimensions. 1 for each item. The GHQ-28 is a self-administered questionnaire with 28 Do not know 4 (7. Each question Formal aid 21 (37. and the of 81.24 The ZBI is a self-report measure Table 1 consisting of 22 items with scores ranging from 1 to 5 (1: never.66 dependence).9) To assess the degree of psychological distress in caregivers. and perceived social support).3) confidential (confidant support) and the affective (demonstrations No 16 (28. the post-intervention evaluations carried out showed respect to care history. No care recipients are shown in Table 2.6% in the control group were retired or were housewives.5) House cleaning 4 (19. Similarly. educational level.8 years.7) 1e3 years 7 (12.02  2. >3 years 29 (51.1) No 10 (16.5%).26 The cut-off point indicating No 12 (21. as the independent variable. the Social relationship changes Yes 36 (64. / Geriatric Nursing 37 (2016) 426e433 429 developed by Martin et al.4) questionnaire in the Spanish version adapted by De la Revilla Reducing working hours et al. Moreover. The mean age of included caregivers. 60% of caregivers in the experimental group and 41. those related to the outcome (burden. indicating severe cognitive impairment. Zabalegui et al. over half of the caregivers (52%) had spent differences with respect to baseline values and the level of burden more than 3 years taking care of their elderly family member. revealed total dependence in the elderly by group experimental group (12. the Institutionalization attempt Yes 9 (16. The most frequent cause of admission to the health centre was a Results new.8) Voluntary care General health questionnaire (GHQ-28) Yes 46 (82.5) 56 is classified as severe. Analysis most of the caregivers received help from another family member.9% in the experimental third at 6-month follow-up (post-test II). cipients’ baseline scores were also included as covariables. the use of Results expressed as mean  SD. Group comparisons were con.7 equal to or less than 46 represents an absence of burden.5  7. nearly always) which provides a global assessment of physical and Total n ¼ 56 psychic health. All study participants received differences were found in dependence and cognitive scores when help from family members. (C) social dysfunction and (D) depression.1) items grouped into four subscales: (A) somatic symptoms.3% in the control group were widows or widowers. 0. A total score lower than Do not know 4 (7. caregiver health. the vast majority was married (70%) and had completed primary education (37. To calculate the subscale scores and general House cleaning þ care 2 (9. Regarding civil status.4) psychological morbidity was set at 5/6. (1996). social activities and economic resources. degree of Social support (Duke-UNK) 35.11 Social support questionnaire (Duke-UNK) Medication Yes 24 (42.8) with scores ranging from 1 to 5.5  2. Somatic symptoms 3. we used a method based on assigning Informal aid 23 (41.1) has four possible responses. (1991).36 ducted through the covariance analysis statistical model (ANCOVA) Anxiety 4. Levels of burden Interestingly. Assessment of the degree of physical functionality and autonomy required to carry out ADL.61  17.3). was carried out at three time-points. emotional distress.1) values of 0.1) Spanish version of the GHQ-28 adapted by Lobo et al. Zarit burden 62. with was similar in both groups before the implementation of the .6  2. between Years of caring 47 and 55 is considered moderate burden and equal to or more than <1 year 20 (35. was 60  14. group and 58. A.3) Moderate 11 (19. as the dependent variables.6  18) and severe in the control group (26  26.2) greater degree of social support. With However.02  6.1 Yes 49 (87.5) psychological distress scores.37 related to care (socio-demographic data.24 with adjusted non-parametric approximations for all variables Depression 0. where higher scores represent a No 41 (73.75  1. A score Dedication (hours/day) 16. As regards civil status.63  2.4) psychological stress.61  2. greater daily commitments in the experimental group.6) of love. Overall characteristics of the informal caregivers and dependent measured using the Barthel Index.9) No 29 (51.1) 32 represents a low level of perceived social support. acute episode of their disease.73 statistics software version 17. with higher scores indicating higher Patient care 15 (71. comparing the experimental and control groups in the follow-up 78% of whom were women.01 Severe 36 (64. (1986)25 was No 43 (76. (B) Shared care anxiety.4 We analyzed. affection and empathy) (Table 1). 1.5) specificity of 78%.8) Perceived social support was assessed through the Duke-UNK Do not know 3 (5. the Pfeiffer Test score in both groups was The baseline characteristics of the informal caregivers and the higher than 7 points.1) General psychological distress (GHQ-28) Analysis of study variables was performed using the IBM SPSS Total 12. With respect to assessment (post-test II).

3) intervention was implemented as intended by evaluating delivery. Unemployed 5 (15. The very last session of the intervention. Zabalegui et al.7) the control group.8) showed significant group differences.3 53. at the second.1%) of participants.1) 12 (50) Treatment fidelity Dependent elderly Age (mean  SD) 81.3) these differences.7%) consistently in each session by the same expert nurse and for each New disease emergency 15 (46. When burden was analysed post- expert nurse observed the techniques. had a beneficial physical and psychological ef- the groups. Confidence and satisfaction experimental group showed greater score changes than the control were measured through a questionnaire at the end of the group.4) 9 (37.5) 3 (12.9  7.158 and p ¼ 0. with a greater change in the Variables Experimental Control experimental group.6  13.09 vs 63.3) support in the experimental group. Informal caregiver Changes in scores in the social dysfunction subscale showed Age 59.8) 10 (41.7) same intervention intensity.5) Perceived social support Occupational status Business or similar 1 (3.1) 2 (8.3) 18 (75) intervention.3) 9 (37.1) 2 (8.5  7. ensuring that participants had the Widowed 15 (46.8) 2 (8. at the second evaluation (post-test II) both scores worsened. No formal education 10 (31.29).001 and p ¼ 0.028). <1-year 11 (34.5) Undergraduate 4 (12. Enactment of the intervention was assessed at post I and post II Emotional health assessment at home.8) When the depression scale was evaluated.6  18 26  26.5 vs 68.9) 14 (58. Married 24 (75) 17 (70. At the first time-point post- Male 6 (18. Female 14 (43.3) experimental group and an increase in the control group were Educational background observed.001) and in givers to assess their caregiving skills. train and Changes in score by subscale were similar for somatic symptoms provide emotional support to informal caregivers of elderly and anxiety. both of which were significant (p ¼ 0.8) 3 (12.4) 0 (0) Housewife 10 (31.5) 3 (12. with a lower level of social Academic 3 (9. Furthermore. There were recipient. While the score improved in the experimental group and worsened in the control group at the first Discussion post-intervention (post-test I) assessment.5) Secondary education 6 (18. a decrease in the Widowed 1 (3. i.2 Treatment fidelity was assessed to determine whether the Gender Male 18 (56.2 significant differences between groups at both post-test I and post- Gender test II (p < 0. Primary education 12 (37. Receipt was measured based on evidence of knowledge and Results expressed as mean  SD or n (%). At the end of each session the participants were asked to demonstrate their theoretical under- standing or asked to perform their new skills acquired while the intervention (62.6 13  8.2) 14 (58. Thus.5) 1e3-year 4 (12. / Geriatric Nursing 37 (2016) 426e433 Table 2 control group (p < 0. . Care assistance Yes 24 (75) 20 (83.1) 1 (4. although there were no significant differences Care duration observed when the groups were compared (p ¼ 0.3) improved in the experimental and worsened in the control group.1) 10 (41.054).1  7.2) Pre-intervention evaluation using the Duke-UNK questionnaire Employee 4 (12. with a larger change in the Study results confirmed our initial hypothesis that the INFOSA experimental group than in controls. The same teaching protocol was applied accurately and Exacerbation disease 10 (31.001). intervention. respectively).01) evaluation.2%) 4 (16.3) same number.5) 11 (45.9%) 13 (54.28 Marital status Delivery was based on evidence that all participants had the Married 17 (53. the 6-month (p ¼ 0. designed to inform.9 shops.6) 2 (8. at the second assessment (post-test II). post-test II. skill acquisition after each session. the difference was not significant (p ¼ 0.3) reduction but with a bigger change in the experimental group.973).3 The sessions were structured in theoretical sessions and work- Pfeiffer test 7. However. Also a self-report questionnaire was completed by care- significant changes in scores at post-intervention (p < 0. these differences were not statistically sig- group n ¼ 32 group n ¼ 24 nificant (p ¼ 0.8 83.9  14. Although the confident they were in applying them.102) (Table 2). scores were lower in the experimental and higher in Marital status the control group. frequency and length of sessions in the intervention Reasons for patient admission Overall health deterioration 7 (21. post-test I scores showed opposing changes in dependent people. Although post-test I scores Retired 9 (28.6 (p ¼ 0.5) these differences were not maintained at post-test II (p ¼ 0. diminishing in the experimental and increasing in the fect on informal family caregivers. The expert nurse asked caregivers to make some of the caregiving techniques learned during the intervention Psychological distress (Global GHQ-28) results prior to the to demonstrate they used them correctly at home with care intervention were similar in both groups (Table 3). Barthel index 12.6  3 7.001). This trend was maintained at the second time-point. both groups showed a score Unmarried 6 (18.9%) 7 (29.5) 9 (37.1  2.2%) program.29).3) improving in the experimental group and worsening slightly in No 8 (25) 4 (16.876) (Table 4).. psychoeducational intervention.3) 8 (33. the assessment strated that they had understood and improved their caregiving conducted at the second time-point. showed a skills by asking them to perform the new techniques and how reduction in degree of burden in both groups.e. although both scores improved Baseline characteristics informal caregiver and dependent elderly by group.5) >3-year 17 (53.5) Other 1 (3.148.8) 6 (25) Female 26 (81. were not significant Time spent caregiving everyday 20.7) receipt and enactment. However. compared to baseline values.430 A.1) 3 (12. the degree of burden was significantly lower in the intervention was a workshop where all the caregivers demon- experimental group (56.

53 (1. through this INFOSA intervention.29.73 (2.53 (2. This was received extensive training in coping strategies.35.35) 0. there was a significant training sessions on physical care skills and management of reduction in levels of burden.65) 2.63 (2.36) 0.88) 0. / Geriatric Nursing 37 (2016) 426e433 431 Table 3 Changes in general health questionnaire (GHQ-28).85 possible helps to reduce the institutionalization of dependent Encourage leisure activities 4. Looking after the person at home for as long as Economic aid 5. the content and the methodology of the sessions were imparted in the socio-health centre.93) <0.89) 0.68) 12. Pre-test Post-test I Post-test II E (n ¼ 32) C (n ¼ 24) E (n ¼ 30) C (n ¼ 24) p E (n ¼ 20) C (n ¼ 11) p Total GHQ-28 Total score 11.001 D score e e 4.001 1.9 (4.35) 4.84 cultural values.33.09 (3.64 (1.13) 1. no clin.001 2. in turn.88) 0.4 (0.4 (1.98) 0. Results expressed as mean (SD).33 (2.1) <0.95 (2. made it a mediumehigh Regarding the efficacy of the INFOSA psychoeducational pro- intensity intervention with a special focus on skills training. A meta-analysis by Sörensen et al.34 others at home to assist with activities of daily living when they are Non-professional aid 6.09 (5. with average scores short-term.17 (1. Post-Test I: Immediately Post-Intervention Post-Test II: Post-Intervention at 6 months.63) 0.35) 1.17 (2.1) 14. nursing professionals conducting the sessions sults suggest that the intervention was beneficial.06  3.4 (1. indicating the INFOSA was longer period of time would have helped to maintain the efficacy in very well accepted.17) <0.21 (2.5 (6. Thus.4 (1. in contrast with (2002)31 found similar results and showed that the effect lasted for the prevalence of depressive symptomatology found in other up to seven months.37) 0.17) 0. fects of the interventions were moderate but significant in the The Zarit scale showed severe burden. mains as to whether an extension of the INFOSA intervention over a only one caregiver voluntarily withdrew.48) þ0.21  3.58 (1.31) 4.012 6. ranging program was well adapted to the study population.93) 0.17 (0.30 gram for informal caregivers of dependent elderly people.63  3. the INFOSA intervention could be optimized.71 unable to care for themselves.17 With the results a greater number of withdrawals. social dysfunction and anxiety.69 Our society currently lacks the social resources required. The INFOSA intervention places Emotional support 6.4) <0.001 0.23 (6.93) 4.37 As the efficacy of INFOSA was only maintained in the long-term Despite the high percentage of lost-to-study participants.69 (1. including personal hygiene or mobility. bearing in mind that all obtained in this study.04  3.001 Somatic symptoms Total score 3. A. ically relevant levels of depression were revealed.18 (0.02 D score e e 1.85  3.2) 0.64 (2. most (6 months) for a decrease in social dysfunction. Results expressed as mean  SD.27 (1. control and especially true bearing in mind that the caregivers in the experi- problem-solving skills.13 (2.028 Depression Total score 0.11) þ2.034 2 (2. It was observed provision.1 Help to work 2.29.15) 3.39) 0.02 2.94) 0. Zabalegui et al.56) 0.84 (2.001 D score e e 0. Moreover.83 (1. the ef- hours devoted to care provision each day.81 (6. including financial and social support for ICs.29 (6.82) 0.15) 0.973 E: Experimental group.74  3.54 (0.68) þ0.78 elderly people which. between 6 and 10 per informal caregiver.55 (0. primary care.45) <0.42 (2. Pre-Test: Pre-intervention.33 As we have shown. has an impact on health costs. tive communication and the self-esteem of the main caregiver.25 (2. The design of the INFOSA program was based on the needs of the which were too long29. The number of sessions. Table 4 Strong community and family values exist in Spain and other Rating aids available.2 (3. clinical trials published between 1996 and 2006 designed to assess the prototypical caregiver was a middle-aged woman with a the efficacy of a variety of interventions in caregivers of dependent considerable degree of “objective burden” related to the number of people over 65 years old.001 6 (6.39 the intervention is underlined by the fact that caregivers continue to suffer social dysfunction in the long-term while their perception of social support worsens.97) 1 (1.158 Anxiety Total score 4.7 (5.42 had caregivers and on published recommendations. (2008)17 in a meta-analysis of 15 randomized similar to those found in previous studies. reducing levels of depression. There was also a focus on asser.16  3.92 (1. more of the evaluated fields in the long-term.91 (2.30 Through this approach.17) 3.88 (2.8 special emphasis on maintaining and focusing on these important Disease information 5.89) 0.54) 3.87) þ0.16) 3.92) 7.33 (0.04) 0.41.38.14) 2.8 (2. it was explained by the added stress experienced by the caregiver due to observed that the INFOSA program proved to be a useful tool for the hospital admission of their family member. The need to extend terventions in which contact with the caregiver was scant.001 D score e e 1. and received that.004 1.87 (1.76 Care skills training 5. C: Control group. These results were in accordance with those published by The characteristics observed among of the caregivers were Zabalegui et al.32.76) 10. Numerous studies indicate that those in. disruptive and agitated behavior.7) <0.001 1.014 D score e e 1. to adequately care for .5 (0.93) 0. studies. the question re- were due to the death or institutionalization of the care recipient.40 or had many assessment points.62) 0.148 Social dysfunction Total score 2. According to this meta-analysis. Mediterranean countries where people look after their significant Professional aid 7.22) 4.096 0. our re- Furthermore.9 (2.35. although these positive effects diminished over time.1) 0.44 (2.27 (2.48) 3.38 Our data could be clinically relevant levels revealed prior to the intervention. With respect to depression.51  3. although there were no higher than those reported in prior studies.34.88 (1.05) þ0. mental group were taking care of elderly individuals with higher givers worked with elements related to specific knowledge of care dependency levels than those in the control group.

according to sampling calculations. Teixeira MJ. et al. Int J Nurs Stud. Help Wanted? Providing and Paying for Long-term Care. There is also the problem of 10. although some interventions showed carried out by the members of the “Cures a la Gent Gran Depen- small but significant long-term effects on some variables. degree of burden for a period of time longer than six months Agency for manegement of University funding and Research without significant benefits being observed over the long-term. Cabrera E. J Am Geriatr Soc. 2008. 2011. 2008 May-Jun. Gaugler JE.1. 2007. study during follow-up was high. the follow-up period did not allow us to 14. et al. Caregiver burden-a critical discussion.22(11):1110e1114. Llena-Nozal A. it was a clinical trial chiatry. for Nonprofessional Caregivers of Individuals with Dementia: Veterans Health Administration-evidence-based Synthesis Program. Izal M. A sys- of principal caregivers. Sorensen S. despite the initial availability of the required number of subjects 11. (Agència de Gestió d’Ajuts Universitaris i de Recerca de la Gen- It is well-known that main-caregiver burden is the most difficult eralitat de Catalunya. family centred care. bility which led them to decline to participate in the follow-up Nurs Sci Q.68(7):1077e1081. 2005. 2005.doi. Enferm Clin.62(2):126e137. content. interventions are 1965. http://dx. Correlates of physical health of informal caregivers: a meta-analysis.pdf? odology and suitable assessment instruments. skills reported by ICs. Harding R. 15. dation of the INFOSA program. Crespo M. Freeman M. 9. Physical and mental health effects of family caregiving. participated in this process. Teixeira HJ.org/10.19(1):72e80. 1988 Jul 1. (2010)43 published a meta-analysis of ran. Zabalegui A.14:56e61. OECD Publishing. caregivers. Efficacy of interventions aimed at the main carers of dependent individuals aged more than 65 years old. Int J Geriatr Psy- Our study had some limitations. caregiving on institutionalization. most studies use measures of burden to assess the efficacy of these interventions. this type of sample facilitated access to participants. . Regoyos S. Kane RA. Functional evaluation: the Barthel index. As recommended by 22. 2004. In view of this dearth of re. Márquez M. 5. 2013. Navarro M. Mercier J. Paula R.42 8. Pfeiffer E. Secondly.27:792e803. Phys Ther. Ageing populations: the challenges ahead. Bove RA. Madrid: Ed.15(4):199e205. Rev Neurol. Silva AL. organic brain deficit in elderly patients. Portland. the INFOSA intervention was designed according to the 3. Available at: characteristics and needs of the participants. The needs of informal caregivers of factor that older patients were not used to health professionals elderly people living at home: an integrative review. et al. revealing a need for further Nurs. Vico MV. No Exp: 2009 SGR 916. 2009. care provision has on caregivers but.45 nurses need to promote person. shown to be effective in reducing the negative repercussions that 20. 2008 Apr.int/iris/bitstream/10665/186463/1/9789240694811_eng. Christensen K. Research group recognized as variable to modify and where interventions have least impact.43(3):157e166. Losada A. which is one of the 2. Scand J Caring Sci. Okamoto K. 2010. despite evidence of a slight 6. Md State Med J.1016/S0140-6736(09)61460-4. of burden. Cuidados a las personas mayores en los hogares españoles. This is further References complicated by implementation of numerous interventions with methodological deficiencies with respect to aims. required which are more methodologically rigorous and durable so 21. importantly. Colombo F. 13. results were inconclusive.doi. 2007 Feb. Leisure and distress in caregivers for As regards the level of social support perceived by the care. Kane RL.44 Psychoeducational intervention programs have been Pirámide: Cuidarse para cuidar. Pinquart M. Arch Gerontol Geriatr. OECD Health Policy Studies. We are especially grateful for the work searchers demonstrated that. using inappropriate assessment instruments. A short portable mental status questionnaire for the assessment of Capezuty and Hamers (2013). This may be due to the cultural 12. Finally. Eficacia de dos inter- main limitations affecting evaluation of the programs. Rev Esp Geriatr Gerontol. 2005. Lancet. Gerontologist.doi.17(1):63e74. The 7. Consequently. National Research and development and funded by the Carlos III hampering the detection and interpretation of effects over the General Subdivision Evaluation and the European Regional Devel- long-term. Rau R. 2007. Tjadens F. El estrés en cuidadores de mayores dependientes. Higginson IJ. show 4. Freitas S. Zabalegui et al. 19. Ubiergo MC.org/ selection or the type of intervention. elderly dependent person to the socio-health centre. which could lead to selection bias. Doblhammer G. integrated into efficacy of the intervention for a period longer than six months. 2007 Nov. Reliability of the modified motor assessment scale and the Barthel index. This consolidated in Catalonia as “Grup de Cures a la Gent Gran is one of the reasons why the literature suggests that.who. What is the best way to help caregivers in cancer and cacy in the long run in more variables. World Health Organization. The authors would like to express their gratitude to the care- domized clinical trials that evaluated the efficacy of interventions givers for their dedication and effort.38(8):701e708.30 In our venciones psicoeducativas para cuidadores de familiares con demencia. improving social or physical func. study. http:// dx. beyond the scope of this study. Given these results and bearing in mind the alarming aging 16. families to keep their elderly relatives at home for as long as 18. Psicothema. Goy E. Pérez G. World Report on Ageing and Health. Losada A.36. Vaupel JW.45:78e89. improvement in the experimental group in the short-term. Newcomer RC. Madrid: IMSERSO.50(3):431e441. Bastawrous M. Harasawa Y. Governments are currently encouraging tematic review. OR: Evidence-based Further research is required to assess whether implementing Synthesis Program (ESP) Center. El soporte de enfermería y la clau- possible and this would imply a need for greater support for dicación del cuidado informal. along with those for anxiety and depression. Reyes R. similar trends and demonstrate short-term positive effects. Crespo M. cover the needs 17. López J. Caregiver psychological characteristics predict discontinuation of care for disabled elderly at home. Mahoney FI. http://apps. Zabalegui A. such as dent” research group and for their part in the creation and vali- acquiring coping strategies. 1975. the INFOSA program with follow-up activities could maintain effi.1093/geront/45. interventions that. and to the professionals who for caregivers of people with oncological illnesses. Clay T.78. the number of subjects lost-to- http://dx. 2015.432 A.21(2):166e172. or reducing anxiety. Firstly. interviews. 2003. using a convenience sample. with rigorous meth. there was only one study that evaluated the opment Fund (ERDF). Hasebe Y. givers. Interventions for caregivers of older and dependent adults: a trend in our population. studies evaluating this variable. In addition. even though Dependent”. with caregivers being included at the time of admission of the 10. Rodriguez E. López J. IMSERSO. the INFOSA intervention helps to enhance these capacities and encourages IC self-care to avoid illness brought Acknowledgements on by care provision.org/10.108(S9):23e27. Kansagara D. only 24% of the studies evaluated the This study was funded by the project PI09/0111. J Gerontol B Psychol Sci Soc Sci. Schulz RS. 2010. it may not be the most valid indicator. A Systematic Evidence Review of Interventions determine how long the beneficial effects persisted. The effects of duration of Nevertheless. AGAUR).374(9696):1196e1208. Northouse et al. Loewen SC. Pa Med J. Barthel D. Rodriquez E.50(3):347e350. levels ua¼1. interviewing them at home and may have felt a sense of vulnera.23(10):433e441. / Geriatric Nursing 37 (2016) 426e433 dependent elderly people at home. it is essential to increase these types of review. Portland VA Medical Center. Montorio I. Am J literature shows contradictory results. Anderson BA. that long-term results can be optimized. sample 1. These re. tioning.1787/9789264097759-en. particularly when looking after older adults sources to facilitate care at home and improve the poor caregiving and their family caregivers. Informal caregiving: perceived needs. elderly patients. palliative care? A systematic literature review of interventions and their effectiveness. Perez A. 2013.

García L. González MF. Health Psychol. Adaptation to our environment of the Zarit 55e61.43:532e546. Gómez RM. interventions for dementia caregivers: 2-year outcomes from the REACH study. . caregivers? an updated meta-analysis. Reducing anxiety in Alzheimer’s disease family 31.43:490e496. et al. Duncan-Jones P.40(suppl 3):30e39. Primary care 30. Losada A. 2005. caregiver burden interview. Sánchez A. Gitlin LN. Validation of a functional social support scale for use in the family 38. Family function 42. Salvadó I. Cancer J Clin. Sustained benefit of supportive and the mental health of the career of the dependent relative. Rev Esp Geriatr Gerontol. Comparison of two brief tests of organic brain impairment. adults.8(9):688e692. / Geriatric Nursing 37 (2016) 426e433 433 23. Porras N. 1991. De la Revilla Ahumada L. Dennis MP. Interventions with psychosocial program in Alzheimer’s caregivers: analysis of outcome at 1 year family caregivers of cancer patients: meta-analysis of randomized trials. Perspectives on how to improve the nursing care of older 2005. 2004.33:240e248. present and future of psychoeducational in. Gerontologist. Bellg A. Lleixá M. Gerontologist. relatives with and without dementia.6:338e346. Zhang L.19:117e123. Rev Esp Geriatr Gerontol. Gerontologist. Roth DI.146:55e61. Fleitas L. Francisco N. Montorio I.28(8):381e384. Aten Primaria. Hamers J. 32. 33.50(9):1153e1155. Effects of the behavior change consortium. 45. Boqué M. Enhancing treatment fidelity on health 2003. CA of follow-up.16(1):135e140. 2011. Prados MA. Gerontol. Alonso A. Nadal S. Rev Gerontol.doi. Nichols LO. 2002. Czaja SJ. 1996. Br J Psychiatry. Pinquart M. Evaluation of a psychoeducational 44. 2003. Int J Nurs Stud. terventions of family caregivers for dependent elderly people. 34. Effectiveness of a 43. Northouse LL. Martindale-Adams J. et al. OECD. J Am Geriatr Soc. Am J Alzheimer’s Dis Other Demen.J. Eisdorfer C. Capezuty E. technology-based intervention on caregiver depression. 695e701. http://dx. Borrelli B. anxiety and depression in family caregivers. 1980. Meta-analytic review of in. Galdona N. intervention for depressive symptoms in caregivers of patients with Alzheimer 2009. Goodchild ME. 2004. Zabalegui et al. de Dios Luna J. López J. Buiza C. 2013.40(3): 24. 2012. et al. Winter L. Knight BG. Matín MA. Toledano P. Resnick B. Yanguas JJ. Aten Primaria. Valdivieso A. behavior change studies: best practices and recommendations from the NIH 39. Validity of the scaled version of the primary career of an intervention carried out on dependent elderly people. Ostwald SK. Lobo A. Psychol Med. Aten Primaria. Lutzky SM. 2013. 41. Duberstein P. Gómez MA. Lummus A. Ferré C. Graney MJ. Aparicio MR.44: 27. López MJ. 2003. 37. 36. 40. Crespo M.40(3):40e45. 28. general health questionnaire (GHQ-28) in a Spanish population. Aten Primaria. Song L. intervention in the principal caregivers of patients with dementia (ALOIS org/10.161:850e856. Chronicity and the general health question. Hauck W. 2005.43:547e555. Gómez S. Stress and emotional status in the caregivers of older MSQ and the short portable MSQ. Martín M.41:621e628. 1985.40(3):46e54. Haley WE. Katapodi MC. Macofsky-Urban F. Garrido A. 2010 Sep-Oct. the 35. Sörensen S. Mittelman MS. Sevilla M.1787/health_glance-2013-en. terventions for caregiver distress: recommendations for future research. Delgado A. Orueta R. OECD Publishing. program) through a quality of life questionnaire. A. Health at a Glance 2013: OECD Indicators. 2004. How effective are interventions with caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. Impact on the 25. Rodríguez E. Artal J. Akkerman RL. Fillenbaum GG. Rev Esp Geriatr Gerontol. Corcoran M. 1986 Feb. Am J Psychiatry. Coon DW. Gerontologist.23:443e451. home environmental skill-building program on the caregiver-care recipient 29. Burns R. Losada A. Bailón E. Past. Pérez A. Effect of family therapy and doctor’s office. 26. Mood DW. 2005. Schinfeld S. Etxeberria I. dyad: 6-month outcomes from the Philadelphia REACH Initiative.42:356e372. Effectiveness of problem solving technique applied by nurses: decreased naire.60(5):317e339. 1993. Loewenstein DA. disease. Rev Esp Geriatr Gerontologist. Pérez-Echeverría MJ.43:521e531.