Efficacy of Nonpharmacological Interventions for Caregiver Burden and Positive Aspects of Caregiving Among Informal Caregivers of People With Dementia: A Systematic Review and Network Meta-Analysis.
TL;DR
Multicomponent interventions show the most effective evidence for reducing caregiver burden, whereas no clearly effective strategy was identified for enhancing PAC.
Abstract
Objectives
To systematically evaluate and compare the efficacy of nonpharmacological interventions in reducing caregiver burden and enhancing positive aspects of caregiving (PAC) among informal caregivers of inidviduals with dementia using network meta-analysis (NMA).
Methods
This systematic review and NMA followed PRISMA-NMA guidelines. Six databases (PubMed, Scopus, Web of Science, CENTRAL, PsycINFO, and CINAHL) were searched. Randomised controlled trials evaluating nonpharmacological interventions for informal caregivers of individuals with dementia were included. Outcomes were caregiver burden and/or PAC assessed using instruments. A random-effects frequentist NMA estimated standardised mean differences (SMDs) and 95% confidence intervals (CIs). Heterogeneity and inconsistency were examined, and treatments were ranked using P-scores. A sensitivity analysis excluding studies at high overall risk of bias was performed, and confidence in the evidence was assessed using CINeMA.
Results
Sixty-seven trials met the inclusion criteria; 43 studies were included in the caregiver burden network, and seven in the PAC network. Multicomponent interventions significantly reduced caregiver burden compared with control (SMD: -0.33; 95% CI: -0.63 to -0.04). Other interventions did not demonstrate statistically significant effects. Seven studies reported PAC outcomes. Because the PAC evidence was sparse and contained no closed loops, PAC findings were synthesised narratively without statistical pooling. Study-level effects varied across intervention comparisons and assessment time points, and the limited evidence was insufficient to identify an effective intervention.
Conclusions
Multicomponent interventions show the most effective evidence for reducing caregiver burden, whereas no clearly effective strategy was identified for enhancing PAC. Further research should focus on theory-driven interventions and standardised outcome measures.