Caring for the Alzheimer's caregivers

Researchers at the University of Houston Andy & Barbara Gessner College of Nursing have published a systematic approach to re-designing a structured life review intervention for patients living with dementia and have outlined the curriculum and teaching strategies developed to educate older adult caregivers. Life review is a natural process, occurring when individuals recall their past experiences, evaluate and analyze them to achieve a more profound self-concept.

For the more than 6 million Americans living with Alzheimer's disease—the most common type of dementia—life review therapy is found to significantly improve the quality of their lives. Research has shown life review to be effective in alleviating depression among older adults while also reducing caregiver burden and stress.

For most every patient who suffers, alongside them is a family caregiver providing oversight and care, but the caregiver's role in life review therapy has never been clearly defined and as the burden of the caregiver increases, so do the caregiver's losses. These losses may include disconnection from the community and society, lack of empowerment, loss of independence and psychological challenges.

Little research has been conducted to designate an effective life review intervention that reduces caregiver burden and extends the physical and cognitive function of people living with dementia.

Until now.

"Caregivers are vulnerable to losing their sense of purpose, closeness with their patients living with dementia, and feelings of mastery and gratification. Depression and the inability to engage in personal interaction with others outside the home are common issues that lead caregivers to social isolation. Caregivers are at risk for high levels of stress and caregiver burden," reports Cheryl Brohard, associate professor of nursing, in The International Journal of Reminiscence and Life Review.

In the article, Brohard and undergraduate student Yolanda Batz report the re-design and implementation of an adapted structured life review intervention for caregivers to facilitate with people living with dementia.

"Interventions such as the creation of Life Story Books have been linked to the improved mood of the patients and decreased caregiver burden," said Brohard. "Caregivers who were spouses of persons with dementia benefited from biographical reminiscence work, reported a sense of hope and enhanced interpersonal trust."

There were five phases in the planning and implementation of this modified intervention. These phases included a literature review, curriculum design, and caregiver training, weekly life review sessions, weekly feasibility sessions, and an evaluation.

"The caregivers found that they wanted more time to learn about each other in the training class. Minimal assistance was needed during the fidelity sessions, which the caregivers completed on a weekly basis while they facilitated life reviews with their care recipients over six weeks," reports Brohard.

Using the theoretical framework of a structured life review and principles found in ethical decision-making, sensitivity training, mindfulness, adult learning, and communication techniques, a blueprint for the curriculum was developed.

"In developing the curriculum for the life review training class, explicit learning objectives and content were designed to educate the non-health care professional on the process of conducting a life review," said Brohard.

"The impact of supporting caregivers and people living with dementia is vital to our teaching and nursing care," said Kathryn Tart, Founding Dean and Professor and Humana Endowed Dean's Chair of Nursing in the Gessner College of Nursing.

"The article supports the American Association of College of Nursing's domains for nursing competence outlined in the Essentials: Core Competencies for Professional Nursing Education. The article helps in guiding the sphere of supportive care in nursing practice and nursing clinical education."