Specialist nurses are no more effective than conventional services at increasing dementia caregiver satisfaction or reducing their depression

Bunn F, Goodman C, Pinkney E, et al.  Specialist nursing and community support for the carers of people with dementia living at home: An evidence synthesis  Health and Social Care in the Community. 2015; doi: 10.1111/hsc.12189

Review question

What services can specialist nurses provide to support family caregivers of people with dementia, and are these services effective at improving the health and satisfaction of caregivers?

Background

The number of patients with dementia will increase significantly in coming decades, and many of these patients will live in their own home and be cared for by informal caregivers, such as a spouse or other family members.

Caring for a person with dementia may have a significant impact on the health and well-being of family caregivers, notably by putting them at increased risk for depression.

Community-care interventions delivered by specialist nurses known as “Admiral Nurses” in the U.K. are a promising means of providing support to informal caregivers.  

How the review was done

A number of electronic databases were searched for studies published prior to November 2012, with those focused on services provided by specialist Admiral Nurses included alongside studies focusing on the effectiveness of community-care interventions designed to support family caregivers of people with dementia.

A total of 3533 unique studies were identified in searches, and after screening for eligibility, 33 studies focused on specialist Admiral Nurses were included alongside 11 studies identifying the effectiveness of interventions designed to provide caregiver support.

This review was funded by Dementia UK.

What the researchers found

Services provided by Admiral Nurses included assessing caregiver needs, providing therapeutic interventions, and offering information, skills training and education.

There was no evidence that specialist Admiral Nurses improved caregiver health or satisfaction compared to conventional dementia support services, although both types of services appeared to lower distress in caregivers.

The evidence that psychosocial and educational interventions could reduce depression in caregivers was weak. However, caregivers were often reported to express high levels of satisfaction with community-based interventions.

Conclusion

There is no evidence that specialist nurses are more effective than conventional dementia support services for reducing distress among dementia caregivers. Community support programs, regardless of who delivers them, may increase caregiver satisfaction, but there was only weak evidence that it could reduce depression in caregivers. Further research should focus on identifying what specialist dementia nurses should reasonably achieve at different stages of the dementia journey, and which aspects of their role are most effective.