Self-Management for Older Adults & Their Caregivers

G. Warner, S. Hutchinson, R.
Genoe and N. Geddes,
Special thanks to….
Robin Parker from Kellogg
Library for assistance in
conducting the database
Funded by…
Nova Scotia Health
Research Foundation
through a REDI team
development grant
What is known from the existing
literature about the delivery and
effectiveness of self-management
interventions for family
caregivers of older adults?
What self-management
components were included in
the identified programs?
What did these programs look
like? (e.g. participants,
duration, group versus
How effective were the
What types of selfmanagement programs are
Self-management programs
teach individuals not only to
medically manage their
condition, but also to manage
the psychological, social and
lifestyle dimensions
associated with living with the
condition. (Barlow, 2002)
 What is self-management for
unpaid caregivers who care for
a spouse/parent or friend with
a debilitating condition.
Where is the
1. Action planning, goal setting &
2. Caregiver self care & stress reduction
3. Decision support tools
4. Group education, coaching session
5. Individual education, coaching
6. Information via computer or
7. telephone or 8. video/audio or 9.
10. Peer group support
11. Problem solving
Must be an intervention
Must include family
caregivers, either alone or as
a caregiver /care receiver
Participant caring for
someone with an ongoing
condition (or limitations due
to aging)
Intervention described as a
self-management/selfcare/patient education
/empowerment program
Study published prior to the
year 2000
Intervention only delivered
psychotherapy or exercise
Delivered primarily as
inpatient/resident program
Care recipients ≤55
Databases Searched: Central,
Cinahl, Medline, Embase,
Cochrane from 2000 to 2012
Located 2227 sources
2 stages: Two individuals
reviewed 1) abstracts then 2)
full manuscripts
Conflicts discussed and
consensus decision
Extracted information using
NVivo and Excel
32 studies met inclusion
Number of Abstracts reviewed =2227
Included/Reviewed= 130 Excluded= 2097
Included after manuscript review= 42
After cross referencing by study = 32
Excluded after manuscript review= 88
Reasons: Study Design= 31
Participants= 31
Intervention= 21
Language= 5
Of the 32 studies examined:
Study Design:
 RCTs = 18
 Caregiver only = 17
 Dyads = 15
Delivery format:
 Individual/dyad = 17
 Group = 9
 Combination = 6
29 out of the 32 interventions
were disease specific
Alz Dis/Dementia = 17
Stroke = 5
Osteoarthritis = 2
Heart failure=2
Cancer = 2
Parkinson’s Disease=1
1. Won Won, 2008:Powerful tools for
caregiving (PTC)
2. Ducharme, 2011:Learning to be a
3. van den Heuvel ,2000: Group and
individual support program for caregivers
of stroke patients
4. Johnston, 2007: Workbook intervention
for stroke patients and carers
5. Gitlin, 2010: Advancing Caregiver Training
6. Glueckauf, 2007: Telephone-based
cognitive-behavioral intervention
 Self-management programs are most
commonly provided to only the
caregiver who is caring for someone
with dementia
 There are some care partner/dyad
interventions for persons with stroke
or chronic heart failure that look
 The sample size for some of the
studies was too small to see if the
intervention is effective, many were
pilots of planned RCTs
All 32 interventions had an education/
coaching component
Other components included were:
• Information delivered (written,
telephone, computer or video) = 28
• Addressed caregiver self-care or
stress reduction = 28
• Involved problem solving = 25
• Had action planning or goal setting
with follow-up = 18
• Included a peer group support = 9
Not possible to conduct a
meta-analysis because of
clinical heterogeneity:
Diverse conditions
161 outcome measures
used, of these 42 were
developed for the study
only ~50% had an RCT
1) Grouped individual
outcome measures by
general categories,
three most prevalent
categories were
 Psycho-social
 Self-care
 Physical health/fitness
2) Ranked results by:
 Statistically significant
 Positive results but not
statically significant
 No effect
The number of studies with
statistically results was not
substantially difference by :
 Delivery method – (in-person,
telephone, computer)
 Format – (group, individual, both)
 Location – (home, community)
 Duration of intervention – (< 6
weeks, 6-11 weeks, 12-20 weeks,
>21 weeks)
 Number of sessions – (< 5, 6 -10,
11-20, > 20)
 Number of self management
components (range 3 – 10)
In-person = 9
• Pros:
• If in home, convenient for caregivers
• Better for communication
• Cons:
• Time consuming for staff
• High cost to provider
• If in community not convenient for
Telephone = 6
Computer = 3
• Pros:
• Less disruption to care duties
• Low cost to caregivers and providers
• Easy to organise and participate in
• Can reach rural populations
• Cons:
• Can hinder communication
• Requires equipment and a connection
In-person +
telephone = 13
• Pros:
• More flexible for individually tailoring
the intervention
• Allows participants opportunity to
meet facilitator but convenience of
telephone access
• Cost effective
• Cons:
• None reported
 Self management programs had two
common objectives;
 teach caregivers self-care or selfmanagement principles and;
 provide information or education tailored to
caregiver concerns, usually related to the care
recipients health condition
Self-management programs are diverse –
conditions, change they hope to effect in the
participant, sometimes in conjunction with
exercise, outcomes
What is feasible?
 one-to-one in person can be high resources
 outside the home may be hard for caregivers
to access
 Telephone is cost efficient but may not be
acceptable for caregivers
 Combo of phone/in person may work the

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