Effects of Mind and Body Interventions on Family Dementia Caregivers: A Systematic Review

Family members caring for a loved one with dementia encounter a multitude of physical and psychological stressors. Current interventions address some of these concerns, but are not adequate to address the daily psychological stress that leads so many dementia caregivers to anxiety and depression. The current review selects empirical research from the past twelve years on the effects of mind and body interventions on family dementia caregivers and finds that, while intervention type varies widely, overall results suggest that MBSR and yoga-based methods implemented for eight weeks can have a beneficial impact on caregiver anxiety, depression, mood, stress, and quality of life. MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! ii Acknowledgements I would like to express sincere gratitude to my research chair, Robin Whitebird, PhD, MSW, LISW, for providing structure, firmness, timely guidance and warmth throughout the research and writing process. I am also appreciative of the wisdom, critical feedback, and encouragement provided by my other two committee members and mentors, Tanya Rand, MSW, LICSW, and Rebecca Lutt-Pournoor, MSW, LICSW. Finally, I thank my partner, close friends, and family for accommodating and supporting me through the balance of personal and academic commitments. MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! iii Table of Contents Conceptual Framework 2 . Mindfulness and Physical Health 4 . Mindfulness and Emotional Coping 4 . Literature Review 5 . Dementia 5 . Family Caregivers 6 . Caregiver Burnout 7 . Traditional Interventions for Caregivers 8 . Complementary and Alternative Interventions 9 . Mind and Body Practices in Therapy 10 . Mind and Body Practices 11 . Meditation. 11 . Yoga. 11 . Tai Chi. 12 . Mind and Body Interventions for Caregivers 12 . Methods 12 . Search Criteria 12 . Search Strategy 13 . MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! iv Data Abstraction and Analysis 13 . Results 14 . Table 1. Key Characteristics 14 . Table 2. Interventions 16 . Table 3. Results 17 . Discussion 19 . Limitations 20 . Cultural Considerations 20 . Implications for Social Work Practice 21 . Implications for Policy 22 . Implications for Research 24 . Conclusion 26 . References 28 . Appendix 35 . MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! 1 Dementia is a chronic, progressive condition currently affecting five million people in the United States, mostly adults ages 65 and older (Alzheimer’s Association, 2015a). The U.S. census predicts older adults will comprise more than 20% of the population in the next 15 years, nearly double the current rate (Ortman, Velkoff & Hogan, 2014). Dementia rates are also therefore expected to increase, as prevalence increases with age (Plassman et al., 2007). People with dementia require increasing levels of assistance with daily tasks as the illness progresses, and this help often comes in the form of a spouse or family caregiver. While caregiving can be a rewarding activity, it can also create significant stress, the effects of which can negatively impact both the physical and psychological health of the caregiver (Connell, Janevic & Gallant, 2001). Caregiver-specific stressors include shifts in family dynamics and changing role expectations, intimacy fluctuations, and financial strain (Mackenzie & Poulin, 2006). Depression, anxiety, overall morbidity and wellbeing have all been shown to be negatively impacted by caregiver burden (Roche, Croot, MacCann, Cramer & Diehl-Schmid, 2015). As this clinical population grows, the health community is challenged to find adequate interventions to mediate the effects of dementia caregiver burden for family caregivers. Current methods include psychoeducation and support groups, which have been moderately successful in reducing burden for caregivers. Schulz et al. (2002) and Selwood, Johnston, Katona, Lykestos, and Livingston (2006) have reviewed studies of caregiver interventions which address both psychosocial needs of caregivers and the environmental and pharmacological needs of care recipients, but have determined that while promising, many of these studies fail to produce MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! 2 outcomes that are clinically meaningful. In addition, these interventions are often problemfocused, which is only one element of the complex caregiver issue (Roche et al., 2015). Mind and body strategies including yoga, meditation, and Mindfulness-Based Stress Reduction (MBSR) have been recently introduced to the physical and mental health communities as effective strategies for teaching clinical populations how to change their relationship to stressors. This is especially key when stressors cannot be eliminated. Yoga has been shown to have a positive effect on remission rates and other psychological symptoms in patients with major depressive disorders (Butler et al., 2008; Shapiro, Cook, Davydov, Ottaviani, Leuchter & Abrams, 2007). Hurley, Patterson and Cooley (2013) have reviewed initial studies of meditationbased interventions on dementia caregivers and found statistically significant effects of reduction in psychological stress and overall burden, but they recommend further rigorous and large-scale studies before conclusive statements can be made. Indeed, even in the two years since Hurley’s review was published, several researchers have explored the effects of mind and body interventions, strengthening the body of literature on its clinical significance for dementia caregivers. Conceptual Framework In laying the groundwork for how we look at mind and body interventions as related to the caregiver population, it is important to note that a conceptual framework has not yet been developed to explain the underpinnings of mindfulness interventions; however, several researchers have begun to develop themes and a theoretical perspective. Hölzel et al. (2011) in particular have gathered together much of the research on how mindfulness works on both biological and emotional levels. MIND BODY INTERVENTIONS FOR DEMENTIA CAREGIVERS ! 3 The roots of mindfulness the most common element of mind and body interventions can be traced back to Eastern practices of Buddhism and yoga. A major tenet of Buddhism is the commitment to silent stillness, cultivating an attitude of non-attachment to stimuli. Additionally, Buddhism illuminates the intrinsic suffering involved with judging experiences and sensations as good or bad, desirable or undesirable. Meditation in the Buddhist tradition aims to guide practitioners toward a mind that is not judging, and is not in a constant state of striving or avoiding. The yogic tradition also places an emphasis on mindful awareness, both in stillness and in movement. Within the practice of intentional breathing and mindful movement through postures called asanas, stud