Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .
Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? A randomised controlled trial.
OBJECTIVES To determine whether a social support intervention ( access to an employed befriending facilitator in addition to usual care ) is effective compared with usual care alone . Also to document direct and indirect costs , and establish incremental cost-effectiveness . DESIGN The Befriending and Costs of Caring ( BECCA ) trial was a cost-effectiveness r and omised controlled trial . Data on well-being and re source use were collected through interviews with participants at baseline and at 6 , 15 and 24 months . SETTING This research was carried out in the English counties of Norfolk and Suffolk , and the London Borough of Havering . It was a community-based study . PARTICIPANTS Participants were family carers who were cohabiting with , or providing at least 20 hours ' care per week for , a community-dwelling relative with a primary progressive dementia . INTERVENTIONS The intervention was ' access to a befriender facilitator ' ( BF ) . BFs , based with charitable/voluntary-sector organisations , were responsible for local befriending schemes , including recruitment , screening , training and ongoing support of befriending volunteers , and for matching carers with befrienders . The role of befrienders was to provide emotional support for carers . The target duration for befriending relationships was 6 months or more . MAIN OUTCOME MEASURES Depression was measured by the Hospital Anxiety and Depression Scale ( HADS ) at 15 months postr and omisation . The health-related quality of life scale EQ-5D ( EuroQol 5 Dimensions ) was used to derive utilities for the calculation of quality -adjusted life-years ( QALYs ) . RESULTS A total of 236 carers were r and omised into the trial ( 116 intervention ; 120 control ) . At final follow-up , 190 carers ( 93 intervention ; 97 control ) were still involved in the trial ( 19 % attrition ) . There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population . The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds , with only a 42.2 % probability of being below 30,000 pounds per QALY gained . Where care-recipient QALYs were included , mean incremental cost per incremental QALY gained was 26,848 pounds , with a 51.4 % probability of being below 30,000 pounds per QALY gained . Only 60 carers ( 52 % ) took up the offer of being matched with a trained lay befriender , and of these only 37 ( 32 % ) were befriended for 6 months or more . A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance ( 95 % CI -0.09 to 2.84 ) . CONCLUSIONS ' Access to a befriender facilitator ' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia , although there is a suggestion of cost-effectiveness for the care dyad ( carer and care recipient ) . In common with many services for carers of people with dementia , uptake of befriending services was not high . However , the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls ( 95 % CI -0.09 to 2.84 ) . While providing only weak evidence of any beneficial effect , further research into befriending interventions for carers is warranted
Caution must therefore be exercised in interpreting results , but the case for investment in parenting and health visitor-related programmes appears most strong , especially when impacts beyond the health sector are taken into account .
In the workplace an economic return on investment in a number of comprehensive workplace health promotion programmes and stress management projects ( largely in the USA ) was reported , while group-based exercise and psychosocial interventions are of potential benefit to older people .