The Coping with Caring Program: a self-directed, evidence-based correspondence intervention for carers of older people with dementia

The Coping With Caring Program (CWCP) is an innovative, self-directed correspondence program to treat mood and stress symptoms in carers of older people with dementia. It is an evidence-based, multiple component intervention consisting of eight weekly workbooks designed to address the most common challenges faced by dementia carers. This research investigated whether a self-directed program such as the CWCP, which consists of workbooks delivered via post, is sufficient to reduce the risk factors associated with the development of emotional and psychological problems in carers, and enhance carers’ self efficacy and coping skills. The CWCP builds on the work of an existing multiple component community treatment program Enhancing Alzheimer’s Caregiver Health (REACH), which improved feelings of burden, increased social support and reduced depression in dementia carers (Burgio et al., 2009). The key difference of the CWCP is the use of a self-directed, correspondence-based intervention to address the negative symptoms associated with caring. Specifically, the aim of this body of research was to develop a multiple component intervention containing the elements necessary to meet the needs of carers in a self-directed correspondence format. Further, the present research sought to assess the efficacy of a self-directed correspondence intervention to reduce negative symptoms such as burden, low mood and anxiety, whilst improving problem solving and coping skills in dementia carers. Participants were 34 Queenslanders (Men = 9, Women=25) caring for a family member with moderate stage dementia. The mean age of participants was 68 years. Participants were recruited through advertising in newsletters, flyers, community papers, public noticeboards and websites, and through presentations to dementia associations and ageing interest groups. Participants were randomly assigned to one of two conditions (1) CWCP: a self-directed, correspondence intervention consisting of eight weekly workbooks and minimal telephone support or (2) Waitlist control: a comparison group who received educational, information only newsletters. When each condition was completed, participants then crossed over to complete the alternate condition. There were a number of improvements at post intervention. Carers reported improvements in care recipient behaviour and levels of sadness and irritation post treatment. Further, the results indicated significant improvements in participants’ overall affect and on subjective measures of hopelessness, happiness, and perceptions of feeling in control post treatment compared to the waitlist control condition. There were no significant effects at post intervention on objective measures of burden, depression, anxiety, strain or perceived positive aspects of care giving. This research provides important information regarding the viability of a self-directed, multiple component correspondence intervention as a treatment protocol for carers of persons with dementia experiencing emotional and psychological stressors. Further, the findings suggest the CWCP could be an effective, practical and inexpensive treatment solution with the potential for widespread dissemination. Potential reasons for the lack of treatment effects are discussed, along with implications for future research