Caregivers and Care Recipients’ Health is Equally Critical Under the Pandemic.

Overview: We adapted our in-person depression intervention for caregiver-care recipient dyads into a virtual mode. While the intervention improved care recipients’ symptoms, it might have pressured caregivers as an additional caregiving task. This lesson taught researchers to acknowledge caregivers’ overwhelming tasks and further adjust the intervention to make it more enjoyable.Proposal text:

Background: Annually 11% of older adults (65+ years) suffer from depression (Steffens et al., 2009) and 5.5 million of them live with Alzheimer’s disease in the U.S. (Alzheimer’s Association, 2017). To alleviate these illnesses, we developed a novel six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for people living with dementia (PWD) and their family caregivers in 2018. We pilot-tested (Nf19 caregiver (CG)-care recipient (CR) dyads) and achieved positive results (Miyawaki et al., 2020). Encouraged by the outcomes, we expanded the study to include long-term care facility (LTCF) residents since the prevalence of depression and dementia is higher (15%) and examined the effect of C-PLR starting in 2020.

Methods: We developed the C-PLR as in-person activities, however, due to the COVID-19 pandemic, we adapted to virtual modes and began recruiting the study dyads. The eligible CGs were family members who cared for their CRs for >8 hours/week, complete a three-hour zoom training and six weekly Life Review (LR) sessions. CRs were community-dwellers or LTCF residents with mild depression and dementia. We collected sociodemographic data and pre- & post-measures on CRs’ depression, satisfaction with life and CG burden, positive aspects of caregiving, and dyad’s relationship quality.

Results: Between August 2020 and December 2021, we contacted 195 LTCFs, 29 senior and community centers, and 148 community-dwellers by phone and emails, and recruited 12 dyads across the nation. Out of 12 dyads, 2 (16.7%) are LTCF residents and 10 (83.3%) were community-dwellers. CGs were on average 54 years old, working (67%), college-educated (83%), female (92%), and in good-excellent health (75%). Most cared for their parent (83%). CRs’ mean age was 83, single (58%), female (92%) and in fair health (50%). CRs’ depression score significantly improved (p=0.0004), however, CG’s burden and positive aspects of caregiving scores worsened (p=0.02).

Conclusions: Amid the pandemic, we faced many recruitment barriers. LTCF closures, staff turnover, and technological disparities made outreach extremely challenging. Despite a small sample, we found CRs in both settings enjoy the LR activities resulting in fewer depression scores. Having been isolated in their homes or LTCFs, the LR activity allowed CRs to connect with their family members regularly, which made a positive psychological impact. On the other hand, CGs seemed to have experienced more burden. This could be the effect of fatigue from the long COVID environment (Czeisler et al., 2020), concerns for their CRs’ safety and health during COVID (Budnick et al., 2021), and the pressure they may feel from having C-PLR as an additional caregiving responsibility. Learning from these experiences, we should consider adjusting the pace of the dyads’ activity. Instead of a weekly visit, each dyad can meet at their own pace so that the LR activity can be more enjoyable for CGs as well. The C-PLR was developed to improve the health and depressive symptoms of vulnerable PWD and their caregivers. Thus, we need to consider both CGs’ and CRs’ physical and mental health capacity as CR’s wellbeing is often heavily dependent on that of CGs.