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A Psychoeducative Group Program for Caregivers of Demented Persons Living at Home

Louise Lévesque, Centre de recherche, Institut universitaire de gériatrie de Montréal, Université de Montréal

Réjean Hébert, Centre de recherche sur le vieillissement, Institut universitaire de gériatrie de Sherbrooke, Université de Sherbrooke

This program entitled “Learning to Feel Better….and Care Better” (see Lévesque et al., 2002) is based on the work of Folkman et al. (1991) who developed a stress management intervention model based on the stress and coping theory of Lazarus & Folkman (1984). The program consists of fifteen 120-minute weekly meetings offered to a small group of caregivers (6 to 8/group). Its primary objective is to develop the ability of caregivers to cope as effectively as possible with their daily sources of stress. A participatory approach is used (discussions, written exercises, role playing) and a great deal of importance is placed on each participant’s own perception of the caregiver experience.

The first fourth sessions covers the key elements of the program (Folkman et al., 1991): to identify stressful situations with precision, to distinguish between the changeable and unchangeable aspects of a specific stressful situation and to ensure a tight match between the choice of coping strategy to use and the changeable and unchangeable aspects of a specific stressful situation (problem-focused coping to deal with changeable aspects and emotion-focused strategy for unchangeable aspects). The other eleven sessions are devoted to three coping strategies: problem solving (problem-focused strategy), reframing (emotion-focused strategy) and seeking social support (problem- and emotion-focused strategy). The intent of this program is to focus on coping strategies, helping to an awareness of the caregivers’ existing and potential abilities. Assignments that caregivers do alone at home are means through which coping strategies are learned and practiced.

The study was a multicenter randomized controlled trial (Province of Quebec). The results (see Hébert et al., 2003) showed significant and persistent decrease (8 months after the program) on the frequency of and caregivers’ reactions to disturbance of the cared-for person’s behavioural problems, together with a significant decrease on caregivers’ psychological distress at eight months (see Hébert et al., in press).

A qualitative process evaluation was undertaken to identify the primary processes of the program in order to better understand intervention outcomes. Participants learned coping strategies, with reframing playing a more important role than problem-solving or seeking social support (see Lavoie et al., 2005).

The results support recommending this new program to health organizations. This program can also be applied in individualized intervention during home visit or counseling.

Key search terms: Coping skills; Group training; dementia

Three documents are available into English or French: Facilitator’s Training Manual, Facilitator’s Workbook and Personal Workbook for caregivers.

Please write to: Louise Levesque louise.levesque@umontreal.ca

Mailing address : 4565 Queen-Mary Road, Montréal (Qc), Canada, H3W 1W5, Tel.: (514) 340-3540 (ext. 4771), Fax: (514) 340-3530. E-mail: louise.levesque@umontreal.ca.

3.Implementing the Intervention

Training qualifications and sessions for those delivering the intervention:

The group facilitators are specialized health clinicians (e.g., nurses, psychologists, social workers) who have experience in group facilitation and knowledge of the issues regarding family caregivers and persons with dementia.

Training sessions have already been given in Switzerland, Fribourg University. We estimate that three days of training courses are necessary for health professionals who wish to implement this program or are interested in integrating the elements of this program in their daily practice with caregivers.

4. For more information:

Hébert, R., Lévesque, L., Vézina, J., Lavoie, J.-P., Ducharme, F., Gendron, C., Préville, M., Voyer, L., & Dubois, M.-F. (2003). Efficacy of a pschoeducative group intervention program for caregivers of a demented persons living at home : A randomized controlled trial. Journal of Gerontology, Social Sciences, 58B(1), S58-S67.

Hébert, R., Lévesque. L., Genron, C., Vézina, J., Ducharme, F., Lavoie, J.-P., Gendron, M., Préville, M., & Voyer. L. (in press). The program “ Learning to feel better…and care better” for family caregivers of community-dwelling older persons with dementia. Revue québécoise de Psychologie.

Lévesque, L. Gendron, C., Vézina, J., Hébert, R., Ducharme, F., Lavoie, J.-P., Gendron, M., Voyer, L., & Préville, M. (2002). The process of a group intervention for caregivers of demented persons living at home: Conceptual framework, components, and characteristics. Aging & Mental Health, 6(3), 239-247.

Lavoie, J.-P., Ducharme, F., Lévesque L., Hébert, R., Vézina, J., Gendron, C., Préville, M. St-Laurent, C., & Voyer, L. (2005). Understanding the outcomes of a psycho educational group intervention for caregivers of persons with dementia living at home: A process evaluation. Aging and Mental Health, 9(1), 25-34.

Funded by the Alzheimer Society of Canada, le Fonds de la recherche en santé du Québec, le Réseau québécois de recherche sur le vieillissement and le Fonds québécois de la recherche sur la société et la culture.