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Health challenges

This paper presents the results of a trial evaluating the effectiveness of a community based intervention for persons with dementia and their caregivers. The study was conducted in Goa, on the west coast of India, and aimed to develop and evaluate the effectiveness of a home based intervention in reducing caregiver burden, promoting caregiver mental health and reducing behavioural problems in elderly persons with dementia.

Information about dementia was widely disseminated through handouts, newspaper articles and through private and public health services. Concerned relatives and older people were urged to contact a special help line. Probable cases of dementia were also identified with the help of key informants (doctors, priests, health workers, local leaders). All probable cases were examined by a trained clinician to confirm the diagnosis of dementia. The principal caregiver, as identified by the family, was enrolled for the trial. The principal caregiver was generally the spouse, although in some instances another family member was the principal caregiver, particularly when the spouse was not in a position to care.

The community based intervention was delivered by a Community Teams, each comprised of two full-time Home Care Advisors (HCA), and a part-time local psychiatrist from the public health services, and a part-time lay counsellor.

The specific components of the intervention carried out by the HCA were:

• basic education about dementia (what is the disease, its course, its features etc)
• education about common behaviour problems and how they can be managed
• support to the caregiver, for example for an elderly caregiver living alone with the patient, in activities of daily living
• referral to psychiatrists or the family doctor when behaviour problems are severe and warrant medication intervention
• networking of families to enable the formation of support groups
• advice regarding existing government schemes for elders

The authors conclude that this pilot trial shows that a community based intervention using locally available resources is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring and is associated with reduced mortality of the person with dementia. Larger trials are needed to demonstrate the effect of such an intervention with greater confidence.

In the context of the rising burden of dementia in developing countries which are witnessing a demographic transition, such community based interventions have considerable potential to improve the quality of life of the caregiver and the person with dementia.

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