Supporting caregivers of people with dementia: A systematic review of guidelines

Caregivers of people with dementia (PwD) frequently experience poor physical, mental and social health. Over the past decade, several guidelines have offered recommendations on supporting caregivers to improve their health outcomes. This systematic review aimed to assess the quality and evidence base of guidelines on supporting caregivers of PwD and review the content of their recommendations on caregiver support to facilitate the adoption and implementation of a specific guideline among policymakers and practitioners. A systematic search for guidelines on supporting caregivers of PwD was performed using journal databases, websites of guideline development organisations and professional dementia-related societies from inception to 30 June 2020. Four independent reviewers performed the quality assessment of the included guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. A thematic synthesis was used to analyse the content of recommendations on caregiver support extracted from the included guidelines by two independent reviewers. The strength of recommendations and level of evidence were reclassified and analysed. Literature searches identified nine guidelines. Their quality was variable. The applicability domain on AGREE II yielded the lowest median score (62.2%; range: 18.6%-86.6%), suggesting that some guidelines lacked applicability in certain fields, leaving them open to interpretation. Most evidence underlying the extracted recommendations was rated as Levels 3 (51.3%) and 4 (31.1%). High-quality evidence is required to fortify these recommendations. The nine guidelines covered six themes-assessment, education, skill training, information provision, psychosocial support and general support policies-which can guide future policies and interventions of caregiver support. The recommendations extracted were consistent across guidelines, but each guideline failed to cover all six themes. Thus, more applicable and comprehensive guidelines that fully address all themes of support for caregivers of PwD are needed.