Effectiveness of Interventions to Support Carers of People With Dementia in Low- and Middle-Income Countries: A...

Family and other carers of people with dementia can potentially benefit from training and support to reduce the negative impacts of caregiving and prevent harm to care recipients. While interventions for carers in low- and middle-income countries (LMICs) are emerging, their effectiveness is not well understood. Through a systematic review and meta-analysis, the objective was to evaluate the effectiveness of interventions to support carers of people with dementia in improving the well-being of carers and their care recipients in LMICs.

This review, registered with PROSPERO (CRD42018106206), built on a systematic mapping of dementia interventions in LMICs under the Strengthening Responses to Dementia (STRiDE) project. It analysed evidence on interventions to support carers in these regions. Title and abstract screening, full-text review, data extraction and risk of bias assessment were each conducted by two reviewers independently, with disagreements resolved through group discussion. Pairwise meta-analyses were conducted, with robustness tested via leave-one-out analysis. Heterogeneity was explored using subgroup analysis, meta-regression and MetaForest. Medline, Embase, Global Health and PsycINFO (via Ovid) and CINAHL (via EBSCO) databases were searched. We included randomised control trials focused on carer well-being in LMICs, 2008-2022. Primary outcomes were perceived burden and depression; other health-related quantitative outcomes were collected.

From 5228 records, 48 studies in English and Chinese were identified as eligible, reporting on 67 carer outcomes and 36 care recipient outcomes. Forty-one studies were at high risk of bias. Meta-analysis revealed statistically significant medium-to-large intervention effects on three key carer outcomes-perceived burden, depression, and anxiety-and on four major outcomes for people with dementia-neuropsychiatric symptoms, cognitive function, quality of life (QoL), and activities of daily living (ADL). These effects were larger than those typically observed in previous studies in high-income countries (HICs).

This review provides a comparative overview and summarises the characteristics of published interventions to support carers in LMICs. It reveals medium-to-large beneficial effects of the interventions on several key outcomes for carers and care recipients in LMICs. Future research employing more rigorous methodologies is recommended, particularly for broader and more diverse populations.