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Family Practice Advance Access originally published online on May 7, 2009
Family Practice 2009 26(4):279-286; doi:10.1093/fampra/cmp024
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Can pharmacological treatment of behavioural disturbances in elderly patients with dementia lower the burden of their family caregiver?

Birgitte Schoenmakers, Frank Buntinx and Jan De Lepeleire

Department of Public Health, Academic Centre of General Practice, Catholic University of Leuven, Kapucijnenvoer 33, blok J, box 7001, Leuven 3000, Belgium

Correspondence to Birgitte Schoenmakers, Academic Centre of General Practice, Catholic University of Leuven, Kapucijnenvoer 33, blok J, box 7001, Leuven 3000, Belgium; E-mail: birgitte.schoenmakers{at}med.kuleuven.be

Received 24 June 2008; Revised 17 February 2009; Accepted 29 March 2009.


  Abstract

Family caregivers of a community-dwelling demented relative experience significant burden in their caregiving role. In particular, behavioural disturbances are expected to be responsible for high caregiver distress and burden. Above, in ~80% of the cases, institutionalization of the demented patients with dementia occurs as a result of a burdened caregiver.

Because of the impressive disruptive character of behavioural disturbances, most caregivers appeal for pharmacological intervention at a given moment, expecting instant suppression of the aberrant behaviour. Beside the antipsychotic drugs, the cholinesterase inhibitors are commonly used in the treatment of agitation, aggression, delusions, etc. Although in meta-analyses on the efficacy of both categories of drugs, only little evidence of their efficacy has been found and an important placebo effect has been reported that >90% of the demented elderly was treated at least once.

The aim of this study was to investigate if pharmacological treatment of behavioural disturbances of the demented can lower the burden and the time spent in the family caregiver irrespective of their effect on the demented himself.

A systematic literature search was performed by means of Medline, Embase, Cochrane DSR, Dare, CCTR and ACP Journal Club.

Based on this review, pharmacological treatment of demented elderly seems to lower caregiver burden (mean difference 0.27) and the time caregivers spent (mean difference 41.65 minutes).

Considering that family caregivers confronted with the troublesome behaviour of their demented relative will apply for pharmacological intervention, future research should particularly focus on the outcome measures of the caregivers’ well-being.

Keywords. Dementia, family medicine, geriatric medicine, meta-analysis, psychiatry.

Schoenmakers B, Buntinx F and De Lepeleire J. Can pharmacological treatment of behavioural disturbances in elderly patients with dementia lower the burden of their family caregiver? Family Practice 2009; 26: 279–286.


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Johannes C van der Wouden
Family Practice, 14 Sep 2009 [Full text]

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