Assessment of the burden of informal caregivers and practical interventions

Unfortunately, systematic assessment of the health and well-being of family caregivers does not belong to routine. A proactive and structured assessment has been shown to contribute to uncovering their mounting desperation and exhaustion. Physicians in close collaboration with social workers can play a crucial role in

• identification of factors that cause or exacerbate distress
• incorporation of the needs and preferences of caregivers in the care planning
• improving caregivers’ understanding of their role
• teaching necessary skills for performing the caregiving tasks (e.g. psychoeducational interventions, skills training, therapeutic counseling)
• encouraging caregivers to make use of technical equipments facilitating independent functioning of people with dementia and reducing their dependency on caregivers (e.g. home monitors alerting for unusual activities, voice reminders, fire and flood detectors, fall sensors)
• conducting longitudinal periodic assessments of care outcomes for both the caregiver and the person with dementia.

Of note, older married couples should be evaluated together, exploring their health status and the caregiving demands at home, whilst additional separate evaluation of the person with dementia and the caregiver should not be precluded, if there is need for communicating confidential information (e.g. elder mistreatment, caregiver stress). The development of an individualized and coherent care plan can support the informal caregiver. It might include provision of short-term relief with an in-home temporary caregiver or inpatient respite enabling the stay of the person with dementia at a facility for a several period of time, supplemental services and other considerations. Respite care could give the caregiver the opportunity to engage in health-promoting behaviors such as physical exercise and further activities improving quality of life especially in the light of the common caregivers’ neglect of their own health.