Veterans enrolled in Veterans Health Administration (VHA) Home Based Primary Care (HBPC), a program providing in-home medical and mental health care by an interdisciplinary care team, often face substantial physical, cognitive, and mental health challenges. This program evaluation examined the impact of a brief problem-solving intervention on depressive symptoms, quality of life, and problem-solving abilities for Veterans enrolled in HBPC.

Pre- and post-intervention outcomes for Veterans, and qualitative feedback from Veterans and clinicians regarding program satisfaction.

A total of 230 HBPC patients (mean age in years = 72.1, SD = 11.6) within the U.S. national VHA health care system.

Six-session, individual Problem-Solving Training (PST-HBPC).

Licensed psychologists and social workers (n = 115) completed training and administered the treatment with HBPC Veterans between 2014 and 2017.

From baseline to post-intervention, Veterans completing five or more PST-HBPC sessions (n = 199) reported significant reductions in depressive symptoms on the Patient Health Questionnaire 9-item (PHQ-9), in difficulty functioning due to depressive symptoms (PHQ-9 item 10), and in thoughts of death (PHQ-9 item 9). They also reported more effective problem-solving on the Social Problem-Solving Inventory – Revised: Short form (total score and subscales), and improved quality of life across life domains on the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. Both clinicians and Veterans also reported satisfaction with the program.

Preliminary findings support the continued dissemination and implementation of this brief PST intervention for HBPC Veterans, and its potential for use with non-VA home care populations with complex comorbidities.

Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.

This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.

Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48–5.51).

Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.

Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders.

In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.

Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).

The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26).

By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.

Feelings of purpose and meaning in life are protective against consequential cognitive outcomes, including reduced risk of Alzheimer’s disease and dementia. Purpose and meaning are likely to also be associated with cognitive functions on the pathway to dementia. The objective of the current research was to test whether both purpose in life and meaning in life are associated with higher verbal fluency and better episodic memory and whether these associations varied by sociodemographic characteristics or economic characteristics of the country.

Prospective meta-analysis of cross-sectional associations based on individual participant data.

Established cohort studies with measures of either purpose in life or meaning in life and verbal fluency and episodic memory.

Across the cohorts, there were over 140,000 participants from 32 countries from North and South America, Europe, and the Middle East.

The meta-analysis indicated that purpose and meaning were associated with better performance on both the verbal fluency (meta-analytic partial r = .098, 95% confidence interval [CI] = .080, .116, p < .001) and episodic memory (r = .117, 95% CI = .100, .135, p < .001) task and that these associations were similar across measures of purpose in life and meaning in life. There was modest evidence that these associations were slightly stronger in relatively lower-income countries, and there was less consistent evidence that they varied by age, gender, or education.

These findings indicate a robust association between purpose/meaning and both verbal fluency and episodic memory across demographic groups and cultural context. Purpose/meaning may be a useful target of intervention for healthier cognitive aging.

To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment.

Cross-sectional study.

Five hospitals, Western Sweden.

Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt.

Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS.

The 7-item GDS according to Broekman et al. (2011), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80–1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS.

The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.

The study’s aims were (i) to identify the prevalence of health anxiety (HA) among the elderly in urban community healthcare centers and (ii) to determine whether HA is related to social, physical, or psychological factors.

It is a population-based observational study.

Data were collected from urban community healthcare centers in Chengdu, China, from October 2016 to March 2017.

A total of 893 participants aged ≥ 60 years.

The Short HA Inventory was used for HA assessment. Mental health status was assessed using the Geriatric Depression Inventory and Mini-Mental State Examination. Other information was collected through face-to-face interviews. Data analysis was performed using SPSS 19.0.

The point prevalence rate of HA was 9.53% (95%CI = 6.99%–12.07%). The number of chronic diseases was a positive factor associated with HA in a regression analysis. As compared with participants without chronic diseases, people with one (OR = 1.796; 95%CI = 0.546–5.909), two (OR = 2.922; 95%CI = 0.897–9.511), and three chronic diseases (OR = 6.448; 95%CI = 2.147–19.363) had higher odds of suffering from HA.

The prevalence of HA was high in the elderly population. Certain physical conditions, such as having chronic diseases, were significant impact factors. More attention should be paid to the situation of HA in this population.

On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff.

Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes.

Visitors and healthcare professionals.

Allowing visitors using local regulations based on national guidelines.

Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations.

National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects.

The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.

Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents’ beliefs, motivation, and aspects of the environment that facilitate or impede SDM.

A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach.

Six long-term care facilities in Sydney, Australia.

Thirty-one residents.

Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician.

This study highlights that the residents’ beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents’ right to participate in SDM.

Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand.

interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales.

A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36–181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51–5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26–4.03), at-risk alcohol use (2.38, 1.30–4.35), and bipolar disorder (2.18, 1.25–3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36–0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35–0.89).

Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.

Loneliness and the onset of depression in old age are growing problems related to the greater life expectancy nowadays. This review investigated the longitudinal association between loneliness and depressive symptoms in the elderly.

A comprehensive search was conducted using three databases (Scopus, PsycInfo, and PubMed) combing for empirical studies published up until July 2020. A total of 4.549 abstracts and 221 full-text articles were assessed. Three authors independently reviewed titles and abstracts; disagreements were resolved by consensus.

Ten studies were included in the final review. We identified two categories of studies based on the outcome considered in each article: 1) the longitudinal effect of loneliness on depressive symptoms and 2) the clinical course of depression and its association with loneliness. All the articles reported a significant and positive association between loneliness and depressive symptoms in their longitudinal design research, ranging from an odds ratio of 0.41 to 17.76. The heterogeneity regarding the effect size in the analyses can be explained by the multifactorial design implemented by most of the studies included.

Future research should investigate the moderators' role and how it may influence the longitudinal association between loneliness and depression over the years.

The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions.

The current study aims to investigate and compare the effect of different types of physical exercise on the NPS.

A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program.

From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied – aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems.

There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.

Impaired olfaction may be a biomarker for early Lewy body disease, but its value in mild cognitive impairment with Lewy bodies (MCI-LB) is unknown. We compared olfaction in MCI-LB with MCI due to Alzheimer’s disease (MCI-AD) and healthy older adults. We hypothesized that olfactory function would be worse in probable MCI-LB than in both MCI-AD and healthy comparison subjects (HC).

Cross-sectional study assessing olfaction using Sniffin’ Sticks 16 (SS-16) in MCI-LB, MCI-AD, and HC with longitudinal follow-up. Differences were adjusted for age, and receiver operating characteristic (ROC) curves were used for discriminating MCI-LB from MCI-AD and HC.

Participants were recruited from Memory Services in the North East of England.

Thirty-eight probable MCI-LB, 33 MCI-AD, 19 possible MCI-LB, and 32HC.

Olfaction was assessed using SS-16 and a questionnaire.

Participants with probable MCI-LB had worse olfaction than both MCI-AD (age-adjusted mean difference (B) = 2.05, 95% CI: 0.62–3.49, p = 0.005) and HC (B = 3.96, 95% CI: 2.51–5.40, p < 0.001). The previously identified cutoff score for the SS-16 of ≤ 10 had 84% sensitivity for probable MCI-LB (95% CI: 69–94%), but 30% specificity versus MCI-AD. ROC analysis found a lower cutoff of ≤ 7 was better (63% sensitivity for MCI-LB, with 73% specificity vs MCI-AD and 97% vs HC). Asking about olfactory impairments was not useful in identifying them.

MCI-LB had worse olfaction than MCI-AD and normal aging. A lower cutoff score of ≤ 7 is required when using SS-16 in such patients. Olfactory testing may have value in identifying early LB disease in memory services.

Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure.

Face-to-face interviews and cross-sectional analyses.

Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain.

One hundred and two family caregivers of a spouse or parent with dementia.

Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer.

The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events.

The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers’ levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers’ activity restriction in the theoretical framework of the model.

While family caregivers (CGs) of persons with dementia are cost-effective for the health system, this form of caregiving leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among CGs. The study goal was to determine the effect of the Reitman Centre CARERS program on key outcomes in family CGs of people with dementia. The Reitman Centre CARERS program is an innovative, group psychotherapeutic skills training intervention based on integrated problem-solving techniques (PST), simulation learning, and group psychotherapy designed to address each CGs’ unique situation.

A quasi-experimental, non-randomized, pre–post evaluation, multiple groups, multisite trial.

Multisite group intervention provided in community agencies and hospital-based locations.

Spousal or adult child family CGs (n = 264) living in the community and providing care to community-dwelling family members with dementia.

CGs were assessed for depression (CES-D); stress (PSS); burden (12-item SZBI); role overload, mastery, caregiving competence, and role captivity (Perlin scales), coping (CISS – Coping Inventory for Stressful Situations), CG reactions to CR’s memory and behavioral symptoms (RMBPC). Care recipients (CRs) were assessed on basic and complex activities of daily living (Katz and Lawton). Paired t-tests and Wilcoxon signed-rank test were used for statistical analysis of both the whole group and a more compromised subgroup of CGs.

For the group as a whole, CGs showed significant positive change on post-intervention outcome measures of stress, depression, burden, competence, role captivity, overload, mastery, coping, and reaction to memory issues. The intervention showed especially robust effect sizes (ES) in more compromised CGs. These positive outcomes emerged despite a significant measured deterioration in CRs’ function.

The CARERS program may be an effective multicomponent intervention to improve the well-being, functioning, and coping skills of dementia CGs.

The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A).

Longitudinal assessment of GAD symptoms pre- and posttreatment.

Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment.

Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions.

Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A.

Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status.

Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

To explore the prevalence of EM in an older Chinese population and examine the mediating role of three psychosocial variables – psychological vulnerability, housework involvement, and financial independence – in the relationship between physical frailty and EM.

Cross-sectional analysis.

The data source was the Third Survey on Chinese Women’s Social Status (SCSSW), which is a nationwide decennial survey conducted in 2010.

Community-dwelling adults aged 60 and older who participated in SCSSW (N = 3516).

The past-year prevalence of EM and its seven subtypes, physical frailty, psychological vulnerability, housework involvement, financial independence, and demographic characteristics.

The past-year prevalence of EM was 4% among Chinese older adults, with psychological abuse being the most common subtype (3.9%). A higher level of physical frailty had a direct influence on EM. Older adults with higher levels of physical frailty were more likely to have higher levels of psychological vulnerability (anxiety, loneliness, and uselessness) and lower levels of housework involvement, which further correlated with increased risk of EM. Frail Chinese older adults were less likely to have financial independence, which in turn, surprisingly predicted a lower probability of EM.

In this nationally representative sample, we provided the first evidence of the prevalence of EM among Chinese older adults and expanded the global understanding of EM by examining the mediating role of three psychosocial variables. Future studies are warranted to corroborate our findings and identify factors contributing to the complex mechanism of EM.

Emotional intelligence (EI) is a strong predictor of negative mood. Applying emotional skills correctly can help to increase positive emotional states and reduce negative ones. This study aims to implement EI intervention designed to improve clarity, repair EI dimensions and coping strategies, and reduce negative mood in older adults.

Participants were randomly assigned to the treatment or control group.

Participants were evaluated individually before and after the intervention.

Participants included 111 healthy older adults; 51 in the treatment group and 60 in the control group.

An EI program was implemented. The program was administered over 10 sessions lasting 90 min each.

EI dimension (attention, clarity, and repair), coping strategies, hopelessness, and mood were assessed.

Analysis of variance for repeated measures was applied. In the treatment group, scores on clarity and emotional repair increased and attention to emotions decreased; problem-focused coping (problem-solving, positive reappraisal, and seeking social support) showed significant increases, whereas emotion-focused coping (negative self-focused and overt emotional expression) obtained significant decreases; scores on negative mood measures declined significantly.

An intervention based on EI is effective in older adults. After the EI intervention, the participants showed significant increases in their levels of clarity and emotional repair and intermediate levels of attention. In addition, the intervention was found to influence adaptation results, increasing the use of adaptive coping strategies and decreasing the use of maladaptive strategies, as well as reducing hopelessness and depressive symptoms.

To investigate factors associated with suicidal ideation (SI) around the time of dementia diagnosis. We hypothesised relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments, and dementia diagnosis subtype would be associated with a higher risk of SI.

Cross-sectional study using routinely collected electronic mental healthcare records.

National Health Service secondary mental healthcare services in South London, UK, serving a population of over 1.36 million residents.

Patients who received a diagnosis of dementia (Alzheimer’s, vascular, mixed Alzheimer’s/vascular, or dementia with Lewy bodies) between 1 Nov 2007–31 Oct 2021: 18,252 people were identified during the observation period.

A natural language processing algorithm was used to identify recorded clinician recording of SI around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer’s dementia to those with Alzheimer’s and used statistical models to adjust for putative confounders.

15.1% of patients had recorded SI, which was more common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, SI was more frequent in those with depression and dementia with Lewy bodies and less common in those with impaired activities of daily living and in vascular dementia. Agitated behavior and hallucinations were not associated with SI in the final model.

Our findings highlight the importance of identifying and treating depressive symptoms in people with dementia and the need for further research into under-researched dementia subtypes.

Policy making increasingly needs cost-effectiveness evidence to inform resource allocation. The objective of this review is to identify and to investigate evidence evaluating the cost-effectiveness of interventions aimed to support adult carers, drawing on the National Institute for Health and Care guideline on Supporting Adult Carers.

The protocol of the review was aimed to identify the economic studies published from 2003 onwards on all types of interventions for supporting adult carers. The applicability to the review and methodological quality of included economic evaluations were assessed using pre-established checklists specified in the National Institute for Health and Care (NICE) manual for developing guidelines.

Our search yielded 10 economic evaluations. The main types of strategies evaluated were psychological and emotional support, training, and education support interventions. We found that the interventions more likely to be cost-effective were usually tailored to the specific carers’ circumstances and delivered face-to-face and were multi-component in nature, including elements of psycho-education, training, psychological and practical support. The narrative synthesis of results indicated a wide variation in cost-effectiveness findings and methodological quality.

This article indicates that systematic reviews of economic evaluations can be considered as an appropriate means to support decision makers in allocating health and social care resources. Given the high economic and social impact of unpaid caring, and based on the research gaps identified, we recommend that future economics research should be targeted on interventions for identifying carers; and programs for providing carers with support and advice to help them to enter, remain in or return to paid work.