Alzheimer’s disease (AD) cases are expected to reach 152.8 million by 2050 (Collaborators GBDDF, 2022). This neurodegenerative disease causes a progressive deterioration in the person’s memory and cognitive function, and there is currently no curative treatment (Williams et al., 2021). Therefore, early detection and diagnosis and individualised, evidence-based treatment are essential to minimise the disease course and symptomatology for the individual. However, during the AD progression, the individuals become increasingly dependent, increasing the burden on the caregiver significantly, which can have physical, psychological and social effects (Atri, 2019).

The burden of care often lies with family members, experiencing challenges associated with social isolation, poor physical health, psychological disorders such as depression and financial difficulties (Brodaty and Donkin, 2009). An informal caregiver is a person who provides some kind of continuous care, usually unpaid, to a person with a chronic disease. This assistance is primarily related to Activities of Daily Living (ADLs), which include bathing, toileting and hygiene, feeding, dressing and mobility; and to Instrumental Activities of Daily Living (IADLs), which include activities related to home care and community use, such as financial assistance, transportation, shopping, cooking, cleaning, and medication administration, among others (Allen et al., 2019). Approximately two-thirds of caregivers of people with AD are women (Freedman and Spillman, 2014; Rabarison et al., 2018) and usually live with the person with the disease (Kasper et al., 2015). Therefore, the burden of caregiving has a direct impact on the quality of life of these women. Quality of life refers to the physical and psychological health, social and economic aspects, personal goals and expectations that have an impact on people’s daily lives (Martens and Addington, 2001). Caregivers must cope with disruptive behaviours of the dependent person, mood disorders, family conflicts, and the provision of basic care, among others, which imply an increased risk of physical and psychological distress, including cardiovascular diseases, depression and anxiety due to stress and burnout (Cheng, 2017). Moreover, depression is more prevalent in caregivers of people with dementia than in other caregivers who provide care to people with schizophrenia or stroke (Sallim et al., 2015; Thunyadee et al., 2015).

The burden of care can affect the caregiver’s occupational balance, defined as the positive balance between different meaningful activities, i.e., those that a person does or expects to do as work or leisure activities (Park et al., 2021; Lee et al., 2023; Evans, 1987). Furthermore, 57% of employed people caring for a person with AD reported that they needed to leave early or arrived later compared to carers with other conditions (Association As, 2024). 18% of caregivers reduced their working hours due to the responsibility of caring for the person with AD, which impacts their professional development and therefore their perceived self-esteem, understood as the positive or negative feelings and perceptions associated with the performance of different life functions (Bhattacharjee et al., 2012). In this sense, stressors can affect subjective perceptions of happiness and life satisfaction, two vital components of caregivers’ well-being (Lin et al., 2010).

Happiness can be considered as a mental state or feeling characterised by pleasure or satisfaction. For years, the World Health Organisation has been making efforts to address this issue as a component of health (Lyubomirsky et al., 2005). The concept of happiness is also related to life satisfaction or evaluation, subjective well-being, psychological well-being, quality of life or affect (Cho, 2017). Previous studies (An et al., 2020; Kim et al., 2022; Milovanska-Farrington and Farrington, 2022) have measured happiness, life satisfaction or well-being in the general population, but few articles have focused on special groups, such as people with disabilities and their caregivers in society.

Social aspects should also be considered when assessing the quality of life of the informal caregiver. There are two types of social support, received social support is the objective quantification of the help received by the social environment; perceived social support is measured in terms of the extent and quality of support perceived by the caregiver from their environment, and directly impacts on psychological burden relief (Ong et al., 2018; Nemcikova et al., 2023). Thus, greater emotional support from family and friends of the caregiver may imply greater caregiving satisfaction, so caregiver-perceived social support and family bonding may positively influence caregiving (Leggett et al., 2021).

Different types of caregiver intervention programmes are found in the literature, including psychoeducational (de Rotrou et al., 2011; Morhardt et al., 2019; Meziane-Damnée et al., 2023), psycho-emotional (Cheng et al., 2019; Wiegelmann et al., 2021), cognitive-behaviour (Gomez Gallego and Gomez, 2017; Kim, 2020), and interventions that include physical exercise (De la Rosa et al., 2020; Cui et al., 2018). Thus, the need to support the quality of life and well-being of informal caregivers is highlighted, as well as the importance of analysing the impact of these programmes and the support they provide for caregiving. For all the above reasons, this study aims to assess the effects of an interdisciplinary intervention (based on cognitive-behaviour, psycho-emotional, and physical activity) on psychoemotional variables such as overload, quality of life, happiness, life satisfaction and occupational balance in informal caregivers of people with AD. The ultimate goal is to provide psycho-educational skills and resources to help and improve their emotional and psychological state, thereby increasing the caregiver’s quality of life and satisfaction.

Table 2 shows the basic characteristics of the sample. No significant differences were found in any of the variables analysed. The main differences were found in Rosenberg’s Self-esteem Scale, without being significant (p = 0.062).

Table 3 indicate the EQ-5D-3L scores for both the three-level descriptive system and the visual analogue scale (VAS). Although no significant differences were found in any of the evaluation moments, an improvement in the IG scores with respect to the CG was observed in both parts of the questionnaire. In the descriptive system, IG scores (pre-intervention = 83.2) improve at 6 (80.5 vs. 83) and 9 months (80.9 vs. 86.2) with respect to CG (pre-intervention = 83.2). Although there were no significant differences, the IG scored better in all evaluations with respect to the initial score (68.2), while the CG scored worse in all evaluations with respect to the initial score.

The results obtained for each variable in each of the evaluations, as well as the difference between groups are also shown in Table 3. Significant differences were found at 3 (p = 0.002), 6 (p = 0.013) and 9 months (p = 0.022) for Occupational Balance Questionnaire-E, in perceived social support at 3 months (p = 0.043) and in life satisfaction at 6 months after the intervention (p = 0.020).

The psycho-emotional, occupational and physical implications experienced by caregivers of people with AD have been widely documented in the scientific literature (Rodriguez-Mora et al., 2023; Nikzad-Terhune et al., 2019; Hernández-Padilla et al., 2021). However, this study adopted an original approach by not simply assessing these implications, but by implementing an intervention programme to compare its effectiveness in mitigating these adverse effects. This study is part of a larger project, and the objective data obtained from our results are essential to determine the financial feasibility and effectiveness of the intervention, which in turn would allow informed policy decisions in the field of health and prevention. To this end, we analysed the effect of the intervention over different timeframes based on participants’ baseline data to identify skills and resources to improve the emotional and psychological state of informal caregivers of people with AD, increasing quality of life and satisfaction.

In the scientific literature, studies were found that analysed the quality of life of caregivers of people with leukaemia (Yu et al., 2018) and cancer (Al-Rabayah et al., 2022), however, research of people with AD is scare. Despite this, one study analysed the quality of life of caregivers of people with dementia, showing very similar results to those found in our research and found no significant differences in caregiver’s quality of life, neither at 3 nor 6 months, showing a greater decrease in IG scores than CG (Birkenhäger-Gillesse et al., 2020). This could be because although caregivers have acquired knowledge and strategies for self-care and caregiving, they still must cope with the illness situation at home.

Regarding caregiver overload, our results did not identify any significant differences, although there is a clear trend towards a decrease in the values of this test over time, showing how caregiver overload is decreasing. One of the reasons why participants may have reduced their caregiver burden is the social development they have experienced, which is a source of resilience against symptoms of anxiety and depression, and they may experience less burden and higher quality of life (Amorim et al., 2017). Moreover, given the interdisciplinary nature of this intervention, having received training that enables family members to care for the sick with a greater degree of information, may also have led to a reduction in overload, as untrained caregivers with a high degree of misinformation can lead to overload (Cerquera Córdoba et al., 2012). Finally, it could also be attributed to certain inherent limitations of the instrument, such as the subjectivity of the responses, the lack of consideration of the context surrounding the caregiver, or the lack of discrimination between professional and non-professional caregivers.

The results in terms of happiness and life satisfaction, as well as self-perception or self-esteem, also showed no significant differences after the intervention. One possible explanation could be that, although the programme includes multiple tools aimed at improving caregivers’ self-care and quality of life, participation in these activities could lead to increased awareness of the seriousness of the situation, increased perception of burden and stress, as well as feelings of comparison with other more or less favourable realities (Cheng et al., 2019). Also, the relationship between patients and their relatives was not assessed during the study, as the relationship between them can be considered a relevant factor in determining life satisfaction in both (Rippon et al., 2020). These factors may limit the study’s ability to detect significant improvements.

Our baseline results, in terms of family functioning, suggest a moderate perception of dysfunction in the IG and CG, with homogeneity in both groups. However, in the evolution of the results with the intervention, a temporary improvement in the scores of the IG was observed. Increases in family functioning also have an impact on life satisfaction, according to another published study regarding the perception of family functioning and general life satisfaction. These results are consistent with those by Cabral et al., 2014, which show increases in IG, although they were not significant (Cabral et al., 2014).

In caregivers, knowledge, perceived social support and self-efficacy are among the protective variables for caregivers’ health (Sołtys and Tyburski, 2020; Tan et al., 2021). In our study, in the first 3 months of intervention the perceived social support improved in IG, however, this improvement was not significant in 6 and 9 months. This could be due to during the first 3 months new social relationships are established and companionship increasing, but over the months, the caregivers’ task is maintained or increased. A broad social network, information and social and emotional support for caregivers of older people with dementia is therefore required (Karg et al., 2018; Sandoval et al., 2019; Vullings et al., 2020). For this, sources of support and care plans related to the health of informal caregivers are necessary (De Maria et al., 1982). In this sense, one option to improve the carer’s perception of support would be the development of accessible, innovative and cost-effective methods of support. A new era of support could be developed through the internet and social networks, as physical limitations would be avoided, providing accessibility and independence in the home environment (Slegers and van Boxtel, 2013). Previous studies have shown the promising effects of online training and support programmes (Boots et al., 2014), in particular e-health interventions tailored to the needs of the caregiver, which could provide a positive experience and be more likely to be accepted by the caregiver (Boots et al., 2015).

Regarding occupations and occupational balance, significant differences were observed between the IG and CG at 3, 6 and 9 months, but not at subsequent follow-up. However, the intervention group shows an improvement in all four-study time. One study among caregivers highlighted the demands of caregiving and how it takes up all their time, resulting in caregiver exhaustion and forgetfulness. The approach used in this investigation was similar to that used in our research Through an intervention, they had the necessary strategies to prioritise activities and time for themselves (Watford et al., 2019). Thus, the results were similar to those reported in our study since the IG can adjust and even improve the OBQ score over the months, compared to the CG. These results suggest an improvement in their perception of occupations over time and support the idea of the duration of the intervention to achieve positive results, even at the 10-month follow-up Nevertheless, another study linked occupational balance impairment and physical disease obtained non-significant results when assessing pharmacological intervention, understanding that occupational balance is a subjective process that depends on the individual and is related to the number and variety of occupations. Previous studies addressing occupational balance after deprivation due to various causes, such as illness or confinement, reflected the difficulty of restoring occupational activities. They also showed the importance of focusing on occupational balance (Rodríguez-Rivas et al., 2022; Kassberg et al., 2021). Previous studies have pointed out the need to help monitor activity patterns and perceived balance to subsequently adopt activity-based strategies to promote quality of life and subjective health perception, which may even have an impact on the quality of care provided (Röschel et al., 2022; Davy et al., 2024; Davy et al., 2022). Our results are in line with the idea that occupational balance is a dynamic process in which caregivers’ adaptive capacities help to restore occupational balance (Mahdizadeh et al., 2023).

It is noteworthy that this study follows the pattern of femininity in care expressed in previous studies (Liu et al., 2024; Cerquera Córdoba et al., 2021; Peña-Longobardo and Oliva-Moreno, 2015). In fact, more than three quarters of the population studied is female.

Among the main limitations of this study were, firstly, the size of the sample (n = 59), which could affect the statistical power of the results and ultimately the statistical significance obtained. Secondly, the lack of assessment of the caregiver context and possible caregiver-patient relationships. Additionally, the collection of further caregiving support, including from family and friends, could have helped to understand the results of our study. Finally, the use of self-reported questionnaires could introduce social desirability and recall biases.

However, we found great strengths in this research. Objective and quantifiable data were collected on an innovative programme designed to ensure that caregivers manage the situation and find a balance between caregiving and their health and happiness. In addition, the repeated evaluation of different measures, as well as the follow-up, allowed us to verify and contrast in a more accurate way the results obtained during the different evaluations carried out temporarily and at the end of the intervention and thus the evaluation process.

A nine-month interdisciplinary programme based on cognitive-behavioural, psychoemotional, and physical activity can significantly increase occupational balance in informal caregivers of people with AD. No significant improvements were found in the quality of life, physical, emotional, and social overload and family functioning, although there were positive trends in the intra-group scores for caregivers overload, quality of life, life satisfaction and family functioning.

This study represents the first step in objectively assessing the cost-effectiveness of such programmes. However, further research is needed to study more variables and to measure over longer periods to identify grasps and observe long-term benefits.