Caregiver response to Alzheimer's disease

Interventions Effective in Decreasing Burden in Caregivers of Persons with Dementia: A Meta-Analysis

Introduction: Chronic non-communicable diseases, including diseases of mental origin such as Alzheimer's, affect all age groups and countries. These diseases have a major impact on the patient and their family environment. It is interesting that different questionnaires are measured in the same direction, given that different health questionnaires are used to measure caregiver burden. Objectives: To identify which type of intervention is the most appropriate to improve the health of the primary caregiver in patients with dementia. To understand the role played by the nurse within multidisciplinary teams and to know whether the different questionnaires used in the studies measure caregiver health in the same direction. Methods: A systematic search of the published and gray literature was carried out without restriction of the language used in the studies. Caregiver burden of patients with dementia, receiving an intervention to improve caregiver burden, was assessed. Standardized mean difference was used as the effect size measure, and there were possible causes of heterogeneity in the effect size. Results: In total, 1512 records were found, and 39 articles with 4715 participants were included. We found individual information with an effect of 0.48 (CI95%: 0.18; 0.79; I2 = 0%); group therapy with an effect of 0.20 (CI95%: 0.08; 0.31; I2 = 6%); workshops with an effect of 0.21 (CI95%: 0.01; I2 = 48%) and 0.32 (CI95%: 0.01; 0.54; I2 = 0%) when a nurse intervenes; respite care with an effect of 0.22 (CI95%: 0.05; 0.40; I2 = 66%); individual therapy with an effect of 0.28 (CI95%: 0.15; 0.4; I2 = 68%); and support groups with an effect of 0.07 (CI95%: 0; 0.15; I2 = 78%). Conclusions: The magnitude of the effects of the interventions has been low-moderate. Different instruments are not associated with the magnitude of the effect. The presence of nurses improves the effect of the intervention on caregivers when it is carried out in the form of workshops.

Investigating the Relationship between Religious Beliefs with Care Burden, Stress, Anxiety, and Depression in Caregivers of Patients with Spinal Cord Injuries

Spinal cord injury (SCI) is one of the most severe diseases associated with the central nervous system of the individuals, which can lead to disability in the patient. The aim of the present study was to determine the relationship between religious beliefs with CG, depression, anxiety and stress (DAS) in caregivers of patients with SCI in the city of Ilam, Iran. This is a descriptive-analytic article, and the study population were caregivers of patients with SCI. A sample size of 150 patients was selected according to previous studies. The questionnaires used for data collection included Religious Coping Questionnaire (RC), Caregiver Questionnaire (CG), and Depression, Anxiety and Stress Scale-21 (DASS-21) Items. In this study, caregivers of patients with SCI were included in the study using convenience sampling method in Ilam city. The researchers identified patient caregivers who met the inclusion criteria. The research objectives were described for caregivers, and the questioners were initiated if caregivers were willing to participate in the study. Literate caregivers completed questionnaires through interviews, and trained questioners completed for illiterate caregivers in the same way (interviewing). Data were analyzed using spss 16 statistical software, and descriptive and analytical methods were used for statistical analysis. According to the findings, the mean (SD) of RC is 18.41 (2.73), negative RC is 7.05 (2.06), positive RC is 11.36 (1.89), stress is 10.78 (6.27), anxiety is 10.12 (5.58), depression is 10.50 (3.08), and CG is 78.16 (27.09). There is a significant relationship between RC levels with stress (P = 0.000, F = 40.565), anxiety (P = 0.000, F = 45.300), and CG (P = 0.000, F = 37.332), but there was no relationship between the RC level with depression status (P = 0.42, F = 0.634). Considering that religion can affect the level of CG, stress, and anxiety of the caregivers of the patients, it is suggested to provide necessary conditions to improve the health status of caregivers of patients with SCI by improving the religion status in patients and performing appropriate interventions in this regard.

Needs, morale and coping strategies of caregivers for persons with Alzheimer's disease in isolated communities in Canada

This study reports perceived needs, morale and strategies for coping with stress for 68 caregivers of persons with Alzheimer's disease living in relatively isolated communities in Northwestern Ontario, Canada. Participants express needs for educational and social support, experience significant difficulties with morale, and employ coping strategies which reflect an inadequate social support system. Some implications for social policy are described.

Understanding Stress in Informal Caregiving

The poor psychological health of caregivers of the frail aged is examined using the stress paradigm and the crises of decline model of caregiving burden. Whereas stress paradigms generally focus on environmental stressors and individual resources, the crises of decline model conceptualizes stress within the social dynamics of the caregiving dyad. Data from a cross-sectional study of 144 caregivers supported both models. Burden was more likely when the primary caregiver experienced degeneration, conflict, enmeshment, unpreparedness, and unwillingness. Minor psychiatric symptoms were explained in part by burden but also by more traditional stressors (supervisory workload) and resources (physical health, self- esteem, mastery, coping strategies, social network availability). Individualistic interventions to relieve burden and symptoms are justifiable on the basis of this study, but with limits to their likely success-limits imposed by family institutions of care in which primary carers lack experience and feel discomfort with degenerative conditions.

Caregiving Burden

This article critically examines the burden concept, its lack of clear definition, the inconsistency between its conceptualization and operationalization, its inappropriate use within the stress paradigm, and its marginal policy relevance. A needs-based conceptualization of burden is presented in which burden is defined in terms of frustration of basic needs arising from five characteristics of family care for frail elderly people: awareness of degeneration, unpredictability, time constraints, the caregiver-receiver relationship, and lack of choice. These contributors to burden are called crises of decline to contrast with the experiences normally encountered through child care. The model has received empirical support and represents a reconceptualization that not only accommodates the increasingly popular stress paradigm but also provides a bridge between research that focuses on burden as an individualistic phenomenon and research that links dominant caregiving practices with social injustice.

Relationship between Husband's Health Status and the Mental Health of Older Women

This study examines the association between husband's health and the mental health of community-dwelling White women 65 to 75 years of age and how the wife's health, socioeconomic and social resources, and marital quality affect this relationship. Husband's health strongly predicts wife's mental health; the negative impact of which is more pronounced when the wife has poor or declining health as well. Marital quality is a strong predictor of the wives' mental health. Analyses examining the independent and joint effects of marital quality and husband's health on wife's mental health indicate that the negative association of illness in a spouse on wife's mental state is, in part, a function of the impact husband's health has on marital intimacy and shared pursuits. Of the socioeconomic and social resources examined, only availability of close friends shows a substantial relationship to the wives' mental health.

Caregiver burden--a critical discussion

Currently, 15%, 12.8% and 17.1% of the Canadian, American and European populations, respectively, are 65 years or older. Due to aging-related disabilities, elderly individuals will require support from family members while in the community. Annually, family caregivers save the Canadian and American healthcare systems $25 billion and $350 billion, respectively. However, to maintain the important role they play, caregivers' experiences must be investigated in order to provide appropriate support. Despite the fact that 'caregiver burden' is preponderantly used as an indicator of the caregiving experience, much disagreement remains on what the term entails and how it should be utilized. This paper endeavors to critically discuss the concept of 'caregiver burden', its use in the literature and the implications this has for future research and clinical practice. The vagueness derived from the various 'caregiver burden' definitions limits the term's relevance to policy-making and clinical practice. Additionally, much of the literature on 'caregiver burden' is not theoretically framed, which reduces the conceptual clarity of the term. Quantitative measures are largely used to investigate 'caregiver burden', which can sometimes fail to capture contextual features that are relevant to caregiving outcomes (e.g., culture). Stress theory and role theory are recommended as guiding frameworks for future research that investigates 'caregiver burden'. Future research on 'caregiver burden' would also benefit from integrating qualitative and quantitative approaches into mixed method designs in order to gain a holistic understanding of the concept.

Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.

Complaints of informal caregivers providing home care for dementia patients: the Pixel study

CONTEXT

Prospective study of the complaints, problems and requirements of the main caregiver providing home care for dementia patients.

OBJECTIVES

To determine the complaints of home caregivers, how they are interrelated and what causes them.

RESOURCES

Self-administered questionnaire of 42 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the attending physician, usually a specialist, freelance or salaried doctor.

RESULTS

408 sets of records were compiled, concerning 236 demented women (77.1 +/- 0.47 years) and 172 demented men (75.7 +/- 0.57 years). In two-thirds of cases, the main caregiver was a woman aged 60.6 +/- 0.79 years. Female caregivers were more vulnerable than male caregivers. The most frequent caregiver complaint, regardless of the stage of the disease, concerned loss of motivation and withdrawal. The patient's awareness of the disorder was accompanied by a reduction in motor dysfunction and aggressiveness, but associated with a higher frequency of the complaint regarding loss of motivation reported by the caregiver. The caregivers' problems concerned mainly the absence of relief and the impossibility of having any time to themselves. Caregivers' requests for information concerned medical information, care structures and day care facilities.

DISCUSSION

The attending physician comes into close contact with the patient, but must take into account the patient's environment. The physician can provides a separate analysis to the caregiver and does not completely answer to certain family questions or needs. He or she is not the family's prime source of information. The caregivers' requirements relate to the areas that are the attending physician's responsibility: the development and characteristics of the disease. The caregiver is anxious about the patient's future and is trapped by his or her involvement in the care, suffering greatly from the lack of relief.

CONCLUSIONS

It is necessary to change the focus of home care for dementia patients to fit the context in which they live and to allow for periods of relief for home caregivers.

The effects of support groups on caregivers of patients with schizophrenia

The purpose of this study was to assess the effects of support groups on caregivers of patients with schizophrenia. This was a time series nonequivalent control group design. Subjects were evaluated in three waves of data collection: before intervention, after intervention and one-month follow-up. The support group's effects were measured using changes in the subjects' perceived levels of burden, depression status and satisfaction about their participation in the program. Professionally led support group had a close and time-limited format. The GEE (generalized estimated equation) revealed differences in caregivers' level of burden and depression status between the support and control groups in the post-test and one-month follow-up. The differences highlighted the fact that participation in support groups provides more effective assistance to caregivers than the control group.

Family, Alzheimer's disease and negative symptoms

BACKGROUND

The aim of this study is to look at the correlation between the presence of apathy measured by Marin's scale and family complaints related to withdrawal and the loss of motivation, or depression. The multicentre study was performed on 58 non-demented elderly people, 132 outpatients with Alzheimer's-type dementia, as well as their main caregiver.

METHODS

After agreement of the patients and the family, the patients were assessed using different scales: Cornell's for depression, Marin's for apathy, MMS for cognitive disorders, and IRG for dependence. At the same time, two self-administered questionnaires were given to the patients' families: one concerning a list of complaints scored from 1 to 4 relating to various disorders and the other addressing the boundary ambiguities translated from Boss' questionnaire. The 58 non-demented people were 81.20 years old+/-13.75. One hundred and thirty-two demented patients were included: 39 men and 93 women. The mean age was 79.47 years+/-9.03.

RESULTS

The first family complaint relates to the loss of motivation (65%). Apathy and depression occur more frequently in dementia, in particular when the MMS is degraded. Depression and apathy attracted a high complaint score. In our study the score of boundary ambiguity is higher among patients with a weak cognitive status. A high level of ambiguity is accompanied by a high score of family complaints. When the family complaint concerning the loss of motivation is present, apathy is significantly more common. Family complaints about withdrawal and loss of motivation are frequently present, and are congruent with the actual presence of apathy in the patient. It bears witness to the distress felt by families faced with the loss of ability noted in the demented person. The family's difficulties are increased by the patient's depression.

Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale

OBJECTIVES

To develop an adjunct scale to the Neuropsychiatric Inventory (NPI) for assessing the impact of neuropsychiatric symptoms in Alzheimer's disease (AD) patients on caregiver distress.

DESIGN

Cross-sectional descriptive and correlational study.

SETTING

University out-patient memory disorders clinics.

PARTICIPANTS

Eighty-five AD subjects and their caregivers (54 spouses, 31 children).

MEASUREMENTS

The NPI and NPI Caregiver Distress Scale (NPI-D) were used to assess neuropsychiatric symptoms in AD patients and related caregiver distress, respectively. Criterion validity of the NPI-D was examined (N = 69) by comparison with an abridged version of the Relatives' Stress Scale (RSS'), a general measure of caregiver stress, using item clusters that had previously been correlated to behavioral disturbances in demented patients. Test-retest (n = 20) and inter-rater reliability (n = 16) of the NPI-D were also assessed.

RESULTS

Test-retest and interrater reliability of the NPI-D were both adequate. Overall, caregiver NPI-D distress ratings were correlated significantly with the RSS' (r = .60, P < .001). RSS' ratings correlated strongly with NPI scores (r = .64, P < .001), even after controlling for degree of cognitive impairment based on the Mini-Mental State Exam (MMSE) score (r = .61). MMSE scores showed a moderate correlation to RSS' ratings (-.30, P = .02), but this association was markedly attenuated when controlling for the degree of neuropsychiatric disturbance based on the NPI score (r = -. 14). NPI-D ratings for 9 of 10 NPI symptom domains correlated most strongly with either NPI symptom severity or total (frequency x severity) scores. Agitation, dysphoria, irritability, delusions, and apathy were the symptoms most often reported to be severely distressing to caregivers.

CONCLUSIONS

The NPI-D provides a reliable and valid measure of subjective caregiver distress in relation to neuropsychiatric symptoms measured by the NPI. Neuropsychiatric alterations are more strongly associated than cognitive symptoms to caregiver distress. The NPI-D may be useful in both clinical and research settings for assessing the contribution to caregiver distress of neuropsychiatric symptoms in AD patients.

Major strain and coping strategies as reported by family members who care for aged demented relatives

This study is based on a previous investigation into 46 caregivers' experience of burden and burnout when caring for a demented elderly relative. The aim of this study was to describe caregivers who develop or experience burnout (group A) and caregivers without experience of burnout (group B) and how they cope with major strain. The interviews focused on the caregivers' descriptions of their major strain (the demented person's memory difficulties and change in behaviour and the caregivers' experiences of their feelings of loss and their new role) and what they did, thought and felt in these situations. The interviews were coded and categorized and a chi-square test was performed. It was found that those in group A more often used an emotion-focused strategy (grieving, worrying and self-accusation). They were also the only ones using wishful thinking and stoicism as strategies. Those in group B used a problem-focused strategy more often (confronting the problem, seeking information and seeking social support). Another interesting finding was that the caregivers in group B frequently used the emotion-focused strategy of acceptance in combination with seeking information and seeking social support. To mix approaches like these seems to be an effective choice of strategy. It was also found that the caregivers' gender seems to have an effect on the coping strategy. The demented person's domicile did not, however, appear to result in any significant difference.

Feelings of anger among caregivers of patients with Alzheimer's disease

The purpose of this article is to examine the caregiver's feelings of anger, the causes of these feelings as described by the caregivers and their reactions. Twenty female caregivers of Alzheimer's disease patients participated in a support group at a psychogeriatric centre for 3 years. The group was directed by a registered nurse and a social worker. Frequently, anger was raised as a major issue in the caregiving. The group directors constructed two models that emerged from the support group's meetings. The first model showed the sources of the anger felt by the caregivers and the second model showed coping strategies. The caregivers said that the most infuriating behaviours of patients Alzheimer's disease were: aggressive behaviour, sleeplessness and verbal or behavioural repetition. The caregiver's reactions to the two models are discussed in this paper together with their feelings, which expressed by the women in their own words.

The impact of anticipatory grief on caregivers of persons with Alzheimer's disease

Caregivers of persons with Alzheimer's disease (AD) and other dementias are known to experience many physical and emotional problems. However, research has consistently shown that the relationship between the demands of caregiving and the effects on the caregiver is not strong. Despite considerable research, a full understanding of how the demands of caregiving uniquely impact the individual has not been established. The present study examines anticipatory grief, an emotion that has not been studied to date for its possible impact on the current functioning of caregivers. Structured interviews, consisting primarily on standardized measures, were conducted with 100 caregivers. Results of the study show that physical and emotional problems and the expectation to place the patient out of the home were more likely to occur among those caregivers who expressed the most intense grief and those feelings of remorse and anger characteristic of the anger and guilt stages of grief.

Exploring the Caregiver Burden Inventory (CBI): further evidence for a multidimensional view of burden

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.

Cognitive impairment, caregiver burden, and the utilization of home health services

This study addresses the relationship between caregiver burden and the use of home health services among older adults with cognitive impairment. Analyses draw on data from personal interviews conducted with 327 older adults with cognitive impairment and living in the community of their primary caregivers. Using the Andersen-Newman framework, the results of ordinary least squares and logistic regression analyses reveal that caregiver burden and formal home health service use are only weakly related. Possible explanations for the findings are discussed.

Alzheimer's and related disorders: loneliness, depression, and social support of spousal caregivers

1. Meeting the myriad of emotional and social needs of caregivers for spouses with Alzheimer's disease (AD) will increasingly challenge nurses and the health care system. 2. Whether the person with AD remains at home or is institutionalized, spousal caregivers are at risk for loneliness and decreased social support. 3. Research studies have consistently found spousal caregivers to suffer from depression. 4. A comprehensive assessment of the caregiver and the care recipient may help the clinician identify aspects of the caregiving situation that are amenable to change.

The health and wellbeing of informal caregivers: a review and study program

Informal caregivers are the families and other unpaid caregivers in the home who support people of all ages with severe and chronic mental or physical disabilities. Home care of this sort has been increasing over the past 30 years because of the reduced number of beds in hospitals and nursing homes and increased outpatient and community care. Moreover, with an aging population and increasing rates of disability, the demand for family caregiving will continue to rise. This has important implications for the development of health, community service and social policy. At the same time, however, very little is known about the impact such changes are having on the caregivers of various ages and in various circumstances. The Victorian Health Promotion Foundation is funding a research and intervention program in Melbourne to promote wellbeing and prevent ill-health in caregivers.

A comparison of the impact of institutionalization on spouse and nonspouse caregivers

We report on a study of 106 spouse and nonspouse primary caregivers of cognitively impaired older people. Half of these caregivers cared for someone in a community setting, half cared for someone in an institution (a nursing home or hospital). The study used the multidimensional Caregiver Burden Inventory (CBI) to measure the burden that these caregivers felt. A 2 x 2 multivariate analysis of variance found an effect of the interaction of relationship and living arrangement on two CBI subscales: Time Dependence Burden and Developmental Burden. Spouses showed a significantly greater difference in Time Dependence Burden scores than did nonspouses in both living arrangement groups, and nonspouses showed a significantly greater difference in Developmental Burden than did spouses in both groups. We conclude with a discussion of how programs can help different types of caregivers cope with feelings of burden.

Use of formal community resources by spouse caregivers of chronically ill adults

This descriptive correlational study examined the use of formal community resources of spouse caregivers of progressively chronically ill individuals. The convenience sample was 61 individuals with a definitive diagnosis of multiple sclerosis and their spouse caregivers. Results indicated that 34.4% of the sample used community resources. Relationships among caregiver demographics, extent of caregiving tasks, subjective burden, perceived uncertainty of the caregiver, functional incapacity of the chronically ill individual, level of social support, and the use of formal community resources were analyzed. Positively correlated (P less than 0.05) with the criterion variable of use of formal community resources were the variables of caregiver age (rpb = 0.342), number of caregiving tasks (rpb = 0.424), caregiver employment level (chi 2 = 8.25), and functional incapacity of the care receiver (rpb = 0.565). Results of discriminate function analysis indicated that three variables, functional incapacity, caregiver age, and number of caregiving tasks, correctly classified users versus nonusers of community resources 83.6% of the time.

The psychological and physical health of family members caring for an elderly person with dementia

Most elderly persons with dementia are cared for at home, usually by the spouse or an adult child. The objective of the present study was to determine whether there is an excess of psychological and physical health problems among family caregivers (CGs) of elderly persons with dementia. Data were obtained by interview from close family members of dementia patients (CGs), and from a comparison group made up of close family members of patients undergoing cataract surgery (non-caregivers, NCGs). CGs had significantly higher levels of depression and physical symptoms than NCGs. The association between caregiving and the health variables was stronger among subjects who were the patient's spouse than among those who were the patient's child. Furthermore, greater behavioral disturbance in the demented patient was associated with higher levels of morbidity in the CG. The results suggest that CGs might benefit from careful monitoring of their health status, and from greater access to specialized support services.