Clinically significant changes in burden and depression among dementia caregivers following nursing home admission
Tóm tắt
Although extensive research exists on informal long-term care, little work has examined the clinical significance of transitions in family caregiving due to a lack of established clinical cut-points on key measures. The objectives of this study were to determine whether clinically significant changes in symptoms of burden and depression occur among caregivers within 12 months of nursing home admission (NHA) of their relatives with dementia, and to identify key predictors of clinically persistent burden and depression in the first year after institutionalization. Secondary longitudinal analysis of dementia caregivers were recruited from eight catchment areas in the United States with 6- and 12-month post-placement follow-up data. The sample included data on 1,610 dementia caregivers with pre- and six-month post-placement data and 1,116 with pre-placement, six-month, and 12-month post-placement data. Burden was measured with a modified version of the Zarit Burden Inventory. Depressive symptoms were assessed with the Geriatric Depression Scale. Chi-square analyses found significant (P < .05) reductions in the number of caregivers who reported clinically significant burden and depressive symptoms after NHA compared to pre-placement. Logistic regression models revealed that wives and daughters were most likely to experience clinically persistent burden and husbands were most likely to experience clinically significant depression after NHA. In addition to suggesting that clinically significant decreases in caregiver burden and depression are likely to occur following institutionalization, the results reveal particular subsets of caregivers who are at continued risk of distress. Such findings can facilitate development of screening processes to identify families at-risk following institutionalization.
Tài liệu tham khảo
Wolff JL, Kasper JD: Caregivers of frail elders: updating a national profile. Gerontologist. 2006, 46: 344-356.
Pinquart M, Sorensen S: Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol B Psychol Sci Soc Sci. 2003, 58: P112-128.
Vitaliano PP, Zhang J, Scanlan JM: Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull. 2003, 129: 946-972. 10.1037/0033-2909.129.6.946.
Logsdon RG: Dementia: psychosocial interventions for family caregivers. Lancet. 2008, 372: 182-183. 10.1016/S0140-6736(08)61048-X.
Mason A, Weatherly H, Spilsbury K, Golder S, Arksey H, Adamson J, Drummond M: The effectiveness and cost-effectiveness of respite for caregivers of frail older people. J Am Geriatr Soc. 2007, 55: 290-299. 10.1111/j.1532-5415.2006.01037.x.
Mittelman MS, Haley WE, Clay OJ, Roth DL: Improving caregiver well-being delays nursing home placement of patients with Alzheimer's disease. Neurology. 2006, 67: 1592-1599. 10.1212/01.wnl.0000242727.81172.91.
Winblad B, Wimo A, Almkvist O: Outcome measures in Alzheimer's disease: Do they go far enough?. Dement Geriatr Cogn Disord. 2000, 11 (supp 1): 3-10. 10.1159/000051226.
Schulz R, O'Brien A, Czaja S, Ory M, Norris R, Martire LM, Belle SH, Burgio L, Gitlin L, Coon D, Burns R, Gallagher-Thompson D, Stevens A: Dementia caregiver intervention research: i6n search of clinical significance. The Gerontologist. 2002, 42: 589-602.
Alzheimer's Association: 2009 Alzheimer's Disease Fact and Figures. 2009, Chicago, IL: The Alzheimer's Association
Bowers BJ: Family perceptions of care in a nursing home. Gerontologist. 1988, 28: 361-368.
Maas ML, Reed D, Park M, Specht JP, Schutte D, Kelley LS, Swanson EA, Tripp-Reimer T, Buckwalter KC: Outcomes of family involvement in care intervention for caregivers of individuals with dementia. Nurs Res. 2004, 53: 76-86. 10.1097/00006199-200403000-00003.
Gaugler JE: Family involvement in residential long-term care: a synthesis and critical review. Aging Ment Health. 2005, 9: 105-118. 10.1080/13607860412331310245.
Gaugler JE, Yu F, Krichbaum K, Wyman JF: Predictors of nursing home admission for persons with dementia. Med Care. 2009, 47: 191-198. 10.1097/MLR.0b013e31818457ce.
Yamamoto MN, Aneshensel CS, Levy-Storms L: Patterns of family visiting with institutionalized elders: the case of dementia. J Gerontol B Psychol Sci Soc Sci. 2002, 57: S234-S246.
Bauer M, Nay R: Family and staff partnerships in long-term care. A review of the literature. J Gerontol Nurs. 2003, 29: 46-53.
Boise L, White D: The family's role in person-centered care: practice considerations. J Psychosoc Nurs Ment Health Serv. 2004, 42: 12-20.
Port CL, Zimmerman S, Williams CS, Dobbs D, Preisser JS, Williams SW: Families filling the gap: comparing family involvement for assisted living and nursing home residents with dementia. Gerontologist. 2005, 45: 87-95.
Port CL: Informal caregiver involvement and illness detection among cognitively impaired nursing home residents. J Gerontol A Biol Sci Med Sci. 2006, 61: M970-974.
Gaugler JE, Pot AM, Zarit SH: Long-term adaptation to institutionalization in dementia caregivers. Gerontologist. 2007, 47: 730-740.
Matsuda O, Hasebe N, Ikehara K, Futatsuya M, Akahane N: Longitudinal study of the mental health of caregivers caring for elderly patients with dementia: effect of institutional placement on mental health. Psychiatry Clin Neurosci. 1997, 51: 289-293. 10.1111/j.1440-1819.1997.tb03200.x.
Schulz R, Belle SH, Czaja SJ, McGinnis KA, Stevens A, Zhang S: Long-term care placement of dementia patients and caregiver health and well-being. JAMA. 2004, 292: 961-967. 10.1001/jama.292.8.961.
Whitlatch CJ, Schur D, Noelker LS, Ejaz FK, Looman WJ: The stress process of family caregiving in institutional settings. Gerontologist. 2001, 41: 462-473.
Zarit SH, Whitlatch CJ: Institutional placement: Phases of transition. Gerontologist. 1992, 32: 665-672.
Gaugler JE, Roth DL, Haley WE, Mittelman MS: Can counseling and support reduce burden and depressive symptoms in caregivers of people with Alzheimer's disease during the transition to institutionalization? Results from the New York University caregiver intervention study. J Am Geriatr Soc. 2008, 56: 421-428. 10.1111/j.1532-5415.2007.01593.x.
Gold DP, Reis MF, Markiewicz D, Andres D: When home care giving ends: A longitudinal study of outcomes for caregivers of relatives with dementia. J Am Geriatr Soc. 1995, 43: 10-16.
Grasel E: When home care ends--changes in the physical health of informal caregivers caring for dementia patients: a longitudinal study. J Am Geriatr Soc. 2002, 50: 843-849. 10.1046/j.1532-5415.2002.50209.x.
Mausbach BT, Aschbacher K, Patterson TL, von Kanel R, Dimsdale JE, Mills PJ, Ancoli-Israel S, Grant I: Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: a longitudinal analysis. J Psychosom Res. 2007, 62: 439-445. 10.1016/j.jpsychores.2006.10.011.
Almberg B, Grafstrom M, Krichbaum K, Winblad B: The interplay of institution and family caregiving: Relations between patient hassles, nursing home hassles and caregivers' burnout. Int J Geriat Psychiatry. 2000, 15: 931-939. 10.1002/1099-1166(200010)15:10<931::AID-GPS219>3.0.CO;2-L.
Majerovitz SD: Predictors of burden and depression among nursing home family caregivers. Aging Ment Health. 2007, 11: 323-329. 10.1080/13607860600963380.
Gaugler JE, Leitsch SA, Zarit SH, Pearlin LI: Caregiver involvement following institutionalization: effects of preplacement stress. Res Aging. 2000, 22: 337-359. 10.1177/0164027500224002.
Gaugler JE, Mittelman MS, Hepburn K, Newcomer R: Predictors of change in caregiver burden and depressive symptoms following nursing home admission. Psychol Aging. 2009, 24: 385-396. 10.1037/a0016052.
Pillemer K, Suitor JJ, Henderson CR, Meador R, Schultz L, Robison J, Hegeman C: A cooperative communication intervention for nursing home staff and family members of residents. Gerontologist. 2003, 96-106. 43 Special Issue II
Levesque L, Ducharme F, Lachance L: Is there a difference between family caregiving of institutionalized elders with or without dementia?. West J Nurs Res. 1999, 21: 472-491.
Tornatore JB, Grant LA: Family caregiver satisfaction with the nursing home after placement of a relative with dementia. J Gerontol B Psychol Sci Soc Sci. 2004, 59: S80-88.
Pearlin LI, Mullan JT, Semple SJ, Skaff MM: Caregiving and the stress process: An overview of concepts and their measures. Gerontologist. 1990, 30: 583-594.
Newcomer R, Yordi C, DuNah R, Fox P, Wilkinson A: Effects of the Medicare Alzheimer's Disease Demonstration on caregiver burden and depression. Health Serv Res. 1999, 34: 669-689.
Miller R, Newcomer R, Fox P: Effects of the Medicare Alzheimer's Disease Demonstration Evaluation on nursing home entry. Health Serv Res. 1999, 34: 691-714.
Sheikh J, Yesavage J: Geriatric Depression Scale: Recent evidence and development of a shorter version. Clin Gerontologist. 1986, 5: 165-173. 10.1300/J018v05n01_09.
Zarit SH, Reever KE, Bach-Peterson J: Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist. 1980, 20: 649-655.
McDowell I, Newell C: Social health. Measuring health: A Guide to Rating Scales and Questionnaires. 1996, New York: Oxford University Press, 2
Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED: Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med. 1997, 157: 449-454. 10.1001/archinte.157.4.449.
Simon S: Stats: ROC curve (online). --- Either ISSN or Journal title must be supplied.. Accessed April 9, 2009, [http://www.childrensmercy.org/stats/ask/roc.asp]
Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.
Zarit SH, Orr N, Zarit J: Understanding the stress of caregivers: planning an intervention. Hidden Victims of Alzheimer's Disease: Families under Stress. Edited by: Zarit SH, Orr N, Zarit J. 1985, New York: NYU Press, 69-86.
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of illness in the aged. The Index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963, 185: 914-919.
Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969, 9: 179-186.
Gaugler JE, Kane RL, Kane RA, Newcomer R: Unmet care needs and key outcomes in dementia. J Am Geriatr Soc. 2005, 53: 2098-2105. 10.1111/j.1532-5415.2005.00495.x.
Greene V: Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care. 1983, 21: 609-619. 10.1097/00005650-198306000-00003.
Lyons KS, Zarit SH: Formal and informal support: the great divide. Int J Geriatr Psychiatry. 1999, 14: 183-196. 10.1002/(SICI)1099-1166(199903)14:3<183::AID-GPS969>3.0.CO;2-J.
Brodaty H, Green A, Koschera A: Meta-analysis of psychosocial interventions for caregivers of people with dementia. J Am Geriatr Soc. 2003, 51: 657-664. 10.1034/j.1600-0579.2003.00210.x.
Higginson IJ, Gao W, Jackson D, Murray J, Harding R: Short-form Zarit Caregiver Burden Interviews were valid in advanced conditions. J Clin Epidemiol. 2010, 63: 535-542. 10.1016/j.jclinepi.2009.06.014.
Yaffe K, Fox P, Newcomer R, Sands L, Lindquist K, Dane K, Covinsky KE: Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA. 2002, 287: 2090-2097. 10.1001/jama.287.16.2090.
Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB: Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol. 1999, 67: 300-307. 10.1037/0022-006X.67.3.300.
McClendon MJ, Smyth KA, Neundorfer MM: Long-term-care placement and survival of persons with Alzheimer's disease. J Gerontol B Psychol Sci Soc Sci. 2006, 61: P220-227.
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