Dementia Family Caregiver Training: Affecting Beliefs About Caregiving and Caregiver Outcomes

Journal of the American Geriatrics Society - Tập 49 Số 4 - Trang 450-457 - 2001
Kenneth Hepburn1, Karin Lindstrom Bremer1, Bruce A. Center1, Sharon W. Ostwald2
1Department of Family Practice and Community Health, University of Minnesota, Minneapolis, Minnesota and
2Center on Aging, University of Texas-Houston School of Nursing, Houston, Texas.

Tóm tắt

OBJECTIVES: Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role‐training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving.DESIGN: Training effectiveness was tested in a trial in which family care receiver dyads were randomly assigned to training beginning immediately or were placed in a wait‐list control group and assigned to receive training in 5 to 6 months, following completion of data collection.SETTING: A community‐based 14‐hour training program provided in seven weekly 2‐hour sessions. The training program curriculum was built on a stress and coping theory base. Recruitment and randomization were ongoing. Programs were begun every 2 months over a two and one half‐year period for a total of 16 programs.PARTICIPANTS: Community health and social service agencies referred primary caregivers and at least one other family member of community‐dwelling persons with dementia to participate.MEASUREMENTS: Data reported in this paper were gathered from each participating family at entry to the study and 5 months later. Standard measures of beliefs about caregiving, burden, depression, and reaction to care receiver behavior were administered to caregivers. A standard measure of mental status was administered to the person with dementia and standardized instruments were used to gather information from caregivers concerning care receivers' behavior and abilities to perform activities of daily living (ADLs).RESULTS: Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data. Treatment and control caregivers and care receivers were similar at baseline, and care receivers in both groups declined similarly over the 5‐month period. Significant within‐group improvements occurred with treatment group caregivers on measures of beliefs about caregiving (P = .044) and reaction to behavior (P = .001). When outcomes were compared, treatment group caregivers were significantly different (in the expected direction) from those in the control group on measures of the stress mediator, beliefs (P = .025), and key outcomes, response to behavior (P = .019), depression (P = .040), and burden (P = .051). There was a significant positive association between the strengthened mediator, the caregivers' having less‐emotionally enmeshed beliefs about caregiving roles and responsibilities, and the outcome, namely improvements in burden (P = .019) and depression (P = .007).CONCLUSION: A caregiver training intervention focused on the work of caregiving and targeted at knowledge, skills, and beliefs benefits caregivers in important outcome dimensions. The results suggest the benefits of providing information, linkage, and role coaching to dementia family caregivers.

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Tài liệu tham khảo

Small GW, 1997, Diagnosis and treatment of Alzheimer disease and related disorders: Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society., JAMA, 278, 1363, 10.1001/jama.1997.03550160083043

10.1377/hlthaff.12.2.164

10.2105/AJPH.84.8.1261

10.1111/j.1532-5415.1999.tb05228.x

10.2307/584767

National Alliance for Caregiving, American Association of Retired Persons, 1997, Family caregiving in the U.S.: Findings from a national survey [abstract]

10.1093/geront/19.1.3

10.1093/geront/27.5.616

Arno PS, 1999, The economic value of informal caregiving., Health Aff, 18, 182, 10.1377/hlthaff.18.2.182

10.1177/089826439500700202

10.1377/hlthaff.17.6.206

10.1111/j.1532-5415.1990.tb03496.x

10.7326/0003-4819-120-2-199401150-00005

10.1111/j.1532-5415.1987.tb04661.x

10.1111/j.1532-5415.1989.tb02230.x

10.1093/geront/39.2.177

10.1002/(sici)1099-1166(199712)12:12<1168::aid-gps711>3.0.co;2-f

10.1093/geront/35.6.771

Hong W, 1999, Chronic stress associated with spousal caregiving of patients with Alzheimer's dementia is associated with downregulation of B‐lymphocyte GH mRNA., J Gerontol A Biol Sci Med Sci, 54, M212, 10.1093/gerona/54.4.M212

10.1111/j.1532-5415.1986.tb04239.x

10.1177/002383099200500108

10.1093/geronj/44.5.S177

10.1300/J018v16n01_03

10.1300/J018v10n02_03

Collins CE, 1994, Interventions with family caregivers of persons with Alzheimer's disease., Nurs Clin North Am, 29, 195, 10.1016/S0029-6465(22)02721-9

10.1111/j.1532-5415.1985.tb01774.x

10.1111/j.1532-5415.1989.tb01248.x

10.1300/J018v17n01_02

10.1002/(sici)1099-1166(1998100)13:10<674::aid-gps840>3.0.co;2-d

10.1093/geront/34.4.548

10.1001/archneur.1993.00540060073021

Mittelman MS, 1996, A family intervention to delay nursing home placement of patients with Alzheimer disease: A randomized controlled trial., JAMA, 276, 1725, 10.1001/jama.1996.03540210033030

10.1093/gerona/54.5.M267

10.1097/00019442-199821001-00005

Morris JC, 1997, Alzheimer's disease: A review of clinical assessment and management issues., Geriatrics, 52, S22

10.1001/jama.269.10.1282

10.1111/j.1532-5415.2000.tb02650.x

10.1093/geront/39.4.457

10.1111/j.1532-5415.1987.tb04920.x

10.1016/s0895-4356(97)00168-6

10.1111/j.1532-5415.1999.tb03846.x

10.1007/BF02600253

10.1177/153331759701200205

10.1016/S0883-9417(99)80024-7

10.1097/00006199-199905000-00007

10.1002/(sici)1099-1166(199904)14:4<302::aid-gps905>3.3.co;2-t

10.2190/AN6L-6QBQ-76G0-0N9A

10.1093/geront/39.3.299

Reisberg B, 1988, Functional assessment staging (FAST)., Psychopharmacol Bull, 24, 653

10.1093/geronb/54B.1.P12

Aneshensel CS, 1995, Profiles in Caregiving: The Unexpected Career

10.1093/geront/30.5.583

10.1093/geronj/46.4.P181

Allen CK, 1988, Occupational therapy: Functional assessment of the severity of mental disorders., Hosp Community Psychiatry, 39, 140

10.1177/089198879400700109

Burns T, 1990, The effectiveness of work programming with an Alzheimer population., Occup Ther Pract, 1, 64

10.1177/153331758900400506

10.1016/0022-3956(75)90026-6

10.1093/geront/9.3_Part_1.179

10.1037//0882-7974.7.4.622

10.1177/014662167700100306

Zarit S, 1985, The Hidden Victims of Alzheimer's Disease: Families Under Stress

10.1002/nur.4770120403

10.1212/WNL.51.1_Suppl_1.S53

10.1017/S1041610297004444

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Journal of the American Geriatrics Society

Tập 49 Số 4

450-457

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