Predictors of Appraisal and Psychological Well-Being in Alzheimer's Disease Family Caregivers
Tóm tắt
The objective of this study was to test a model of stress, appraisal, and adaptation in 114 family caregivers of patients diagnosed with dementia of the Alzheimer's type (white non-Hispanic, N = 64; Hispanic-American, N = 50). Results of structural equation analysis show that appraised caregiver burden played a central role in determining the psychological well-being of family caregivers. The findings indicate that this mediating variable, negative caregiver appraisal, was predicted by increased functional limitations and behavioral disturbances in the patient, poorer perceived physical health, and lower levels of perceived emotional support. Contrary to a priori hypotheses, functional limitations in the patient also exhibited a direct association with caregiver depression. Further, patient cognitive impairment and caregiver ethnicity were not related to caregiver appraisal. Overall, these results support the role of appraised burden in mediating the relationships between caregiving factors and the adaptational outcome of depression. The implications of these findings, limitations of the study, and future directions are discussed.
Tài liệu tham khảo
Agar, S., Moniz-Cook, E., Orbell, S., Elston, C., and Wang, M. (1997). Measuring the outcome of psychosocial intervention for family caregivers of dementia sufferers: A factor analytic study. Aging Ment. Health 1: 166-175.
Anderson, E. M., Bowley, N., Rothenberg, B. M., Panzer, R., and Katz, P. (1996). Test-retest performance of a mailed version of the Medical Outcomes Study 36-item short-form health survey among older adults. Med. Care 34: 1165-1170.
Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., and Whitlatch, C. J. (1995). Profiles in Caregiving: The Unexpected Career, Academic Press, San Diego, CA.
Aranda, M. P., and Knight, B. G. (1997). The influence of ethnicity and culture on the caregiver stress and coping process: A sociocultural review and analysis. Gerontologist 37: 342-354.
Arbuckle, J. (1995).AMOS: Analysis of Moment Structures User's Guide, SmallWaters Coorporation, Chicago, IL.
Blessed, B. E., Tomlinson, B. E., and Roth, M. (1968). The association between quantitative measures of dementia and of senile change in cerebral gray matter of elderly subjects. Brit. J. Psychiat. 114: 797-811.
Bollen, K., and Long, J. E. (1993). Testing Structural Equation Models, Sage Publishing Company, Newbury Park, CA.
Bradburn, N. M. (1969). The Structure of Psychological Well-Being, Aldine Publishing Company, Chicago, IL.
Brislin, R. W. (1970). Back-translation for cross-cultural research. J. Cross-Cult. Psychol. 1: 185-216.
Brody, E. M. (1985). Parent care as a normative family stress. Gerontologist 8: 677-685.
Cho, M. J., Moskicki, E. K., Narrow, W. E., Rae, D. S., Locke, B. Z., and Regier, D. A. (1993). Concordance between two measures of depression in the Hispanic Health and Nutrition Examination Survey. Soc. Psychiat. Psychiat. Epidemiol. 28: 156-163.
Cohen, D., and Eisdorfer, C. (1986). The Loss of Self, W. W. Norton & Company, New York.
Cohen, S., Kamarck, T., and Mermelstein, R. (1983). A global measure of perceived stress. J. Health Soc. Behav. 24: 385-396.
Cole, D. A. (1987). Utility of confirmatory factor analysis in test validation research. J. Consult. Clin. Psychol. 55: 584-594.
Cox, C., and Monk, A. (1990). Minority caregivers of dementia victims: A comparison of Black and Hispanic families. J. Appl. Gerontol. 9: 340-354.
Cox, C., and Monk, A. (1993). Hispanic culture and family care of Alzheimer's patients. Health Soc. Work 18: 92-100.
DeBettignies, B. H., Mahurin, R. K., and Pirozzolo, F. J. (1993). Functional status in Alzheimer's disease and Multi-Infarct dementia:Acomparison of patient performance and caregiver report. Clin. Gerontol. 12: 31-49.
Deimling, G. T., and Bass, D. M. (1986). Symptoms of mental impairment among elderly adults and their effects on family caregivers. J. Gerontol. 41: 778-784.
Draper, B. M., Poulos, C. J., Cole, A. D., Poulos, R. G., and Ehrlich, F. (1992). A comparison of caregivers for elderly stroke and dementia victims. J. Am. Geriat. Soc. 40: 896-901.
Eagles, J. M., Craig, A., Rawlinson, F., Restall, D. B., Beattie, J. A. G., and Besson, J. A. Q. (1987). The psychological well-being of supporters of the demented elderly. Brit. J. Psychiat. 150: 293-298.
Erkinjuntti, T., Hokkanen, L., Sulkava, R., and Palos, J. (1988). The Blessed Dementia Scale as a screening test for dementia. Int. J. Geriat. Psychiat. 3: 267-273.
Folstein, M. F., Folstein, S. E., and McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiat. Res. 12: 189-198.
George, L. K., and Gwyther, L. P. (1986). Caregiver well-being: A multidimensional examination of family caregivers of demented adults. Gerontologist 26: 253-259.
Grad, J., and Sainsbury, P. (1968). The effects that patients have on their families in a community care and a control psychiatric service: A two year follow-up. Brit. J. Psychiat. 114: 265-278.
Greene, J. G., Smith, R., Gardiner, R., and Timbury, G. C. (1982). Measuring behavioral disturbance of elderly demented patients in the community and its effects on relatives: A factor analytic study. Age Ageing 11: 121-126.
Guarnaccia, P. J., and Parra, P. (1996). Ethnicity, social status, and families' experiences of caring for a mentally ill family member. Commun. Ment. Health J. 32: 243-260.
Haley, W. E., Roth D. L, Coleton, M. I., Ford, G. R., West, C. A. C., Collins, R. P., and Isobe, T. L. (1996). Appraisal, coping, and social support as mediators of well-being in Black and white family caregivers of patients with Alzheimer's disease. J. Consult. Clin. Psychol. 64: 121-129.
Harper, S., and Lund, D. A. (1990). Wives, husbands, and daughters caring for institutionalized and noninstitutionalized dementia patients: Toward a model of caregiver burden. Int. J. Aging Human Dev. 30: 241-262.
Harwood, D. G., Barker, W.W., Cantillon, M., Loewenstein, D. A., Ownby, R. L., and Duara, R. (1998). Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: A cross-ethnic comparison. Alzheimer Dis. Assoc. Disord. 12: 340-346.
Henderson, A. S., Korten, A. E., Jacomb, P. A., Mackinnon, A. J., Jorm, A. F., Christensen, H., and Rodgers, B. (1997). The course of depression in the elderly: A longitudinal community-based study in Australia. Psychol. Med. 27: 119-129.
Henderson, J. N., and Gutierrez-Mayka, M. (1992). Ethnocultural themes in caregiving to Alzheimer's disease patients in Hispanic families. Clin. Gerontol. 11: 59-74.
Holmes, T. H., and Rahe, R. H. (1967). The social readjustment rating scale. J. Psychosom. Res. 11: 213-218.
Hooker, K., Monahan, D., Bowman, S. R., Frazier, L. D., and Shifren, K. (1998). Personality counts for a lot: Predictors of mental and physical health of spouse caregivers in two disease groups. J. Gerontol. Psychol. Sci. 53: 73-85.
Hooker, K., Monahan, D., Shifren, K., and Hutchinson, C. (1992). Mental and physical health of spouse caregivers: The role of personality. Psychol. Aging 7: 367-375.
Kanner, A. D., Coyne, J. D., Schaefer, C., and Lazarus, R. S. (1981). Comparison of two modes of stress measurment: Daily hassles and uplifts versus major life events. J. Behav. Med. 4: 1-39.
Kennedy, G. J., Kelman, H. R., and Thomas, C. (1990). The emergence of depressive symptoms in late life: The importance of declining health and increasing disability. J. Commun. Health 15: 93-104.
Kiyak, H. A., Teri, L., and Borson, S. (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: Self-reports versus family reports. Gerontologist 34: 324-330.
Kline, R. B. (1991). Latent variable path analysis in clinical research: A beginner's tour guide. J. Clin. Psychol. 47: 471-484.
Lawton, M. P., Kleban, M. H., Moss, M., Rovine, M., and Glicksman, A. (1989). Measuring caregiving appraisal. J. Gerontol. Psychol. Sci. 44: 61-71.
Lawton, M. P., Moss, M., Kleban, M. H., Glicksman, A., and Rovine, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. J. Gerontol. Psychol. Sci. 4: 181-189.
Lawton, M. P., Rajagopal, D., Brody, E., and Kleban, M. H. (1992). The dynamics of caregiving for a demented elder among Black and White families. J. Gerontol. Soc. Sci. 47: 156-164.
Lazarus, R. S. (1966). Psychological Stress and the Coping Process, McGraw-Hill, New York.
Lazarus, R. S., and Folkman, S. (1984). Stress, Appraisal, and Coping, Springer Publishing Company, New York.
Lewinsohn, P. M., and Teri, L. (1982). Selection of depressed and nondepressed subjects on the basis of self-report data. J. Consult. Clin. Psychol. 50: 590-591.
Mack, J. L., and Patterson, M. B. (1994). The evaluation of behavioral disturbances in Alzheimer's disease: The utility of three rating scales. J. Geriat. Psychiat. Neurol. 7: 101-117.
Mangone, C. A., Sanguinetti, R. M., Paumann, P. D., Gonzalez, R. C., Pereyra, S., Bozzola, F. G., Gorelick, P. B., and Sica, R. E. P. (1993). Influence of feelings of burden on the caregiver's perception of patient's functional status. Dementia 4: 287-293.
McHorney, C. A. (1996). Measuring and monitoring general health status in elderly persons: Practical and methodological issues in using the SF-36 Health Survey. Gerontologist 36: 571-583.
McKhann, G., Drachman, D., Folstein, M. F., Katzman, R., Price, D., and Stadian, E. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 34: 939-944.
Mega, M. S., Cummings, J. L., Fiorello, T., and Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology 46: 130-135.
Mintzer, J. E., Rubert, M. P., Loewenstein, D., Gamez, E., Millor, A., Quinteros, R., Flores, L., Miller, M., Rainerman, A., and Eisdorfer, C. (1992). Daughters caregiving for Hispanic and non-Hispanic Alzheimer's patients: Does ethnicity make a difference? Commun. Ment. Health J. 28: 293-303.
Monahan, D. J. (1995). Informal caregivers of institutionalized dementia residents: Predictors of burden. J. Gerontol. Soc. Work 23: 65-82.
Monroe, S. M., and Kelley, J. M. (1995). Measurement of stress appraisal. In Cohen, S., Kessler, R. C., and Gordon, L. U. (eds.), Measuring Stress: A Guide for Health and Social Scientists, Oxford University Press, Oxford, UK, pp. 122-147.
Moritz, D. J., Kasl, S. V., and Berkman, L. F. (1989). The health impact of living with a cognitively impaired elderly spouse: Depressive symptoms and social functioning. J. Gerontol. Soc. Sci. 44: 17-27.
O'Connor, D. W., Pollitt, P. A., Roth, M., Brook, C. P. B., and Reis, B. B. (1990). Problems reported by relatives in a community study of dementia. Brit. J. Psychiat. 156: 835-841.
Pearlin, L. I. (1983). Role strains and personal stress. In Kaplan, H. B. (ed.), Psychosocial stress: Trends in Theory and Research, Academic Press, New York, pp. 3-32.
Pearlin, L. I., Mullan, J. T., Semple, S. J., and Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. Gerontologist 30: 583-594.
Phifer, J. F., and Murrell, S. A. (1986). Etiologic factors in the onset of depressive symptoms in older adults. J. Abnorm. Psychol. 95: 282-291.
Pratt, C. C., Schmall, V. L., Wright, S., and Cleland, M. (1985). Burden and coping strategies of caregivers to Alzheimer's patients. Fam. Rel. 34: 27-33.
Pruchno, P. A., Peters, N. D., and Burant, C. J. (1995). Mental health of coresident family caregivers: Examination of a two-factor model. J. Gerontol. Psychol. Sci. 50: 247-256.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Measure. 1: 385-401.
Radloff, L. S., and Teri, L. (1986). Use of the Epidemiologic Studies Depression Scale with older adults. Clin. Gerontol. 5: 119-136.
Rankin, E. D., Haut, M. W., and Keefover, R. W. (1992). Clinical assessment of family caregivers in dementia. Gerontologist 32: 813-821.
Reis, M. F., Gold, D. P., Gauthier, S., Andres, D., and Markiewicz, D. (1994). Personality traits as determinants of burden and health complaints in caregiving. Int. J. Aging Human Dev. 39: 257-271.
Reisberg, B., Borenstein, J., Salob, S. P., Ferris, S. H., Franssen, E., and Georgotas, A. (1987). Behavioral symptoms in Alzheimer's disease: Phenomenology and treatment. J. Clin. Psychiat. 48: 9-15.
Reisberg, B., Franssen, E., Sclan, S. G., Kluger, A., and Ferris, S. H. (1989). Stage specific incidence of potentially remediable behavioral symptoms in aging and Alzheimer disease: Astudy of 120 patients using the BEHAVEAD. Bull. Clin. Neurosci. 54: 95-112.
Schulz, R., O'Brien, A. T., Bookwala, J., and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. Gerontologist 35: 771-791.
Sclan, S. G., Saillon, A., Franssen, E., Hugonot-Diener, L., Saillon, A., and Reisberg, B. (1996). The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVEAD): Reliability and analysis of symptom category scores. Int. J. Geriat. Psychiat. 11: 819-830.
Stone, R., Cafferata, G., and Sangl, J. (1987). Caregivers of frail elderly: A national profile. Gerontologist 27: 616-626.
Taussig, M., and Mack, W. (1995). A Comparison of Spanish versus English-speaking caregivers' perception of early symptoms of Alzheimer's disease. The American Journal of Alzheimer's Disease. September/October: 33-39.
Thoits, P. A. (1995). Stress, coping, and social support processes: Where are we? What next? J. Health Soc. Behav. 36: 53-79.
Thompson, E. H., Jr., Futterman, A. M., Gallagher-Thompson, D., Rose, J. M., and Lovett, S. B. (1993). Social support and caregiver burden in family caregivers of frail elders. J. Gerontol. Soc. Sci. 48: 245-254.
Tower, R. B., Kasl, S. V., and Moritz, D. J. (1997). The influence of spouse cognitive impairment on respondents' depressive symptoms: The moderating role of marital closeness. J. Gerontol. Soc. Sci. 52: 270-278.
Tsai, L., and Tsuang, M. T. (1979). The Mini Mental State test and computerized tomography. Am. J. Psychiat. 136: 436-438.
US Department of Health and Human Services. (1992). Progress report on Alzheimer's disease. NIH Publication No. 92-3409. US Government Printing Office, Washington, DC.
US Department of Health and Human Services. (1993). Special report on aging. NIH Publication No. 92-3409. US Government Printing Office, Washington, DC.
Valle, R. (1994). Culture-fair behavioral symptom differential assessment and intervention in dementing illness. Alzheimer Dis. Assoc. Disord. 8: 21-45.
Vitaliano, P. P., Russo, J., Young, H. M., Teri, L., and Maiuro, R. D. (1991). Predictors of burden in spouse caregivers of individuals with Alzheimer's disease. Psychol. Aging 6: 392-402.
Ware, J. E. (1993). SF-36 Health Survey: Manual & Interpretation Guide. Nimrod Press, Boston.
Weiler, P. G., Chiriboga, D. A., and Black, S. A. (1994). Comparisons of mental status tests: Implications for Alzheimer's patients and their caregivers. J. Gerontol. Soc. Sci. 49: 44-51.
Zarit, S., Reever, K., and Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist 20: 649-655.