Domain-Specific Associations between Burden and Mood State in Dementia Caregivers

Research indicates that caregiver burden is related to caregiver mood state. The current study investigated the relationship between caregiver burden and affect via the Caregiver Burden Inventory and the Profile of Mood States. The sample was comprised of 31 female caregivers of individuals with dementia. Regression analyses revealed that developmental burden predicted caregiver tension-anxiety, and along with time dependence burden (an inverse predictor), was predictive of caregiver depression-dejection. Social burden emerged as a predictor of caregiver anger-hostility and confusion-bewilderment, and in conjunction with physical burden it predicted caregiver fatigue-inertia. The current findings are reviewed with regard to treatment implications.     

Predictors of Anticipatory Grief in Dementia Caregivers

The current study examines several indicators of dementia severity and their relationship to anticipatory grief (AG) to investigate which aspects of the caregiving situation may lead to greater levels of AG. Eighty informal dementia caregivers completed interviews and questionnaires assessing their experiences, and regression analyses were used to examine the relationship between primary stressors (disease stage, hours of weekly care, ADL and IADL impairments and behavior problems) and AG. Results revealed that behavior problems were the only variable which was significantly associated with AG, and follow-up analyses revealed that adult child and spouse caregivers responded differently to different types of behavior problems. Overall, the grief experiences of dementia caregivers appear to be more strongly related to behavioral problems than other indicators of disease severity.     

Primary Care Providers' Views of Challenges and Rewards of Dementia Care Relative to Other Conditions

OBJECTIVES: To compare primary care providers' (PCPs') perceptions about dementia and its care within their healthcare organization with perceptions of other common chronic conditions and to explore factors associated with differences. DESIGN: Cross‐sectional survey. SETTING: Three California healthcare organizations. PARTICIPANTS: One hundred sixty‐four PCPs. MEASUREMENTS: PCPs' views about primary care for dementia were analyzed and compared with views about care for heart disease, diabetes mellitus, and selected other conditions. Differences in views about conditions according to PCP type (internists, family physicians) were assessed. Multivariate analysis examined relationships between provider and practice characteristics and views about dementia care. RESULTS: More PCPs strongly agreed that older patients with dementia are difficult to manage (23.8%) than for heart disease (5.0%) or diabetes mellitus (6.3%); PCPs can improve quality of life for heart disease (58.9%) and diabetes mellitus (61.6%) than for dementia (30.9%); older patients should be routinely screened for heart disease (63.8%) and diabetes mellitus (67.7%) than dementia (55.5%); and their organizations have expertise/referral resources to manage diabetes mellitus (49.4%) and heart disease (51.8%) than dementia (21.1%). More PCPs reported almost effortless organizational care coordination for heart disease (13.0%) or diabetes mellitus (13.7%) than for dementia (5.6%), and a great deal or many opportunities for improvement in their ability to manage dementia (50.6%) than incontinence, depression, or hypertension (7.4–34.0%; all P<.05). Internists' views regarding dementia care were less optimistic than those of family physicians, but PCP type was unrelated to views on diabetes mellitus or heart disease. CONCLUSION: Improving primary care management of dementia should directly address PCP concerns about expertise and referral resources, difficulty of care provision, and PCP views about prospects for patient improvement.     

Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home‐Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center

Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home‐based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community‐dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow‐up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home‐based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures.     

Development of the Risk Appraisal Measure: A Brief Screen to Identify Risk Areas and Guide Interventions for Dementia Caregivers

OBJECTIVES: To develop and validate a brief screening measure for use in research, healthcare, and community settings to systematically assess well-being and identify needed areas of support for caregivers of patients with dementia.
DESIGN: This study used data from Resources for Enhancing Alzheimer's Caregiver Health (REACH II), a multisite randomized clinical trial of a behavioral intervention designed to improve the quality of life of caregivers in multiple domains.
SETTING: REACH II.
PARTICIPANTS: Two hundred twelve Hispanic, 211 black, and 219 white family caregivers providing in-home care to patients with dementia.
MEASUREMENT: Based on conceptual and psychometric analyses, a 16-item measure was developed that assesses six domains linked to caregiver risk and amenable to intervention: depression, burden, self-care and health behaviors, social support, safety, and patient problem behaviors. The reliability and validity of the instrument was evaluated with 642 dementia caregiver dyads from the REACH II program.
RESULTS: The measure was found to have acceptable internal consistency for a multidimensional scale and similar measurement properties for each of the racial and ethnic groups. Concurrent validity was also demonstrated for the measure.
CONCLUSION: The REACH Risk Appraisal Measure developed in this study shows promise as an assessment tool that can be used in research, clinical, and community settings to guide, prioritize, and target needed areas of support for caregivers of patients with dementia.