Predicting longitudinal changes in caregiver physical and mental health: a stress process model

The dynamics of caregiving: transitions during a three-year prospective study

This prospective study (n = 476) examined 3 types of caregiving transitions experienced by wives and daughters of older persons: entry, institutionalization, and bereavement. Daughters were more likely to enter the caregiving role than wives, but the impact of entering the role was more pronounced for wives. After becoming a caregiver, wives decreased in their participation in leisure activities, perceptions of quality of family relations, and marital satisfaction. Daughter caregivers were more likely than wives to place their care recipient in an institution, and they increased in social participation and decreased in subjective burden after placement. Roughly the same percentage of wife and daughter caregivers were bereaved during the study period, and for wives bereavement was accompanied by an increase in social involvement and personal growth. The results underscore the highly dynamic nature of the caregiving career and the importance of the kinship relationship between caregiver and care recipient in conditioning the effects of caregiving transitions.

Longitudinal course of behavioral problems during Alzheimer's disease: linear versus curvilinear patterns of decline

BACKGROUND

Patients with Alzheimer's Disease (AD) are commonly assumed to experience a linear decline in behavioral functioning that parallels progressive cognitive decline. However, some researchers have suggested that specific behavioral problems either decline at different rates or improve in late dementia.

METHODS

The present analyses examined 150 AD patients at an initial assessment, 61 of whom were also evaluated annually on two additional occasions. Measures of cognitive impairment and behavioral problems were obtained.

RESULTS

Cross-sectional results indicated curvilinear associations between dementia severity and certain behavioral problems (forgetful behaviors, and emotional and impulsive behaviors). Longitudinal analyses further indicated trends for curvilinear rates of behavioral disturbance across time, with some problem areas showing improvement as AD progresses through the most severe stages.

CONCLUSIONS

Even though Alzheimer's disease is a progressive dementia characterized by increasing cognitive deterioration, it appears to be inaccurate to expect behavioral functioning to show the same linear decline across time.

The stress and psychological morbidity of the Alzheimer patient caregiver

BACKGROUND

Alzheimer's family caregivers suffer from psychological and physical morbidity associated with the care of the Alzheimer's patient. The objectives of the study were to compare stress and psychological morbidity between family caregivers of Alzheimer's disease patients and family caregivers of aged non-demented chronically ill patients and to explore the impact of cognitive and non-cognitive patient symptoms on caregivers.

METHOD

Fifty-eight caregivers of Alzheimer's patients (cases) and 32 caregivers of non-demented chronically ill patients (controls) were studied. A cross-sectional case-control design was employed using validated scales to assess patient symptomatology and self-report questionnaires to measure stress and psychological morbidity in caregivers.

RESULTS

Compared to controls, stress and psychological morbidity were higher in caregivers of Alzheimer's patients. Behavioral symptoms and impairment in instrumental activities of daily living were associated with caregiver stress. Length of care was associated with caregiver psychological morbidity.

CONCLUSIONS

Caregiver stress may be reduced with special attention paid to the treatment and management of behavioral and functional symptoms in the Alzheimer's disease patient. Caregiver education and coping skills should also be included.

Beyond the Folstein: dementia in primary care

As the population of elderly patients continues to increase world-wide, the importance of identifying patients with dementia in primary care practices will increase. Our ability to see patients for an extended period of time may enable primary care physicians to identify patients with dementia early in their disease process. This enables patients, families, and caregivers to initiate treatment early, with the hope that future research will identify successful treatment modalities. This article discusses the identification of dementing syndromes, the importance of identifying familial needs and coping strategies, and the importance of caregiver stress.