Two sides of the same coin? Revisiting the relationship between burden and positive aspects of caregiving in dementia

What Has the Pandemic Taught Us About Caregiving? Mental Health in Family Caregivers of People with Dementia One Year After the Lock-Down Due to COVID-19 Pandemic

Caregiving for a person with dementia is considered a situation of chronic stress, with consequences on caregivers' physical and psychological health. The usual challenges of dementia care were intensified during the pandemic due to the risk of contagion, social isolation measures, and decrease in healthcare resources. The COVID-19 pandemic increased the stress both in the persons with dementia and their caregivers. This commentary reflects on the long-term effects of the pandemic on caregivers' mental health, focusing on the study by Olavarría and colleagues and drawing future research lines for culturally diverse family caregivers.

The Positive Aspects of Caregiving Scale can be shortened to six items: application of item response theory

OBJECTIVE

For nearly two decades, with one exception, researchers have used the Positive Aspects of Caregiving Scale (PACS) without a close examination of how the items behave. This study examined PACS' measurement model and item response characteristics, including differential item functioning (DIF) by race.

METHODS

Item response theory was used to analyze the baseline data of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) I trial (N = 1229). Bifactor confirmatory models were estimated to assess dimensionality, and whether the items behaved differently in African Americans and Hispanics, with Whites serving as the comparison, were examined using the multiple-indicators multiple-causes model.

RESULTS

For both 9- and 11-item versions, 1-factor and bifactor solutions supported a unidimensional structure. However, the items performed generally poorly in differentiating levels of the latent construct, especially between moderate and high true scores. Additionally, five items were found to have DIF, which were unrelated to relationship differences among racial groups. While African Americans and Hispanics reported higher positive gains than Whites, their differences were accentuated by the DIF items as a whole. A 6-item version called PACS-II was created by removing the DIF items. Besides reducing estimated racial differences, PACS-II removed race-based heterogeneity of variance that was evidenced in the original, longer versions.

CONCLUSIONS

Being free of racial bias, PACS-II is preferred over the original versions, though the ceiling effect of measurement (prevalence of extreme scores on the high end) remains to be an issue for improvement.

Positive aspects of caregiving attenuate the relationship between behavioral bother and anxiety and depressive symptoms in dementia family caregivers

AIM

To examine the protective role of positive aspects of caregiving (PAC) in terms of whether it dampens the relationship between behavioral bother and anxiety/depressive symptoms.

METHODS

The baseline data of the Resources for Enhancing Alzheimer's Caregiver Health I trial were used. US dementia family caregivers (N = 1222) responded to standard self-report measures of PAC, behavioral bother, depression, anxiety, challenging behaviors, and functional impairment. The buffering effect of PAC was tested using moderational regression.

RESULTS

Controlling for caregivers' age, sex and behavioral bother, and care-recipients' challenging behaviors and functional impairment, PAC was mildly inversely related to depressive and anxiety symptoms. Moreover, a significant PAC × behavioral bother interaction effect was found such that the relationship between behavioral bother, on the one hand, and depression and anxiety, on the other, became weaker with higher PAC. In particular, when behavioral bother was low, depressive and anxiety symptoms were similar regardless of levels of PAC. But when behavioral bother was high, caregivers who reported higher levels of PAC were less depressed and anxious than those with lower levels, with their standardized mean differences being small to moderate.

CONCLUSIONS

PAC was found to be associated with less mood symptoms partly directly and partly through modifying the effect of behavioral bother on depression and anxiety. Caregivers who were highly troubled by the relative's challenging behaviors, but who found higher levels of PAC at the same time, experienced better emotional well-being. Having PAC may make the burden of caregiving more tolerable, thereby alleviating caregiver distress down the road. Geriatr Gerontol Int 2023; 23: 366-370.