Psychological distress in Brazilian caregivers of relatives with dementia

A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study

BACKGROUND

By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners-together called a "dyad." Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms.

OBJECTIVE

This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures.

METHODS

All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses.

RESULTS

This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023.

CONCLUSIONS

We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/45532.

Young- and Late-Onset Dementia: A Comparative Study of Quality of Life, Burden, and Depressive Symptoms in Caregivers

OBJECTIVE

To compare the quality of life, burden, and depressive symptoms of caregivers of individuals with young-onset dementia (YOD) and late-onset dementia (LOD).

METHODS

Using a cross-sectional design, a convenience sample of 110 dyads of individuals with dementia and their caregivers, all living in the community, was included. The care recipients completed assessments about cognition, quality of life, and awareness of disease. Caregivers' quality of life, resilience, depressive and anxiety symptoms, hopelessness, and burden of care were assessed.

RESULTS

A significant difference was found in caregivers' burden and depressive symptoms according to the age of onset. However, there was no difference in caregivers' quality of life between YOD and LOD groups. In both groups, a linear regression analysis indicated that caregivers' perspective of quality of life of care recipient and caregivers' hopelessness were associated with their quality of life. In addition, in the LOD group, caregivers' burden was associated with their perspective of the quality of life of care recipient, type of kinship, and presence of emotional problems. In the YOD group, caregivers' burden was associated with duration of caregiving role, cohabitating with care recipient, and their anxiety symptoms. Caregivers' depressive symptoms were associated with anxiety symptoms in the YOD group, whereas hopelessness was associated with caregivers' depressive symptoms in both the groups.

CONCLUSION

Our findings suggest that the factors that affect quality of life, burden, and depressive symptoms of caregivers of individuals with LOD differ from those that affect the caregivers of individuals with YOD.

A Customized Intervention for Dementia Caregivers: A Quasi-Experimental Design

Objective: The aim of this study is to test the effects of a customized intervention on distress among caregivers of persons with dementia (PWD) using a quasi-experimental design. Method: Fifty-one spouse caregivers in the experimental group and 51 in the control group participated in the study. The effects of the intervention were examined by comparing caregivers' responses with questionnaires at pre-intervention baseline (T0) and immediately after intervention (T1). Differences were quantified using repeated-measures ANOVA. Results: The analyses indicated a stabilizing effect of the intervention on caregivers' perceptions of PWD's daily functioning, self-esteem related to caregiving, quality of family support, and feeling of distress. Linear increases were observed regarding sense of preparedness and impact on daily routine, while no differences (interaction and linear effects) were observed for degree of self-efficacy, depression, impact on finances, or self-rated health. Conclusion: These findings show a preliminary efficacy of the intervention proposed in this study to prevent the exacerbation of caregivers' distress.

mHealth applications as an educational and supportive resource for family carers of people with dementia: An integrative review

Family carers encounter several challenges related to caring for people with dementia, and they need support in managing care recipients’ health needs. This study aims to identify, appraise and synthesise the existing evidence on the use of mHealth/smartphone applications as an educational and supportive resource for family carers of people with dementia. An integrative literature review approach was used. Seven databases were searched. The search generated 117 articles, with seven meeting the inclusion criteria. Three categories and their attendant sub-categories emerged from the literature. The categories are ‘carer support’, ‘evaluation strategies’ and ‘barriers and challenges’. mHealth applications appear to be a feasible intervention for family carers of people with dementia despite the limited available research and barriers for their development and implementation. Further research on mHealth applications with strong methodological rigour and more research on mHealth applications as an educational and supportive resource for carers of people with dementia are needed.

Predictors and moderators of quality of life in caregivers of amputee patients by type 2 diabetes

BACKGROUND

The amputation of a foot or a leg is one of the complications caused by diabetes that creates fear. After the amputation, the patient becomes dependent on a caregiver, who is often not prepared for this new phase of life. Knowing the factors that influence care delivery in caregivers of amputee type 2 diabetes patients is important from an heuristic point of view, since very few studies have focused on this population.

OBJECTIVES

This study analysed the predictors and moderators of quality of life, in caregivers of amputee patients due to type 2 diabetes.

METHODS

This study has a cross-sectional design. All ethical standards were followed in the conduct of this study. The sample comprised 101 caregivers who answered the following instruments: Carer's Assessment of Managing Index, Burden Assessment Scale, Depression Anxiety Stress Scales, Revised Impact of Events Scale, Family Assessment Device, Family Disruption from Illness Scale and the Short Form Health Survey-36.

RESULTS

The practice of physical activity, lower burden, better family functioning and less traumatic symptoms were predictors of better mental quality of life. Having no chronic disease and less physical symptoms predicted better physical quality of life. Duration of care moderated the relationship between traumatic symptoms and mental quality of life, but not with physical quality of life. Receiving help in caregiving moderated the relationship between traumatic symptoms and mental quality of life. The limitations of this study include the exclusive use of self-report instruments and the fact that the caregivers who have participated in this study were those who accompanied the patient to the hospital.

CONCLUSION

In order to promote physical quality of life, future intervention programmes should consider the presence of chronic disease in the caregiver and the duration of care, as well as the caregivers' physical symptoms.

The contribution of caregiver psychosocial factors to distress associated with behavioural and psychological symptoms in dementia

OBJECTIVE

The objective of the study is to examine caregiver factors as predictors of BPSD-related distress and their potential mechanisms.

METHOD

Informal caregivers of people with dementia (n = 157) recruited from 28 community mental health teams in six NHS Trusts across England completed questionnaires regarding psychosocial factors (relationship quality, competence, guilt, health-related quality of life in the caregiver and person with dementia, reactivity to behavioural and psychological symptoms in dementia [BPSD] and burden) and frequency of BPSD. Analyses of BPSD-related distress include hierarchical multiple regression, mediation, moderation and path analysis.

RESULTS

Caregiver psychosocial factors explained 56% of the variance in BPSD-related distress. After controlling for these factors, frequency of BPSD was not a significant predictor of BPSD-related distress. Caregiver reactivity to BPSD, burden, competence and relationship quality directly influenced BPSD-related distress. Guilt influenced distress indirectly via competence, burden and reactivity to BPSD. The final model accounted for 41% of the variance in BPSD-related distress and achieved a good fit to the data (χ²  = 23.920, df = 19, p = 0.199).

CONCLUSIONS

Caregiver psychosocial factors including sense of competence, guilt, burden and reactivity to BPSD contribute to BPSD-related distress. Tailored interventions for managing behaviour problems in family settings could focus on these factors associated with BPSD-related distress to minimise distress in families. Copyright © 2016 John Wiley & Sons, Ltd.

A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

BACKGROUND

Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.

METHODS

Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).

RESULTS

Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.

CONCLUSIONS

The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

The Thoughts Questionnaire (TQ) for family caregivers of people with dementia

OBJECTIVES

To develop a new measure of dysfunctional thoughts for family caregivers of people living with dementia. These thoughts can contribute to negative outcomes, but they may be modifiable.

METHOD

A stepwise process was used to develop the Thoughts Questionnaire, commencing with item generation, concept mapping, and pilot testing in a sample of professional and nonprofessional caregivers of people with dementia (n = 18). Next, an independent sample of 35 family caregivers of people with dementia (30 female; M_age = 64.30, standard deviation = 10.65) completed: (a) the Thoughts Questionnaire; (b) an existing measure of dysfunctional thoughts, the Dementia Thoughts Caregivers Questionnaire; and (c) separate validated measures of depressive symptoms, caregiver stress, and coping, respectively.

RESULTS

The level of agreement with dysfunctional thought statements from the Dementia Thoughts Caregivers Questionnaire and Thoughts Questionnaire was low. However, a small number of Thoughts Questionnaire statements were strongly endorsed by over 85% of the sample. Both dysfunctional thought measures had adequate reliability, but total scores were not significantly intercorrelated (r = .287, p = .095). Only the Thoughts Questionnaire was significantly, positively correlated with most caregiver stress measures. Thoughts Questionnaire items required a much lower reading level than the Dementia Thoughts Caregivers Questionnaire items.

DISCUSSION

This study provides preliminary data on a tool for assessing the negative role-related thoughts that family caregivers of people with dementia may experience. Given that these thoughts are implicated in depression but they may be modified, the capacity to identify dysfunctional thoughts may prove useful in caregiver support programs.

The psychophysiological impact of childhood autism spectrum disorder on siblings

OBJECTIVE

The negative impact of caring for a child with autism spectrum disorder (ASD) on parents' psychophysiological functioning has been widely evidenced. However, siblings, who also face emotional, social and physical challenges associated with having a brother/sister with ASD, have been less widely studied. This study examined the psychophysiological impact of childhood ASD on siblings.

METHODS

A sample of 25 siblings of children with ASD (and their mothers) and a control group of 20 siblings of neuro-typical children (and their mothers) completed questionnaires assessing: (a) demographic and lifestyle information, (b) family characteristics, (c) child behaviour problems, (d) social support and (e) depressive symptomology. Saliva samples were collected at several time points on two consecutive days, and estimates of the cortisol awakening response (CAR), diurnal cortisol slope and mean diurnal cortisol output were derived.

RESULTS

Total depressive symptoms were higher in siblings of children with ASD compared with controls. Group differences with respect to depressive symptomology were driven more by emotional than functional problems. With respect to physiological functioning, groups were comparable on all cortisol indices. In siblings of children with ASD, social support, especially from parents and close friends, predicted total depressive symptoms, as did the behaviour problems of their brother/sister with ASD.

CONCLUSION

Siblings of children with ASD experience greater emotional problems and overall depressive symptoms compared with a control group. Interventions that enhance social support, as well as helping siblings better understand the behaviour problems of their brother/sister with ASD, might be effective for alleviating depressive symptoms.

Transcendental Meditation for the improvement of health and wellbeing in community-dwelling dementia caregivers [TRANSCENDENT]: a randomised wait-list controlled trial

Background

Dementia is a prevalent neurodegenerative disorder affecting an estimated 24.3 million people across the globe. The burden on those caring for people with dementia is substantial, with widespread implications for the caregiver, the care recipient and the community. Relaxation techniques, such as Transcendental Meditation® (TM), have been shown to reduce stress and anxiety in healthy workers; similar benefits are anticipated in dementia caregivers. The objective of this study was to ascertain whether TM can improve psychological stress, quality of life, affect and cognitive performance in dementia caregivers.

Methods

The study was conducted as a pilot prospective, multi-centre, community-based, randomised wait-list controlled trial. Community-dwelling caregivers of persons with diagnosed dementia were randomly assigned to a 12-week (14-hour) TM training program or wait-list control. Participants were assessed for quality of life, stress, affect, cognitive performance and adverse effects. The feasibility of the study was also evaluated.

Results

Seventeen caregivers were recruited and randomised. Improvements in WebNeuro response speed scores over time were significantly (p = 0.03) greater in the TM group relative to control. Changes between groups over time in all other primary and secondary outcome measures did not reach statistical significance. However, there was a trend toward greater improvement in WebNeuro stress, depression and negativity bias scores in the TM group. Adverse events were reported amongst 63 % of TM-treated subjects; however, events were generally transient, of mild-moderate intensity and only ‘possibly’ related to TM.

Conclusions

Dementia caregivers exposed to TM demonstrated varying degrees of improvement in several measures of cognitive function, mood, quality of life and stress following exposure to TM. However, as the pilot study was underpowered, no firm conclusions can be made about the effectiveness of TM in this caregiver population. Findings from full-scale trials are now warranted.

Trial registration

Australian New Zealand Clinical Trial Registry ACTRN12613000184774 (Registered 15th February 2013).

Compassion fatigue in adult daughter caregivers of a parent with dementia

Adult daughters face distinct challenges caring for parents with dementia and may experience compassion fatigue: the combination of helplessness, hopelessness, an inability to be empathic, and a sense of isolation resulting from prolonged exposure to perceived suffering. Prior research on compassion fatigue has focused on professional healthcare providers and has overlooked filial caregivers. This study attempts to identify and explore risk factors for compassion fatigue in adult daughter caregivers and to substantiate further study of compassion fatigue in family caregivers. We used content analysis of baseline interviews with 12 adult daughter caregivers of a parent with dementia who participated in a randomized trial of homecare training. Four themes were identified in adult daughter caregiver interviews: (a) uncertainty; (b) doubt; (c) attachment; and (d) strain. Findings indicated adult daughter caregivers are at risk for compassion fatigue, supporting the need for a larger study exploring compassion fatigue in this population.

Correlation between neuropsychiatric symptoms and caregiver burden in a population-based sample from São Paulo, Brazil: a preliminary report

Neuropsychiatric symptoms and caregiver burden are highly prevalent in older adults with Alzheimer's disease (AD).OBJECTIVE: To evaluate the correlation between neuropsychiatric symptoms and caregiver burden in a community-based sample from São Paulo, Brazil.

METHODS

A total of 1,563 randomly-selected subjects were assessed by the Mini-Mental State Examination, Fuld Object Memory Evaluation, Informant Questionnaire on Cognitive Decline in the Elderly and Bayer - Activities of Daily Living Scale. Subjects considered screen-positives were submitted to a dementia workup and diagnosis was determined according to ICD-10 criteria. The neuropsychiatric Inventory was applied to caregivers to evaluate neuropsychiatric symptoms and the Zarit Burden Interview was also applied to assess caregivers' burden.

RESULTS

Sixty-one AD patients, 25 Cognitively Impaired Non Demented (CIND) and 79 healthy elderly subjects were evaluated. Zarit mean scores for controls, CIND and AD were 2.32, 3.92 and 20.11, respectively. There was strong positive correlation between total NPI and Zarit scores.

CONCLUSION

In conclusion, neuropsychiatric symptoms showed a significant association with higher rates of caregiver stress.

Compassion fatigue: an application of the concept to informal caregivers of family members with dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue.

Does filial piety decrease depression among family caregivers?

OBJECTIVES

To examine the effects of filial piety - the practice of filial respect of and care for parents - on depressive symptoms among adult children caregivers of elderly Arab parents in Israel, and to identify factors that may mediate the association.

METHOD

Cross-sectional data were collected in 2006-2007 by a structured interview from 250 randomly sampled Arab-Israeli adult children caregivers (response rate, 94%). Path analysis was used to examine the study objectives.

RESULTS

Filial piety was not directly related to depression, but rather worked indirectly through caregiving burden. Caregiver depression was predicted positively by caregiving burden, while burden was predicted negatively by filial piety. Sense of mastery emerged as a major (negative) predictor and as a mediator between caregiving burden and depressive symptoms.

CONCLUSION

The analysis showed that caregiving burden in this population of traditional caregivers was associated with depressive symptoms, while most other variables were mediated through caregiving burden, sense of mastery, or filial piety. Researchers and practitioners should be sensitive to issues of family care among such traditional populations in transition.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease.

Depressão e relação com idade em cuidadores de familiares portadores de síndrome demencial

Avaliou-se a presença de sintomas depressivos em cuidadores de familiares portadores de síndrome demencial comparados a não cuidadores e a relação deste desfecho em três faixas etárias. Participaram 84 cuidadores e 101 não cuidadores que residiam na região metropolitana de Porto Alegre, RS, Brasil. Aplicou-se um questionário de dados sociodemográficos e o Inventário Beck de Depressão. Os cuidadores revelaram níveis mais elevados de sintomas depressivos e com maior gravidade nos aspectos cognitivos e afetivos do inventário de depressão quando comparados aos não cuidadores. Foram encontrados níveis mais baixos de sintomas de depressão em indivíduos de maior faixa etária (65 a 83 anos). São discutidas as limitações do inventário na avaliação de sintomas de depressão em pessoas idosas. Ressalta-se a necessidade de suporte psicológico e apoio social aos cuidadores de familiares com síndrome demencial.

Sociodemographic profile and level of burden of dementia patients' caregivers who participate in a support group

The Brazilian Alzheimer's Association recommend the dementia patient's caregiver to attend group meetings which aim to give information and enable them to express and share feelings with individuals who are facing similar difficulties.

Objectives

To identify the sociodemographic profile of the individuals who attend the Support Group for Family Members of Individuals with Alzheimer's disease at Hospital de Clínicas de Porto Alegre, and to verify the degree of burden associated to the care given to this kind of patient.

Methods

Forty-eight participants were sub-divided into two groups: 23 non-caregivers and 25 caregivers. All participants answered a sociodemographic questionnaire, and the caregivers also answered the Zarit Burden Interview (ZBI). Student's t test was used for comparison of parametric data, and Chi-square test for categorical data between caregivers and non-caregivers. Spearman's rho correlation analysis was performed for the ZBI and the studied variables.

Results

Participants were predominantly women. Only age differentiated one subgroup from the other. The mean score on the ZBI was 35.1 (14.7), and most of the caregivers presented up to moderate burden.

Conclusions

Women attended the Support Group either as caregiver or non-caregiver. The level of burden among caregivers of high educational attainment was relatively high besides the short time as caregiver (up to a year).

Stress Levels amongst Caregivers of Patients with Osteoporotic Hip Fractures – A Prospective Cohort Study

Introduction: We evaluated if there was significant stress in caregivers of elderly patients with osteoporotic hip fractures and determine any contributory factors. Materials and Methods: A prospective cohort study was performed from June 2005 to June 2006 in a single tertiary hospital. Patients admitted during this period and their primary caregivers were interviewed on admission and at 6 months. Information on patient’s demographics, comorbidities, functional and mental status, placement post-discharge and financial strain were noted. Caregiver stress was measured using the caregiver strain index (CSI). Relationships between key variables were analysed to derive possible correlations. Results: The study comprised caregivers of 76 patients with a mean age of 77 years (range, 50 to 95; SD, 11). Within 1 week of admission, 45 of the 76 caregivers (59.2%) were significantly stressed based on the CSI while at 6 months, 30 of the caregivers (50%) were significantly stressed. The mean CSI within 1 week of admission and at 6 months post-admission was 7.18 and 6.25 respectively (P = 0.042). The most significant contributory factor to stress was financial strain (P = 0.01) attributable to medical bills, rehabilitation costs and transport expenses. Conclusion: There is a significant amount of stress that is experienced by caregivers of elderly patients with hip fractures which commences from admission of the patient and it remains high at 6-months post-fracture. Financial strain has been found to be the only significant cause on both univariate and multivariate analysis. Adequate resources should be available to caregivers of patients with osteoporotic hip fractures. Key words: Caregiver strain index, Hip fractures

The impact of different shift work schedules on the levels of anxiety and stress in workers in a petrochemicals company

This study evaluated anxiety and stress in workers under different shift work conditions. The sample comprised 239 workers, with an average age of 42.6, standard deviation = 5.7 years, divided into fixed daytime working (n=52) and different working shifts (n=187). Documentation: Free and informed consent form; ID's; State-Trait Anxiety Inventory; Lipp's Stress Symptom Inventory for Adults. We used the t-test for independent samples, ANOVA, Pearson's correlation and the two-sample Comparison of proportions Test. Results showed that shift workers had higher State-Trait Anxiety scores than fixed daytime workers (t=-4.994; p=0.0001; t=-2.816; p=0.005, respectively). Both samples exhibited stress, but there were no statistically significant differences between the groups (t=-1.052; p=0.294). Shift work schedules caused more situational and dispositional anxiety, but did not significantly increase stress levels when compared to fixed daytime working.

Oral health behaviour and socio-demographic profile of subjects with Alzheimer's disease as reported by their family caregivers

OBJECTIVE

To evaluate the oral health care provided to subjects with Alzheimer's disease (AD) as reported by their family caregivers.

METHOD

Structured interviews were performed with 56 Alzheimer caregivers from the Group of relatives and friends of subjects with AD of the Hospital de Clínicas de Porto Alegre. Spearman and Pearson correlations were performed.

RESULTS

The mean age of the subjects with AD was 76.09 (+/-7.76) years, 53.6% were female and 58.9% were in the advanced stage of AD. The mean number of teeth present was 11.66 (+/-10.94), and oral hygiene was performed 2.21 (+/-1.04) times/day. The provision of oral health care to subjects with AD was carried out by caregivers in 85.7%. Oral hygiene was provided by the caregivers to the subjects with AD with the aid of a toothbrush and/or gauze embedded with non-fluoridated mouthwash in the majority of the cases. Complete dental prostheses were cleaned with the aid of mouthwashes instead of denture brushes by 44% of the subjects/caregivers. There was a significant association between the number of teeth in the subjects with AD and the number of oral hygiene procedures performed per day and current smoking.

CONCLUSION

Oral health care planning for subjects with AD should take into account caregivers' perceptions and knowledge about oral health and hygiene as caregivers represent the primary providers to these patients when the disease progresses from early to more advanced stages.