Risk and Resiliency Factors Related to Dementia Caregiver Mental Health

Validation and expansion of a behavioral framework for dementia care partner resilience (CP-R)

BACKGROUND AND OBJECTIVES

Resilience - the ability to bounce back after a stressor - is a core component of successful family caregiving for people living with dementia. In this manuscript, we describe the preliminary empirical validation of a new behavioral framework developed from existing literature for assessing care partner resilience, CP-R, and propose its potential value for future research and clinical care.

METHODS

We selected 27 dementia care partners who reported significant challenges prompted by a recent health crisis of their care recipient from three local university-affiliated hospitals in the United States. We conducted semi-structured interviews to elicit care partners' accounts of what they did to address those challenges that helped them recover during and after the crisis. Interviews were transcribed verbatim and analyzed using abductive thematic analysis.

FINDINGS

When persons with dementia experienced health crises, care partners described various challenges in managing new and often complex health and care needs, navigating informal and formal care systems, balancing care responsibilities with other needs, and managing difficult emotions. We identified five resilience-related behavioral domains, including problem-response (problem-solving, -distancing, -accepting, and -observing), help-related (help-seeking, -receiving, and -disengaging), self-growth (self-care activities, spiritual-related activities, and developing and maintaining meaningful relationships), compassion-related (self-sacrifice and relational compassion behaviors), and learning-related (learning from others and reflecting).

DISCUSSIONS AND IMPLICATIONS

Findings support and expand the multidimensional CP-R behavior framework for understanding dementia care partner resilience. CP-R could guide the systematic measurement of dementia care partners' resilience-related behaviors, support individual tailoring of behavioral care plans, and inform the development of resilience-enhancing interventions.

Primary and Secondary Caregivers of People with Dementia (PwD): Differential Patterns and Implications for Psychological Support

Very little attention has been paid to identifying the differential characteristics of primary and secondary dementia caregivers. The aims of this study were: to determine whether differences exist between primary and secondary caregivers of people with dementia (PwD) and to explore the profile of primary and secondary caregivers reporting symptoms of anxiety and/or depression. The participants were 146 caregivers of PwD, 73 primary caregivers and 73 secondary caregivers. The results revealed different patterns for each type of caregiver. Primary caregivers showed a more negative profile in terms of poorer self-rated health and higher levels of anxiety and depression: 61.6% of primary and 42.5% of secondary caregivers reported symptoms of anxiety, and 24.7% and 11% reported depression, respectively. The frequency of problem behavior, subjective burden, health, and the comorbidity between anxiety and depression were associated with depression and anxiety among primary caregivers, whereas gender (being a woman), subjective burden, health, and the comorbidity between anxiety and depression were associated among secondary caregivers. These findings may help to guide professionals in targeting psychological support programs and customizing the strategies and skills that need to be provided in accordance with the type of caregiver in question: primary or secondary. The practical implications of the findings are discussed.