Caregiving intensity and caregiver burden among caregivers of people with dementia: The moderating roles of social support

Using the Pearlin stress process model, the present study aimed to test if there was an association between caregiving intensity and caregiver burden, to analyze what type of association existed, and to test if different indicators of social support moderated such association among caregivers of people with dementia. Data from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) (N = 637) were used. Caregiver burden (12-item Zarit caregiver burden scale), caregiving intensity (caregiving hours), and social support (Lubben social network, received support, satisfaction with support, and negative interactions) were the main measurements. Separate multivariate regression models were conducted with Stata 16. The results showed that the relationship between caregiving hours and caregiver burden was a nonlinear inversed U shape after controlling all of the socio-demographic variables. Further analyses showed that when caregiving hours reached 14 hours per day, the levels of burden were the highest. In addition, received support, satisfaction with support, and social network significantly buffered the relationship between caregiving hours and caregiver burden when they were examined separately. However, only social network played a significant buffering role when examining the four social support indicators simultaneously. These findings suggest the need for programs and practices that emphasize the importance of identifying, gaining, and strengthening positive aspect of social support, especially in how to broaden a caregiver's social network while caring for a family member with dementia.

Leisure activity, gender and depressive symptoms among dementia caregivers: findings from the REACH II

Objectives: Providing care to individuals with dementia places burden on family caregivers, which may relate to depressive symptoms. Although leisure activities may serve as a coping resource to relieve caregiving stress, only a few studies exist on how leisure and depressive symptoms associate in dementia caregivers. Moreover, less is known about the role of gender in this relationship. Thus, this study examined the relationship among leisure activity, gender and depressive symptoms.Method: A cutoff score (≥10) on the short form of the Center for Epidemiological Studies Depression Scale was used to measure presence of depressive symptoms. Independent variables were frequency of engagement in and satisfaction with leisure activities.Results: Logistic regression analyses from 632 dementia caregivers in the Resources for Enhancing Alzheimer's Caregiver Health II Study showed that more frequent and higher satisfaction in leisure engagement were negatively related to having depressive symptoms. Moreover, the negative association between frequent leisure engagement and depressive symptoms was more pronounced among male caregivers.Conclusion: Providing respite care for dementia caregivers to engage in leisure can be a promising coping strategy for this population. Also, gender difference in leisure-depressive symptoms relationship suggests different support needed for male and female caregivers in addition to leisure.

Individualized support for informal caregivers of people with dementia - effectiveness of the German adaptation of REACH II

Background

Individualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia. In this study, we adapted and evaluated a multicomponent intervention (Resources for Enhancing Alzheimer’s Caregiver Health II, REACH II), which was developed in the USA, to the German health-care system. Therefore the project is called the German adaptation of REACH II (in German: Deutsche Adaptation der REACH II, DE-REACH).

Methods

The effectiveness of DE-REACH was examined in a randomized, controlled trial on 92 informal caregivers of people with dementia. The intervention comprised 12 individual two-weekly sessions (9 at home with the informal caregiver and 3 via telephone) and combined five modules. The reduction of the burden of the informal caregivers was chosen as the primary outcome.

Results

The results showed a great stabilizing effect of the intervention on caregiver burden (effect size d = 0.91), that is, comparing pre- and post-measurements the burden decreased very slightly in the intervention group whereas it increased very strongly in the control group. After a three-month follow-up period this effect decreased from a great to a moderate effect. There were also improvements as a result of the intervention in somatization, health-related psychological quality of life and the reaction of the informal caregivers in response to challenging behaviors of the relative with dementia. Moreover, the frequency of challenging behaviors of the affected person itself was reduced in favor of the intervention.

Conclusion

The findings of this study provide further evidence for the impact of multicomponent support interventions for informal caregivers of people with dementia.

Clinical trial registration

NCT01690117. Registered September 17, 2012.

Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention

OBJECTIVE

Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organizational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention.

METHODS

Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organizational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioral problems.

RESULTS

Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers.

CONCLUSION

Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services.

Dementia Caregivers' Use of Services for Themselves

PURPOSE OF THE STUDY

Health care and social services such as physician visits and support groups used by dementia caregivers for themselves were examined. Caregivers (N = 642) were from the Resources for Enhancing Alzheimer's Caregivers Health (REACH II) study.

DESIGN AND METHODS

Caregiver predisposing, enabling, and need variables were examined using chi-squared and t-tests to characterize service users. Stagewise linear regression was used to explain numbers of services used.

RESULTS

Predisposing, enabling, and need variables were significantly related to dementia caregivers' service use. In regression, caregivers who were older, more educated, married, not employed, depressed, with functional disability needs, more illness-related reduced activity days, more medications, more symptoms, and fewer hours on duty per day used significantly more services for themselves. The statistically significant model explained 22.2% variance in numbers of services used. Service users, compared with nonusers, evidenced greater burden, bother with behaviors, and more desire to institutionalize.

IMPLICATIONS

This study shows that caregiver service use is related to caregiver characteristics. Future work should examine the impact of caregiving on health care and social service use and costs. The societal costs of caregiving may be better understood when we account for additional service use by caregivers themselves. A significant clinical and policy issue is who should assess and support the caregiver. Possibilities include the care recipient's health care practitioner, the caregiver's health care practitioner, or a formal caregiver-focused program based in the health care system or the social service network.