ABSTRACT
PURPOSE: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities. DESIGN AND METHODS: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression. RESULTS: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident-caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors. IMPLICATIONS: These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes.
Subject(s)
Alzheimer Disease/nursing , Caregivers/psychology , Depression/diagnosis , Homes for the Aged , Nursing Homes , Stress, Psychological/complications , Adaptation, Psychological , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Cost of Illness , Depression/psychology , Female , Geriatric Assessment , Humans , Male , Risk FactorsABSTRACT
PURPOSE: This study examined the decision-making capacity of persons with cognitive impairment with respect to their everyday care preferences and choices. This is the first in a series of articles to report on findings from a larger study that examines choice, decision making, values, preferences, and practices in everyday care for community-dwelling persons with cognitive impairment and their family caregivers. DESIGN AND METHODS: Fifty-one respondent pairs, or dyads, were interviewed, that is, persons with cognitive impairment (n = 51) and their family caregivers (n = 51). All persons with cognitive impairment were interviewed twice within a week using a parallel interview to determine stability and accuracy of responses. The family caregiver was interviewed once. RESULTS: Persons with mild to moderate cognitive impairment (i.e., Mini-Mental State Exam scores 13-26) are able to respond consistently to questions about preferences, choices, and their own involvement in decisions about daily living, and to provide accurate and reliable responses to questions about demographics. IMPLICATIONS: Including the perspective of persons with cognitive impairment in both research and practice has the potential to enhance their autonomy and improve their quality of life.
Subject(s)
Alzheimer Disease/psychology , Choice Behavior , Mental Competency , Activities of Daily Living/psychology , Adult , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Caregivers/psychology , Decision Making , Female , Geriatric Assessment , Humans , Male , Mental Status Schedule , Middle Aged , Neuropsychological TestsSubject(s)
Nursing Assistants/standards , Nursing Homes , Career Mobility , Decision Making, Organizational , Education, Continuing/organization & administration , Education, Continuing/standards , Job Satisfaction , Nursing Assistants/education , Personnel Management/standards , Quality of Health Care , United States , WorkforceABSTRACT
This study examined the predictors of caregiver depression and "adaptation" over time in a sample of 202 family caregivers of cognitively impaired adults. By examining caregiver adaptation (i.e., a caregiver's ability to adjust psychologically to the demands of providing long-term in-home care), we were able to account for initial levels of depression, regression to the mean, and floor and ceiling effects. Results indicated that the strongest predictors of caregiver depression 1 year after baseline were initial levels of depression, worsening of caregiver subjective physical health status and burden, and short-term use of in-home respite assistance. These findings suggest that caregivers who experience deterioration in levels of physical health and burden and who use in-home respite on a short-term or sporadic basis may be especially vulnerable to the chronic stress of providing long-term in-home care.
Subject(s)
Caregivers/psychology , Depression , Health Status , California , Cost of Illness , Demography , Humans , Sex Factors , Socioeconomic Factors , Time FactorsABSTRACT
The consequences of institutionalization were examined for a sample of caregivers of dementia patients. Consistent with the stress process model, institutionalization was hypothesized to have a large impact on the primary effects of caregiving and lesser influence on secondary effects and well-being. Following placement, relatives experienced relief from primary effects of caregiving (e.g., feelings of overload and tension) and improved well-being, whereas other indicators of stress remained unchanged.
Subject(s)
Caregivers/psychology , Dementia , Institutionalization , Nursing Homes , Stress, Psychological , Family , Female , Humans , Male , Multivariate AnalysisABSTRACT
This paper presents a reanalysis of data from a previously reported study with family caregivers of dementia patients using the method of prediction analysis. Compared with subjects on a waiting list or enrolled in support groups, caregivers in individual and family counseling were more likely to have successful outcomes on all dependent measures (Brief Symptom Inventory, personal strain, and role strain).
