Interventions with care givers of dementia patients: comparison of two approaches

We compared the effect of two approaches, family counseling and support groups, for relieving the stress and burden experienced by care givers of dementia patients. Both treatments are designed to implement features of a stress-management model that have been identified in prior research with this population: providing information about the patient's disease and its effects on behavior, teaching behavioral problem solving for managing difficult behavior, and identifying potential support for care givers. Subjects were primary care givers of dementia patients living in the community; they included husbands, wives, daughters, and other relatives. Although subjects in the treatment groups made significant gains over time, they did not differ from wait-list subjects who showed similar improvements. One-year follow-up interviews indicated that gains made during the treatment period were maintained.     

Transitions in caregivers' use of paid home help: associations with stress appraisals and well-being

This study examines the associations between transitions in paid home care and stress appraisals and psychological well-being of family caregivers of dementia relatives. The sample consisted of 264 caregivers who completed up to 3 interviews during 1 year. Longitudinal analyses (i.e., generalized estimating equations) showed that the onset of paid home care was associated with increases in feelings of worry and strain and a worsening in positive affect. Ending paid home care was strongly associated with a decrease in depressive symptoms, whereas sustained use of paid home care was related to reduced overload. Several possible mechanisms for the complex relationship of paid home care and family caregivers' stress appraisals and well-being are discussed.     

Longitudinal patterns of risk for depression in dementia caregivers: objective and subjective primary stress as predictors

The present study examined how patterns of risk for depression over 1 year in 188 dementia caregivers (consistently asymptomatic, n = 88; consistently symptomatic, n = 40; changing risk, n = 60) could be predicted by objective (behavior problems of the relative) and subjective (role captivity and overload) primary stress. Results reveal that all primary stressors differentiated caregivers who remained at low levels of symptomatology over the course of 1 year from those who were at risk for experiencing a depressive disorder. In addition, caregivers' subjective experience of role captivity predicted the chronicity of risk. Findings extend prior caregiving research on patterns of depressive symptomatology by highlighting the relationship between subjective primary stressors and stability and change in caregivers' mental health.     

Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist.

The Revised Memory and Behavior Problems Checklist (RMBPC), a 24-item, caregiver-report measure of observable behavioral problems in dementia patients, provides 1 total score and 3 subscale scores for patient problems (memory-related, depression, and disruptive behaviors) and parallel scores for caregiver reaction. Data were obtained from 201 geriatric patients and their caregivers. Factor analysis confirmed 3 first-order factors, consistent with subscales just named, and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89. Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment, and caregiver burden. The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of behavior problems in dementia patients.     

Family caregiving to dependent older adults: stress, appraisal, and coping

Articles presented in this 1987 APA symposium adopt a stress, appraisal, and coping framework for conceptualizing the experience of family caregiving. Each article emphasizes 2 themes: (a) caregivers' adaptation to the chronic demands of in-home caregiving and (b) factors that mediate the relationship between caregiving stress and caregiver's adaptation. The articles presented in this symposium illustrate both the utility of this theoretical approach to studying caregiving stress and the difficulty inherent in its use.     

Examining dynamic links between perceived control and health: longitudinal evidence for differential effects in midlife and old age

Perceived control and health are often closely linked in adulthood and old age. Little is known, however, about their time-ordered interplay at various phases of adult life. By applying dynamic models to four waves of data over 15.5 years from the Americans' Changing Lives Study, we examined time-ordered relations between perceived control and health in midlife and old age. Results revealed that levels of perceived control predict subsequent changes in health over time in old age (65+ years of age; n = 1,238) but not in midlife (25-64 years of age; n = 2,364). No evidence was found for predictive effects of health for changes in perceived control in either age group. These age-differential findings were corroborated with nested-model comparisons. Predictive effects of perceived control for health were attenuated to the null in models covarying for sociodemographic and psychosocial factors (physical activity, memory, emotional support, and depressive symptoms), suggesting that these variables play an important role in control-health relations. Our discussion focuses on the importance of perceived control for healthy living in old age and the differential implications of perceived control for health in midlife and old age.     

Modeling caregiver adaptation over time: the longitudinal impact of behavior problems

Although cross-sectional research has established the link between care demands and various indicators of caregiver adaptation, few studies have examined the impact of care recipients' problematic behavior over time. The present analysis determines the importance of behavior problems when predicting rates of change in subjective stressors (role overload and role captivity) and depression. Using 4-wave longitudinal data (N = 137) on dementia caregivers, the authors fit individual growth curve models for care demands (i.e., behavior problems, activities of daily living dependencies, and cognitive impairment), subjective stressors, and depression. Subsequent structural equation models found that increases in behavior problems were most likely to predict increases in role overload. The findings emphasize the deleterious long-term impact of behavior problems on individuals' emotional adaptation to caregiving.     

Relationship Quality with Parents: Implications for Own and Partner Well‐Being in Middle‐Aged Couples

Relationships with parents have significant implications for well‐being throughout the lifespan. At midlife, these ties are situated within both developmental and family contexts that often involve the adult offspring's spouse. Yet, it is not known how ties with aging parents are related to psychological well‐being within middle‐aged couples. This study examined how middle‐aged wives’ and husbands’ views of the current quality of relationships with their own parents (positive and negative) are linked to their own and their partner's psychological well‐being. Using a sample of 132 middle‐aged couples from Wave 1 of the Family Exchanges Study, we estimated actor–partner interdependence models to evaluate these dyadic associations while controlling for each spouse's marital satisfaction. Both actor and partner effects were observed. With respect to actor effects, wives who reported more negative relationship quality with their own parents had elevated depressive symptoms and lower life satisfaction. Husbands who reported more negative relationship quality with their own parents had lower life satisfaction. In terms of partner effects, husbands had lower depressive symptoms and greater life satisfaction when wives reported more positive relationship quality with their own parents. Finally, the link between wives’ positive ties with parents and husbands’ lower depressive symptoms was intensified when husbands had less positive relationships with their own parents. Findings suggest that relationship quality with wives’ aging parents has implications for both spouses’ well‐being and may serve as a critical social resource for husbands.     

The onset of dementia caregiving and its longitudinal implications

This study examined patterns of entry into the caregiving role and how onset influences outcomes pertinent to the caregiving process. Using 3-year longitudinal data, the present analysis classified dementia caregivers into 1 of 4 onset sequences: those whose entry into caregiving was defined by diagnosis, those who first recognized symptoms and then obtained a diagnosis, those caregivers who first recognized symptoms and then provided care, and those who provided care prior to diagnosis or recognition. Analyses revealed that respondents who experienced a less abrupt entry into caregiving were less likely to institutionalize their relatives and reported greater decreases in well-being. The findings point to the dynamic process that defines entry into caregiving and emphasize that how individuals assume caregiving roles have implications long after onset.