A Comparison of Psychosocial Outcomes in Elderly Alzheimer Caregivers and Noncaregivers

doi:10.1016/j.jagp.2012.10.001

The American Journal of Geriatric Psychiatry

Volume 21, Issue 1, January 2013, Pages 5-13

https://doi.org/10.1016/j.jagp.2012.10.001 Get rights and content

Objective

To conduct an analysis of the stress, coping, and mood consequences of Alzheimer caregiving.

Design

Cross-sectional.

Setting

Community-based study.

Participants

Sample included 125 Alzheimer caregivers and 60 demographically similar older adults with nondemented spouses (i.e., noncaregivers).

Measurements

We compared caregivers and noncaregivers on stress, coping, and mood outcomes. We also examined antidepressant use within the caregiver sample. An emphasis was placed upon effect size differences, including Cohen's d as well as more clinically meaningful effect sizes.

Results

Caregivers were significantly more likely to endorse depressive symptoms and to meet clinically significant cutoff for depression (40% for caregivers; 5% for noncaregivers). Approximately 25% of caregivers reported taking antidepressant medication, although 69% of these continued to experience significant symptoms of depression. Caregivers also utilized fewer positive coping and greater negative coping strategies than noncaregivers.

Conclusion

The number of caregivers will increase dramatically over the next two decades, and caregivers will likely seek care from primary care providers. We provide an overview of the psychological issues facing caregivers so that effective screening and treatment may be recommended.

Section snippets

Participants

Participants were 125 CGs of spouses with AD and 60 participants married to nondemented spouses (i.e., NCs) enrolled in the Alzheimer's Caregiver Project at the University of California, San Diego. The primary purpose of this study was to longitudinally evaluate psychological and physical health in CGs of dementia patients and demographically similar NCs. Because a greater proportion of CGs were anticipated to place their spouses into long-term care and/or lose their spouses to death, two CGs

Participants

Demographic characteristics of CG and NC are presented in Table 1. As seen in the table, CG and NC were demographically similar in all respects except race/ethnicity, in which a greater proportion of NC was minority. As expected, significant group differences existed for CDR scores (t = 17.46, df = 182, p <0.001).

Psychosocial Outcomes

Group comparisons on psychosocial outcome domains are presented in Table 1. As seen, CGs and NCs differed on a number of outcomes. Specifically, CGs endorsed greater levels of global

Conclusions

This study compares a breadth of psychosocial outcomes in demographically similar CGs and NCs and highlights not only the many struggles that AD CGs face, but also the many areas that care providers may intervene to improve CG's overall well-being. Indeed, few studies highlight CG/NC differences on the number of outcomes assessed in this study (∼30 outcomes). Although some of our outcomes overlap those presented in prior studies (e.g., depressive and anxiety symptoms), this study provides new

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Citation Excerpt :
Caring for a relative with dementia is commonly described as a chronically stressful situation with negative consequences for caregivers’ mental health. One of the most studied consequences of caregiving is depression, with caregivers often experiencing significantly more clinical symptoms than their noncaregiver peers.1–3 Research shows, however, that depression is a complex problem, composed by several dimensions.
Caring for a relative with dementia is considered a chronically stressful role associated with negative consequences for psychological health such as higher levels of depression. However, the subjective experience of depressive symptomatology is complex as it relates to two unique domains: positive affect (PA) and negative affect (NA). The objective of this study was to analyze, through a longitudinal design, the associations of caregivers’ cognitive (avoidance coping, personal mastery, and coping self-efficacy) and behavioral (frequency of pleasant events) coping strategies with depressive symptoms, PA, and NA.
A total of 111 caregivers of a spouse with dementia participated in this study. They were assessed yearly across 5 years. Mixed model regression analyses were conducted separately for depressive symptoms, PA, and NA, analyzing within and between-person associations of caregivers’ age, gender, role overload, sleep quality, and coping variables previously mentioned.
The results showed that different coping strategies were associated with different components of depressive symptomatology. While avoidant coping was associated with NA and depressive symptoms but not PA at both within- and between-person levels, frequency of pleasant events was associated only with NA and depressive symptoms at the within-person level, showing no effect at the between-person level. Personal mastery and coping self-efficacy were found to be more transversal variables, being associated with most of the mood outcomes in both within and between-person effects.
Findings support the concept of depressive mood as a complex construct and highlights the importance of analyzing different coping strategies when trying to comprehend the caregiving stress process.
BARRIERS TO AND FACILITATORS OF FAMILY CAREGIVING OF PATIENTS WITH COVID-19 EARLY IN THE PANDEMIC
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In 2020, many family members were thrust into the role of caregiving for a relative with COVID-19 with little preparation, training, or understanding of the disease and its symptoms.
To explore the barriers to and facilitators of caregiving experienced by family caregivers of patients with COVID-19 who had been in intensive care in the pandemic’s earliest months.
In-depth qualitative interviews were conducted by web conference with 16 adults recovering at home after intubation for COVID-19 in an intensive care unit at a major academic medical center and their primary caregivers from March to August 2020 (N = 32). Thematic qualitative analysis was done using Watkins’ rigorous and accelerated data reduction technique with MAXQDA software.
Seven themes emerged regarding factors that facilitated or posed barriers to care: other health conditions that increased complexity of care, interactions and experiences in the health care system, COVID-19’s proliferation into other areas of life, the psychological well-being of the patient-caregiver dyad, experience of support from the dyad’s network, the role of caregiving in the dyad, and contextual circumstances of the dyad. The themes often included both barriers and facilitators, depending on the experience of the dyad (eg, feeling encouraged vs fatigued by their support network).
Understanding how patients with COVID-19 and their caregivers experience illness management across the recovery journey can help clarify the COVID-19 care-giving process and identify intervention targets to improve overall health and well-being of the care dyad.
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Regular Research ArticleA Comparison of Psychosocial Outcomes in Elderly Alzheimer Caregivers and Noncaregivers

Objective

Design

Setting

Participants

Measurements

Results

Conclusion

Section snippets

Participants

Participants

Psychosocial Outcomes

Conclusions

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Am J Prev Med

National Ambulatory Medical Care Survey: 2004 Summary. Advance Data From Vital and Health Statistics; no 374

Hospitalization in the United States, 2002: HCUP Fact Book No. 6

Cost Overdose: Growth in Drug Spending for the Elderly, 1992-2010

The epidemiology of emergency medical services use by older adults: an analysis of the National Hospital Ambulatory Medical Care Survey

Acad Emerg Med

Retooling for an Aging America: Building the Health Care Workforce

World Alzheimer Report 2010: The Global Impact Of Dementia

Psychiatric and physical morbidity effects of caregiving

J Gerontol

Increased Framingham Coronary Heart Disease Risk Score in dementia caregivers relative to non-caregiving controls

Gerontology

A path model of chronic stress, the metabolic syndrome, and coronary heart disease

Psychosom Med

Psychological, social, and health consequences of caring for a relative with senile dementia

J Am Geriatr Soc

Acute care utilization by dementia caregivers within urban primary care practices

J Gen Intern Med

Caregiving as a risk factor for mortality: the Caregiver Health Effects Study

JAMA

Chronic stress and depressive disorders in older adults

J Abnorm Psychol

Anxiety and depressive disorders in adult children caring for demented parents

Psychol Aging

Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: a diathesis-stress model of psychopathology

J Abnorm Psychol

Chronic stress and age-related increases in the proinflammatory cytokine IL-6

Proc Natl Acad Sci USA

Regular Research Article
A Comparison of Psychosocial Outcomes in Elderly Alzheimer Caregivers and Noncaregivers