EditorialIssues in Dementia Caregiving: Effects on Mental and Physical Health, Intervention Strategies, and Research Needs
Section snippets
WHAT ARE THE COSTS OF CAREGIVING?
Caregiving can have both psychosocial and physical health effects. Women, spouses, and those in lower socioeconomic groups appear more vulnerable.7 Compared to noncaregivers, dementia caregivers report higher levels of stress, more depression and anxiety symptoms, and lower levels of subjective well-being, self-efficacy,8 and anxiety.9 In addition, they experience worse physical health outcomes, including higher levels of stress hormones, compromised immune response, antibodies, greater
WHY IS CAREGIVING STRESSFUL?
For dementia caregivers the strongest predictor of caregiver burden, depressive symptoms, and physical health issues are primary stressors, such as the patient's behavior problems, including day and nighttime wandering, emotional outbursts, and inappropriate behavior.14., 15. However, the type of dementia and the type of behavioral problems most closely associated with it may play a role in caregiver distress as well.16., 17. Dementia caregivers experience more burden when caregiving intensity
WHAT FACTORS MODERATE OR MEDIATE THE IMPACT OF STRESS ON CAREGIVERS?
Recent studies and meta-analyses have identified several important moderators and mediators captured in our conceptual model (Figure 1) as “secondary stressors,” “exacerbating/ameliorating factors,” and “appraisal,” as well as “background factors.” First, cultural background may change the strength of relationships between certain caregiving stressors and their outcomes.18 Asian Americans and Latinos do not differ from whites in reported burden but they do report more depression symptoms.
CAREGIVER INTERVENTIONS
Research to date indicates that, overall, intervention effects are relatively small. Of the numerous types of caregiver interventions,31 psychoeducational approaches are most effective at improving caregiver knowledge, reducing caregiver burden and depression symptoms, and increasing subjective well-being and caregiver satisfaction. However, except for knowledge increase, these effects are present only if the interventions call for active participation and behavior management skills-building.32
Characteristics of the Intervention
Individualized interventions can be more easily adapted to the specific needs of the caregivers and may, therefore, be more effective for modifying burden or distress for caregivers in general.32 However, interventions in groups are more effective in increasing social support and those that avoid dilution of the participant's active involvement are likely to be as effective as individual approaches. Longer interventions generally are more effective at reducing distress and delaying
ISSUES IN CURRENT CAREGIVING RESEARCH AND FUTURE RESEARCH DIRECTIONS
We have identified several continuing areas of need for caregiving research. First, the identification of the most vulnerable caregivers requires additional attention. These are often individuals with preexisting mental or physical health conditions. Individualization of interventions requires adequate preintervention assessment to identify caregivers who would most benefit from interventions before they develop clinically significant symptoms. Several studies have addressed the pressing need
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