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A path analysis of patient dependence and caregiver burden in Alzheimer's disease

Published online by Cambridge University Press:  01 March 2016

J. Garre-Olmo ,
J. Vilalta-Franch ,
L. Calvó-Perxas ,
O. Turró-Garriga ,
L. Conde-Sala  and
S. López-Pousa
J. Garre-Olmo*
Affiliation:
Girona Biomedical Research Institute [IDIBGI], C/ Dr. Castany s/n, 17190 Salt, GironaSpain Institut d'Assistència Sanitària, C/ Dr. Castany s/n, 17190 Salt, GironaSpain Department of Medical Sciences, University of Girona, C/ Dr. Castany s/n, 17190 Salt, GironaSpain
J. Vilalta-Franch
Affiliation:
Girona Biomedical Research Institute [IDIBGI], C/ Dr. Castany s/n, 17190 Salt, GironaSpain Dementia Unit, Hospital de Santa Caterina, Salt; Faculty of Psychology, University of Barcelona; Passeig Vall d'Hebron, 171, 08035, Barcelona, Spain
L. Calvó-Perxas
Affiliation:
Girona Biomedical Research Institute [IDIBGI], C/ Dr. Castany s/n, 17190 Salt, GironaSpain Institut d'Assistència Sanitària, C/ Dr. Castany s/n, 17190 Salt, GironaSpain
O. Turró-Garriga
Affiliation:
Girona Biomedical Research Institute [IDIBGI], C/ Dr. Castany s/n, 17190 Salt, GironaSpain Institut d'Assistència Sanitària, C/ Dr. Castany s/n, 17190 Salt, GironaSpain
L. Conde-Sala
Affiliation:
Department of Developmental Psychology, University of Barcelona, Barcelona, Spain
S. López-Pousa
Affiliation:
Girona Biomedical Research Institute [IDIBGI], C/ Dr. Castany s/n, 17190 Salt, GironaSpain Dementia Unit, Hospital de Santa Caterina, Salt; Faculty of Psychology, University of Barcelona; Passeig Vall d'Hebron, 171, 08035, Barcelona, Spain
*
Correspondence should be addressed to: Josep Garre-Olmo, Girona Biomedical Research Institute; C/ Dr. Castany s/n; 17190 Salt, Girona, Spain. Phone: #34-972-182600 (extension 1833); Fax: #34-972-189017. Email: [email protected].
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Abstract

Background:

The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants.

Methods:

Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence.

Results:

The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress.

Conclusions:

Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Keywords

Alzheimer's diseasedementiadependencecaregiver burden
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 7 , July 2016 , pp. 1133 - 1141
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S. and Lachs, M. S. (2014). Caregiver burden: a clinical review. Journal of the American Medical Association, 311, 1052–1060.Google Scholar
Au, L., Lai, M.-K., Pan, P.-C., Lam, L., Thompson, L. and Gallager-Thompson, D. (2009). Social support and well-being in dementia family caregivers: the mediating role of self-efficacy. Aging Mental Health, 13, 761–768.Google Scholar
Azheimer's Association. (2013). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 9, 208–245.Google Scholar
Bergvall, N., Brinck, P., Eeek, D., Gustavsson, A., Wimo, A. and Jönsson, L. (2011). Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer's disease. International Psychogeriatrics, 23, 73–85.Google Scholar
Blesa, R. et al. (2001). NORMAlisation of cognitive and functional instruments for DEMentia. Clinical validity of the ‘mini-mental state’ for Spanish speaking communities. Neuropsychologia, 39, 1150–1157.Google Scholar
Brodaty, H., Woodward, M., Boundy, K., Ames, D. and Balshaw, R. (2013). Prevalence and predictors of burden in caregivers of people with dementia. American Journal of Geriatric Psychiatry, 22, 756–765.Google Scholar
Conde-Sala, J. L., Garre-Olmo, J., Turró-Garriga, O., Vilalta-Franch, J. and López-Pousa, S. (2010). Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design. International Journal of Nursing Studies, 47, 1262–1273.Google Scholar
Conwell, Y., Forbes, N. T., Cox, C. and Caine, E. D. (1993). Validation of a measure of physical illness burden at autopsy: the cumulative illness rating scale. Journal of the American Geriatrics Society, 41, 38–41.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosemberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory. Comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini Mental State.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gallagher, D. et al. (2011). Dependence and caregiver burden in Alzheimer's disease and mild cognitive impairment. American Journal of Alzheimer's Disease and Other Dementias, 26, 110–114.Google Scholar
Garre-Olmo, J., Vilalta-Franch, J., Calvó-Perxas, L., Monserrat-Vila, S. and López-Pousa, S. (2015). Dependence scale for Alzheimer's disease relationship with other clinical indicators and psychometric properties. Journal of Geriatric Psychiatry and Neurology, 28, 117–125.Google Scholar
Gélinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471–481.Google Scholar
Jones, R. W. et al. (2015). Dependence in Alzheimer's disease and service use cost, quality of life and caregiver burden: the DADES study. Alzheimer's & Dementia, 11, 280–290.Google Scholar
Kaplan, D. (2009). Path analysis, modeling systems of structural equations among observed variables. Structural Equation Modeling: Foundations and Extensions, 2nd edn. Thousand Oaks: Sage Publications.Google Scholar
Kaufer, D. I. et al. (1998). Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the neuropsychiatric inventory caregiver distress scale. Journal of the American Geriatrics Society, 46, 210–215.Google Scholar
Lawton, M. P., Moss, M., Kleban, M. H., Glicksman, A. and Rovine, M. (1991). A two-factor model of caregiving appraisal and psychological well-being. Journal of Gerontology, 46, P181–P189.Google Scholar
Lin, W. C., Tsai, C. F., Wang, S. J., Hwang, J. P. and Fuh, J. L. (2012). Comparison of the burdens of family caregivers and foreign paid caregivers of the individuals with dementia. International Psychogeriatrics, 24, 1953–1961.Google Scholar
Martín, M. et al. (1991). Adaptación para nuestro medio de la Escala de Sobrecarga del Cuidador (Caregiver Burden Interview) de Zarit. Revista de Gerontología, 6, 338–346.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939–944.Google Scholar
McLaughlin, T. et al. (2010a). Assessment of potential measures in models of progression in Alzheimer disease. Neurology, 75, 1256–1262.Google Scholar
McLaughlin, T. et al. (2010b). Dependence as a unifying construct in defining Alzheimer's disease severity. Alzheimer's & Dementia, 6, 482–493.Google Scholar
Miller, L. A., Mioshi, E., Savage, S., Lah, S., Hodges, J. R. and Piquet, O. (2013). Identifying cognitive and demographic variables that contribute to carer burden in dementia. Dementia and Geriatric Cognitive Disorders, 36, 43–49.Google Scholar
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Scaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist, 30, 583–594.Google Scholar
Sörensen, S. and Conwell, Y. (2011). Issues in dementia caregiving: effects on mental and physiscal health, intervention strategies, and research needs. American Journal of Geriatric Psychiatry, 19, 491–496.Google Scholar
Spackman, D. E., Kadiyala, S., Neumann, P. J., Veenstra, D. L. and Sullivan, S. D. (2013). The validity of dependence as a health outcome measure in Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 28, 245–252.Google Scholar
Springate, B.A. and Tremont, G. (2014). Dimensions of caregiver burden in dementia: impact of demographic, mood, and care recipient variables. American Journal of Geriatric Psychiatry, 22, 294–300.Google Scholar
Stern, Y. et al. (1994). Assessing patient dependence in Alzheimer's disease. Journal of Gerontology, 49, M216–M22.Google Scholar
Van der Lee, J., Bakker, T., Duivenvoorden, H. J. and Dröes, D. M. (2014). Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Research Review, 15, 76–93.Google Scholar
Vilalta-Franch, J., Lozano-Gallego, M., Hernández-Ferrándiz, M., Llinàs-Reglà, J., López-Pousa, S. and López, O. L. (1999). The neuropsychiatric inventory. Psychometric properties of its adaptation into Spanish. Revista de Neurología, 29, 15–19.Google Scholar
Vitalino, P. P. (1990). A model of burden in caregivers of DAT patients. In Light, E. and Lebowitz, B. D. (eds.), Alzheimer's disease Treatment and Family Stress (pp. 267–291). New York: Hemisphere Publishing Corporation.Google Scholar
Zarit, S. H., Todd, P. A. and Zarit, J. M. (1994). Subjective burden of husbands and wives as caregivers: a longitudinal study. The Gerontologist, 26, 260–266.Google Scholar