This first risk algorithm for onset of major depression functions as well as similar risk algorithms for cardiovascular events and may be useful in prevention of depression.

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ObjectivesIn the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia‐specific formal care services. Results can identify which specific factors should be a target to improve access.MethodsA total of 451 People with middle‐stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks.ResultsThe most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender.ConclusionThe Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care.

Objective Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives. Methods Cross‐sectional data were used from the Actifcare cohort study of 451 community‐dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC). Results Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress, and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia, and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and discrepancies was carer stress (negative feelings subscore). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two. Conclusions In this European sample, carer SOC was associated with carer‐reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.

RESUMOO impacto da demência em cuidadores informais ou familiares tornou-se uma questão de saúde pública. A escala de sobrecarga "Zarit Burden Interview" constitui um instrumento bem reconhecido de avaliação do impacto emocional, físico e social sobre os cuidadores. Tem vindo a ser utilizada em todo o mundo em estudos epidemiológicos, ensaios clínicos (farmacológicos ou psico-sociais), bem como na investigação de serviços de saúde. O enquadramento inicial na demência estendeu-se a outros contextos clínicos, principalmente em Geriatria e em Cuidados Paliativos. Dadas esta diversidade de aplicações, os aspectos envolvendo a validade e fiabilidade das traduções nacionais são cruciais para assegurar que toda a evidência obtida seja de elevada qualidade. Para além disso, é necessário cuidado na utilização de cut-offs para definir níveis de sobrecarga sobre o cuidador ou de subescalas resultantes de análises factoriais exploratórias em estudos locais de pequena escala. Tal como sucede com outras traduções de instrumentos de avaliação aplicados no âmbito dos cuidados de saúde, os investigadores e clínicos portugueses devem conhecer o modo de abordar os eventuais enviesamentos quer na utilização da "Zarit Burden Interview" quer na interpretação dos resultados obtidos. Palavras-chave: Cuidadores; Cuidados Paliativos; Demência; Entrevistas como Assunto; Portugal; Psicometria. ABSTRACTThe impact of dementia on informal or family caregivers became a public health issue. One well-established tool for the assessment of emotional, physical and social impact on caregivers is the Zarit Burden Interview. Worldwide, it is widely used in epidemiological studies, drug or psychosocial clinical trials, and health services research. The original focus on burden among dementia caregivers has spread to other clinical contexts, mostly in old age and palliative care. Given these diverse applications, issues around the validity and reliability of national translations are crucial to assure that all evidence gathered is indeed of high quality. Moreover, caution is needed on the use of cut-offs for categorizing levels of caregiver strain or of subscales derived from recurrent exploratory factor analyses in small-scale local studies. As with other translations of measures in the health field, researchers and clinicians in Portugal must be aware of how to address bias in using the Zarit Burden Interview and interpreting findings. Keywords: Caregivers; Dementia; Interviews as Topic; Palliative Care; Portugal; Psychometrics. The Burden InterviewThe Zarit Burden Interview-ZBI 1 is widely used in dementia research, including family caregiving studies, drug and psychosocial intervention clinical trials.2,3 The ZBI is a self-report questionnaire, used to assess the feelings of burden of informal caregivers regarding the impact of the disease on their lives. The questions refer to problems arising in several domains: health and well being, personal and social life and finances. The ZBI has become useful in the assessment of subjective burden in carers...

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ObjectivesSense of coherence (SOC) is increasingly recognized as an important health determinant, particularly for mental health. Part of the evidence comes from informal caregivers in diverse clinical conditions. The extent to which SOC influences caregiving outcomes, however, is relatively under‐researched in dementia, particularly regarding positive experiences. We analysed the association of SOC with dementia caregivers' subjective burden, psychological distress and positive aspects of care.Methods/DesignThis is a secondary analysis of cross‐sectional data from the Lisbon study of Families of Persons with Dementia, involving a convenience sample of 99 primary caregivers of community‐dwelling patients of neurology and psychiatry services. SOC was assessed with the Orientation for Life Scale. Measures of caregivers' outcomes were: the Zarit Burden Interview, the General Health Questionnaire for psychological distress and the Positive Aspects of Caregiving scale. Analyses controlled for demographics, caregiving arrangements, objective burden, social support, patients' neuropsychiatric symptoms and dementia stage.ResultsLower SOC was associated with higher psychological distress (p = 0.001). No significant associations were found for subjective burden (p = 0.081) or positive aspects of caregiving (p = 0.688). Additional analyses showed that lower SOC was associated with less emotional support (p < 0.001) and past psychiatric illness (p = 0.044).ConclusionsThese findings support previous research suggesting that SOC is protective for psychological distress, and extend evidence to the positive aspects of care in dementia. The cross‐sectional design and small‐scale convenience sampling preclude both causality presumptions and generalizability. SOC assessments may be useful to define subgroups of dementia caregivers at risk for anxiety and depression.