Behavioral and psychological symptoms of dementia and caregivers’ stress appraisals: Intra-individual stability and change over short-term observations

Fauth, Elizabeth B.; Zarit, Steven H.; Femia, Elia E.; Hofer, Scott M.; Stephens, Mary Ann Parris

doi:10.1080/13607860600638107

Cited by 60 publications

(47 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Past research on the Weekly Record of Behavior, as a whole, has found it reliable and valid (Fauth, Zarit, Femia, Hofer, & Stephens, 2006; Zarit, et al, 2011). For the current analyses, the subset of six items related to behavior problems during eating, bathing, and dressing (RTC) yielded an internal consistency (Cronbach's alpha) coefficient of .53.…”

Section: Design and Methodsmentioning

confidence: 99%

Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: associations with informal caregivers’ stress and well-being

Fauth

Femia

Zarit

2015

Aging & Mental Health

View full text Add to dashboard Cite

Objectives Behavior problems that co-occur during assistance with Activities of Daily Living (Resistiveness to Care; RTC) are considered challenging, but are mostly studied in institutions with implications for patients and formal caregivers. RTC is related to, but independent from agitation, and detection of RTC may be left out of common assessments of persons with dementia in studies of informal caregiving (e.g. global assessments of dementia behavioral symptoms, standard assessments of ADL function). This study examines how RTC (frequency and caregivers’ stress appraisals of RTC) are related to caregivers’ well-being. Method 234 caregivers of people with dementia reported care receivers’ ADL impairment (eating, bathing, dressing), RTC frequency (of eating, bathing dressing), and their stress appraisals of these behaviors (RTC appraisals). Caregivers also self-reported their role overload, role captivity, and depressive symptoms. Hierarchical linear regression models included independent variables (demographics, ADL impairment, RTC frequency, RTC appraisals) with three separate dependent variables (overload, captivity, depressive symptoms). Results Two-thirds of informal caregivers reported RTC. Care recipients’ ADL impairment was associated with caregiver outcomes, but only before RTC was entered into the models. RTC frequency significantly predicted caregivers’ overload, captivity, and depression. RTC appraisals predicted overload and captivity. Conclusion RTC is common in persons with dementia residing at home, and RTC has more negative association with informal caregivers’ well-being than assistance with ADL. Adding RTC frequency and appraisal items to standard ADL measures may better estimate caregiver needs and risk, and identify modifiable environmental features by assessing behavioral symptoms in context.

show abstract

Section: Design and Methodsmentioning

confidence: 99%

Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: associations with informal caregivers’ stress and well-being

Fauth

Femia

Zarit

2015

Aging & Mental Health

View full text Add to dashboard Cite

show abstract

“…(2,3,4) Behaviors are the most challenging aspect of caregiving, contributing to caregiver distress, depression, increased care costs, and risk for nursing home placement. (5,6,7,8) There are few tested interventions to minimize behavioral occurrences. Recent research has shown that pharmacological approaches may not be effective and may cause harm (9,10,11).…”

Section: Objectivesmentioning

confidence: 99%

Tailored Activities to Manage Neuropsychiatric Behaviors in Persons With Dementia and Reduce Caregiver Burden: A Randomized Pilot Study

Gitlin

Winter

Burke

et al. 2008

American Journal of Geriatric Psychiatry

144

216

View full text Add to dashboard Cite

Objective-To test whether the Tailored Activity Program for at-home dementia patients reduces neuropsychiatric behaviors and caregiver burden.Method-A prospective, two-group controlled pilot study with 60 dyads randomized to treatment or wait-list control. Dyads were interviewed at baseline and 4 months (trial endpoint); control participants then received intervention and were reassessed 4 months later. The 8-session occupational therapy intervention involved neuropsychological and functional testing from which activities were customized and instruction in use provided to caregivers. Conclusions-Results suggest clinically-relevant benefits for both dementia patients and caregivers, with treatment minimizing the occurrence of behaviors that commonly trigger nursing home placement. (1) Neuropsychiatric behaviors such as apathy, depressed affect, lability, agitation, and aggressiveness are common occurrences, with most patients manifesting these behaviors over the course of the disease. (2,3,4) Behaviors are the most challenging aspect of caregiving, contributing to caregiver distress, depression, increased care costs, and risk for nursing home placement. (5,6,7,8) There are few tested interventions to minimize behavioral occurrences. Recent research has shown that pharmacological approaches may not be effective and may cause harm (9,10,11). A few caregiver intervention studies report minimal behavioral benefits (12,13,14,15), with most studies not examining patient symptom reduction. Thus, developing and testing nonpharmacological approaches to address behaviors is an important public health priority as articulated in recent position statements by the American Association for Geriatric Psychiatry (16) and Annals of Internal Medicine. (17) One promising approach is activity. Research shows that purposeful activity results in reduced depressive and agitated behaviors. (18,19) However, studies have focused exclusively on nursing home residents, involved small sample sizes, used non-experimental designs, or have not tested systematic approaches to developing activities. Lack of research on communityliving patients is significant given that the home is the primary care setting for this population. Results-At KeywordsThis pilot controlled study evaluates an activity-based intervention, the Tailored Activity Program (TAP) that seeks to reduce behavioral disturbances by identifying patients' preserved capabilities and devising activities that build on them. The trial tested whether tailored activities reduced behavioral occurrences in dementia patients and caregiver burden and enhanced patient engagement, caregiver mastery, self-efficacy, and use of simplification strategies to manage behaviors. Also, because the intervention required caregiver involvement, we evaluated whether caregiver depressive symptoms moderated dementia patient and caregiver outcomes.Using a two-group randomized, parallel design, 60 dyads (dementia patients and their caregivers) were assigned to treatment or wait-list control. Treatment grou...

show abstract

“…Behavioral symptoms are a hallmark of dementia, almost universal, occur across disease progression, and are associated with high caregiver distress, health care utilization, risk of nursing home placement, and if untreated, rapid disease progression (Beeri et al ., 2002; Fauth et al ., 2006; Gitlin et al ., 2012; Lyketsos et al ., 2011). …”

mentioning

confidence: 99%

Factors associated with caregiver readiness to use nonpharmacologic strategies to manage dementia‐related behavioral symptoms

Gitlin

Rose

2013

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Background Nonpharmacologic strategies to manage dementia-related behavioral symptoms depend upon caregiver implementation. Caregivers may vary in readiness to use strategies. We examined characteristics associated with readiness, extent readiness changed during intervention, and predictors of change in readiness. Methods Data from a randomized trial involving 119 caregivers in a nonpharmacologic intervention for managing behavioral symptoms. Baseline measures included caregiver, patient, and treatment-related factors. At initial (2 weeks from baseline) and final (16-weeks) intervention sessions, interventionists rated caregiver readiness as pre-action (precontemplation=1; contemplation=2; preparation=3) or action (=4). Ordinal logistic regression identified baseline characteristics associated with initial readiness. Mc Nemar-Bowker test of symmetry described change in readiness; binary logistic regression identified baseline predictors of change in readiness (initial-to-final session). One-way MANOVA identified treatment factors (dose/intensity, number of strategies used, perceived benefits, therapeutic engagement) associated with change in readiness. Results At initial intervention session, 67.2% (N=80) of caregivers were in pre-action, 32.8% (N=39) in action. Initial high readiness was associated with better caregiver mood, less financial difficulty, lower patient cognition and more behavioral symptoms. By final session, 72% (N=79) were in action, 28% (N=31) in pre-action; caregivers with less financial difficulty improved in readiness (B =−.70, p=.017); those in action were more therapeutically engaged (F (2,107)=3.61, p=.030) and perceived greater intervention benefits (F (2, 88)=6.06, p=.003). Conclusion Whereas patient and caregiver-related factors were associated with initial readiness, financial stability, therapeutic engagement and perceived benefits enhanced probability of change. Understanding caregiver readiness and factors associated with its change may be important considerations in nonpharmacologic interventions.

show abstract

Behavioral and psychological symptoms of dementia and caregivers’ stress appraisals: Intra-individual stability and change over short-term observations

Cited by 60 publications

References 38 publications

Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: associations with informal caregivers’ stress and well-being

Resistiveness to care during assistance with activities of daily living in non-institutionalized persons with dementia: associations with informal caregivers’ stress and well-being

Tailored Activities to Manage Neuropsychiatric Behaviors in Persons With Dementia and Reduce Caregiver Burden: A Randomized Pilot Study

Factors associated with caregiver readiness to use nonpharmacologic strategies to manage dementia‐related behavioral symptoms

Contact Info

Product

Resources

About