Caregivers' Judgments of the Functional Abilities of the Alzheimer's Disease Patient: A Comparison of Proxy Reports and Objective Measures

Loewenstein, David; Argüelles, Soledad; Bravo, Marina; Freeman, Rhonda Q.; Argüelles, Trinidad; Acevedo, Amarilis; Eisdorfer, Carl

doi:10.1093/geronb/56.2.p78

Cited by 156 publications

(159 citation statements)

References 21 publications

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“…Observer (relative or caregiver)-completed assessments are commonly used in pediatric [49][50][51][52][53][54][55][56][57][58][59] and cognitively impaired human populations. [60][61][62][63][64][65][66][67] Although the subjective worlds of young children, demented adults, and dogs are not directly accessible, readily observable behaviors offer a basis for assessments to be made by individuals who are knowledgeable about the subjects. Development of these tools is based on the concepts that there can be a proxy evaluation of pain intensity via a global assessment based on such things as facial characteristics, body posture, and movement patterns of the subject; pain can interfere with activities of daily living; and a knowledgeable observer can reliably rate the behavior of a subject.…”

Section: Discussionmentioning

confidence: 99%

Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis

Brown¹,

Boston²,

Coyne³

et al. 2007

ajvr

192

207

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Objective-To develop and psychometrically test an owner self-administered questionnaire designed to assess severity and impact of chronic pain in dogs with osteoarthritis.Sample Population-70 owners of dogs with osteoarthritis and 50 owners of clinically normal dogs.Procedures-Standard methods for the stepwise development and testing of instruments designed to assess subjective states were used. Items were generated through focus groups and an expert panel. Items were tested for readability and ambiguity, and poorly performing items were removed. The reduced set of items was subjected to factor analysis, reliability testing, and validity testing.Results-Severity of pain and interference with function were 2 factors identified and named on the basis of the items contained in them. Cronbach's α was 0.93 and 0.89, respectively, suggesting that the items in each factor could be assessed as a group to compute factor scores (ie, severity score and interference score). The test-retest analysis revealed κ values of 0.75 for the severity score and 0.81 for the interference score. Scores correlated moderately well (r = 0.51 and 0.50, respectively) with the overall quality-of-life (QOL) question, such that as severity and interference scores increased, QOL decreased. Clinically normal dogs had significantly lower severity and interference scores than dogs with osteoarthritis. Conclusions and Clinical Relevance-A psychometrically sound instrument was developed.Responsiveness testing must be conducted to determine whether the questionnaire will be useful in reliably obtaining quantifiable assessments from owners regarding the severity and impact of chronic pain and its treatment on dogs with osteoarthritis.It is crucial to have quantitative measures of chronic pain that are valid and reliable in clinical patients to enable development and testing of interventions (such as drugs or surgical procedures) designed to reduce such pain. In the past, studies designed to test the efficacy of interventions intended to decrease chronic pain in dogs with osteoarthritis have relied heavily on a veterinarian's assessment of lameness supported by values generated through gait analysis by use of a force plate. When collected properly, data on gait analysis offer an objective measure that can be reliably monitored over time; however, it can be extremely time consuming, requires specialized equipment, and relies on relatively strict inclusion criteria. In addition, these measures only evaluate an animal at 1 specific point in NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript time, and weight bearing on an affected limb is only 1 part of the much larger picture of chronic pain in dogs with osteoarthritis. [1][2][3][4][5] When an owner brings a dog to a veterinarian with a concern that the dog has signs of a chronic painful condition, they report a number of behaviors that they attribute to the painful condition (eg, no longer climbs stairs or jumps onto the bed). In monitoring the progression of the dog's cond...

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Section: Discussionmentioning

confidence: 99%

Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis

Brown¹,

Boston²,

Coyne³

et al. 2007

ajvr

192

207

View full text Add to dashboard Cite

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“…67 The objective assessment of functional status is not a routine procedure when evaluating subjects with suspected cognitive impairment; rather, it usually relies on the subjective appraisal of a relative or caregiver, or even on the patient's self-judgment, rendering this information inaccurate and subject to several sources of bias, including the informant's personality, mood, and cognitive state. 68 Therefore, the objective assessment of functional status may overcome some, if not most, of the limitation of informant-based scales. Also, the objective assessment of functional status not only helps to establish the threshold at which cognitive decline significantly impact ADL performance, but enables the investigation of which functional abilities are more sensitive to such alterations.…”

Section: Longitudinal Studies and MCI Prognosismentioning

confidence: 99%

Mild cognitive impairment (part 1): clinical characteristics and predictors of dementia

Forlenza

Diniz

Stella

et al. 2013

Rev. Bras. Psiquiatr.

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Objective: To critically review and evaluate existing knowledge on the conceptual limits and clinical usefulness of the diagnosis of mild cognitive impairment (MCI) and the neuropsychological assessment and short-and long-term prognosis thereof. Methods: We conducted a systematic search of the PubMed and Web of Science electronic databases, limited to articles published in English between 1999 and 2012. Based on the search terms mild cognitive impairment or MCI and epidemiology or diagnosis, we retrieved 1,698 articles, of which 248 were critically eligible (cross-sectional and longitudinal studies); the abstracts of the remaining 1,450 articles were also reviewed. Results: A critical review on the MCI construct is provided, including conceptual and diagnostic aspects; epidemiological relevance; clinical assessment; prognosis; and outcome. The distinct definitions of cognitive impairment, MCI included, yield clinically heterogeneous groups of individuals. Those who will eventually progress to dementia may present with symptoms consistent with the definition of MCI; conversely, individuals with MCI may remain stable or return to normal cognitive function. Conclusion: On clinical grounds, the cross-sectional diagnosis of MCI has limited prognostic relevance. The characterization of persistent and/or progressive cognitive deficits over time is a better approach for identification of cases at the pre-dementia stages, particularly if these cognitive abnormalities are consistent with the natural history of incipient Alzheimer's disease.

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“…Answering this question requires that we first identify factors that contribute to caregiver rating bias. Although not definitive, the literature suggests a number of candidate variables including caregiver depression (10, 13), burden (7, 10, 13), patient depression (10), patient cognitive status (6, 11, 14), and the domain being rated (e.g., subjective state vs. observable behavior) (6, 14). That is, larger discrepancies are reported when either the patient or caregiver is depressed, the patient is more cognitively impaired, the caregiver is more burdened, and the domains being rated are subjective states of the patient as opposed to observable behaviors such as physical functioning.…”

Section: Introductionmentioning

confidence: 99%

Magnitude and Causes of Bias Among Family Caregivers Rating Alzheimer Disease Patients

Schulz

Cook

Beach

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Family caregivers generally underestimate the health and well-being of Alzheimer’s disease (AD) patients when compared to patient self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias. Methods 105 patients with AD and their family caregivers were assessed twice by trained interviewers one year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies. Results Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy. Conclusions Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers’ ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver’s own well-being is compromised.

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Caregivers' Judgments of the Functional Abilities of the Alzheimer's Disease Patient: A Comparison of Proxy Reports and Objective Measures

Cited by 156 publications

References 21 publications

Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis

Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis

Mild cognitive impairment (part 1): clinical characteristics and predictors of dementia

Magnitude and Causes of Bias Among Family Caregivers Rating Alzheimer Disease Patients

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