How does carer management style influence the performance of activities of daily living in people with dementia?

Abstract

Introduction People with Dementia (PwD)'s performance of activities of daily living (ADLs) has been associated with apathy, cognitive deficits, carers' depression and burden. However, it is not known if the carers' management style affects ADL performance, particularly alongside PwD's cognitive deficits and apathy. Thus, the aim of this study was to explore the contribution of intrinsic (cognition, apathy) and extrinsic (carer management styles) dementia factors to ADL performance. Methods PwD (n = 143) were assessed on global cognition (ACE‐III); apathy (CBI‐R); ADLs (Disability Assessment for Dementia‐DAD). Carers' (n = 143) criticism, encouragement and active‐management styles were assessed with the Dementia Management Strategy Scale (DMSS). Multiple linear regression analysis investigated contributions of carer styles, cognition, apathy (independent variables) on ADLs (dependent variable). Results The best model explaining the variance of the DAD scores included cognition (β = 0.413, t(142) = 4.463, p = 0.001), apathy (β = –0.365, t(142) = –5.556, p = 0.001), carer criticism (β = –0.326, t(142) = –2.479, p = 0.014) and carer encouragement styles (β = 0.402, t(142) = 2.941, p = 0.004) accounting for 40% of the variance of the DAD scores. Conclusions This novel study demonstrated that PwD's level of apathy and the carer's use of criticism negatively affected ADL performance while PwD's cognitive abilities and carer encouragement style improved ADL performance. These findings have critical implications for the development of novel multi‐component non‐pharmacological interventions to maintain function and delay disease progression in dementia, as well as direct relevance to current carers and families.

Contributions of Caregiver Management Styles to the Discrepancy Between Reported and Observed Task Performance in People with Dementia

“…This was a surprising finding given that the use of criticism style was found to negatively affect PwD's performance of daily tasks [14]. One way to explain this finding may be that criticism strategies are based on communication-related interactions, rather than providing actual support, and therefore its use had no effect on the comparative ADL score.…”

“…Caregivers' level of depression and anxiety had no effect on the comparative ADL score either. This can be attributed to the nature of the PwD's performance of daily tasks which is based on how their skills are affected by intrinsic dementia factors [14] and extrinsic factors such as the environment [31], rather than on the way the caregivers feel. Other studies have published contradictory results on the way depression affected caregivers' reports of ADL performance [6,7,11] and, to date, none of those studies measured the effect of caregiver level of anxiety on the discrepancy between informant and performance-based measures.…”

“…Active management includes engaging the PwD, stimulating and assisting them while encouragement refers to a caregiver who would praise the PwD using an emotional-based approach to solve problems. A recent study showed how the caregiver's use of criticism and encouragement styles affected PwD's ADL performance [14]. However, it is still unclear how caregiver management styles may influence the discrepancy between reported and observed performance.…”

Trajectories of cognitive and perceived functional decline in people with dementia: Findings from the IDEAL programme

“…This could comprise qualitative interviews at regular intervals and a brief objective measure of iADL with corresponding appraisal ratings; this would allow for a deeper understanding of how caregivers and people with dementia perceive iADL difficulties as well as help understand changes in caregiver adjustment, coping strategies, and stress/burden. This is especially salient as coping strategies, adjustment, and burden influence how informants rate iADL difficulties, 10,40,45–47 and higher perceived stress is often associated with more perceived iADL difficulties 3,10,15,17,19 …”

“…This could comprise qualitative interviews at regular intervals and a brief objective measure of iADL with corresponding appraisal ratings; this would allow for a deeper understanding of how caregivers and people with dementia perceive iADL difficulties as well as help understand changes in caregiver adjustment, coping strategies, and stress/burden. This is especially salient as coping strategies, adjustment, and burden influence how informants rate iADL difficulties, 10,40,[45][46][47] and higher perceived stress is often associated with more perceived iADL difficulties. 3,10,15,17,19 How ratings accord with actual abilities is unknown, though a previous study found that people with mild-to-moderate dementia were able to rate performance on iADL tasks more accurately than corresponding ratings by their caregivers, particularly with tasks that do not largely rely on intact memory ability; for example, telling the time, or identifying medication.…”