Impact of three dementia‐related behaviors on caregiver depression: The role of rejection of care, aggression, and agitation

Abstract

Objective The relationship of specific dementia‐related behaviors to caregiver depression and moderating factors is unclear. We examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. Methods The method used was a cross‐sectional, secondary analysis using baseline data from two community‐based clinical trials. We examined frequency of occurrence of presenting behaviors and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioral clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioral symptom clusters and caregiver depression. Results Three of four symptom clusters (all three behaviors [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02‐4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06‐6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17‐5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioral clusters and caregiver depression. Conclusion Caregiver depression was associated with different combinations of behaviors but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.

An empowerment program for family caregivers of people with dementia

“…The increased prevalence of PWD has resulted in a need for coping and preparedness in families, and this has social implications that extend beyond personal and family concerns (National Academies of Sciences, Engineering, and Medicine, 2016). Research on family caregivers of PWD is steadily increasing, and caregivers have been shown to experience stress, depression, anxiety, and decreased self-efficacy and well-being (Choi et al, 2019;Leggett et al, 2018;Park & Park, 2015). Further, several studies have examined the maladaptive consequences between family member conflicts and economic burdens (Miranda-Castillo, Woods, & Orrell, 2013).…”

Problems Associated with the Measurement of Neuropsychiatric Symptoms of Dementia

“…As with several other dementia behaviors, aggression is often measured as a symptom of agitation rather than a distinct NPS. However, research suggests that these NPS should be differentiated, do not always co-occur, and have differential effects on caregivers and unique treatment routes [57,58]. In contrast to agitation, aggression is related to a greater likelihood of caregiver depression and perceived burden [49,59].…”

Behaviors of Persons with Dementia: A Review and New Perspective for Future Research

“…Multiple studies have examined the impact of caregiving and stress on various aspects of health and well-being using the SPM and the SPM for IWDs. With the specific focus on the primary objective stressor of behaviors, researchers testing this model can assess the role by which the objective primary stressor of behaviors influences subjective stressors, secondary strains, and outcomes of well-being of caregivers [48,49]. Understanding this process allows for the development of nonpharmacological interventions related to behaviors and caregivers distress.…”

“…The NPI has been used to study the effectiveness of a wide range of non-pharmacological interventions on reducing neuropsychiatric symptoms or BPSD. Some of these interventions include, conditional effects of caregiver social support and mastery of behaviors [49], the effects of individualized tailored activity programs on reducing neuropsychiatric symptoms [41] and the efficacy of music therapy on behaviors [70].…”

“…These types of behavioral interventions tend to focus on developing interventions for PWDs [24,33,42] who are in the moderate to severe stages of the illness [36,81] and primarily living in nursing homes or long-term care facilities [33,82,83]. Typically, behavioral interventions target a specific behavior such as agitation [31,82] or rejection of care [42,49]. Few behavioral studies address the changes in behaviors across the different stages of the illness, those that do use observational measurement scales such as the NPI and RMBPC (which are administer by researchers or trained staff).…”