Predictors of Change and Continuity in Home Care for Dementia Patients

Abstract

Objective. To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design. A prospective longitudinal study with a follow‐up period of 10 months. Setting. Dementia patients living in the community selected by Dutch general practitioners. Subjects. Pairs of demented patients and their primary caregivers (N=138). Main outcome measures. Sense of competence: a 27‐item scale (α=0.79) based on issues derived from the family crisis model and the Burden Interview. Continuity in home care is determined by the number of patient's admissions to a nursing or retirement home. Results. Regression analysis revealed that a change in the caregiver's sense of competence was independently predicted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was associated with a longer duration of dementia and the patient's more agitated behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient. A positive influence on the change in the sense of competence was found when these females received a professional intervention consisting of support for the caregiver. Reporting to be a Catholic or a Protestant compared with not being religiously involved positively influenced the change in sense of competence. Logistic regression analysis identified that continuity in home care was predicted by characteristics of the demented patient and the professional social network of the patient. Predictors of continuation of home care were: lower severity of dementia, patient's higher ADL impairment, the intervention and involvement of regular home help. Institutionalization was more likely when the patient's behaviour was more apathetic and a district nurse was involved in the care. Conclusions. Caregiver characteristics influenced the change in sense of competence but did not influence the risk for institutionalization. Findings suggest that health professionals should pay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demented patient.

Factors related to sense of competence in family caregivers of people living with dementia in the community: a narrative synthesis

“…In terms of coping strategies, the use of emotion-focused (Lau et al, 2015) coping was moderately related to sense of competence. In a regression analysis, religious involvement positively predicted sense of competence (Vernooij-Dassen et al, 1997), whereas the use of negative caregiving strategies was moderately related to a lower sense of competence (Tan et al, 2013). In a longitudinal study, there was a significant difference between caregivers who used a supporting strategy and those who used a non-adaptive strategy, with carers using a supportive coping strategy scoring higher on sense of competence.…”

Interventions for Caregivers Caring for a Family Member With Advanced Illness at Home: A Systematic Review

“…On the other hand, competence refers not only to the caregiver's feeling of being able to manage the provision of care (Vernooij‐Dassen et al. 1997 ) but also to the results of care obtained for the patient (Stansfeld et al. 2019 ).…”

“…Khan et al (2021) define self-efficacy as confidence in managing caregiving stressors, learning medical skills, controlling disruptive thoughts, accessing community support, assisting with activities of daily living, and maintaining a good relationship with his/her social environment. On the other hand, competence refers not only to the caregiver's feeling of being able to manage the provision of care (Vernooij-Dassen et al 1997) but also to the results of care obtained for the patient (Stansfeld et al 2019). Therefore, researchers must consider these differences when designing interventions for caregivers.…”

Predictors of outcomes from a ward for demented elderly: gender differences

“…Previous reports [11][12][13][14][15] regarding predictors of nursing home placement focused on the characteristics of both the patients and caregivers. Fisher and Lieberman 16 showed that families scoring high on emotional closeness, high on negative family feelings and low on family efficiency institutionalized their sick elderly at a significantly higher rate than other families, especially at low levels of patient severity.…”