Stress in the caregivers of Alzheimer's patients: An experimental investigation in ltaly

Abstract

In Italy, the family constitutes the major caregiving response to the needs of the elderly who are no longer self-sufficient. These caregivers are often wives or daughters who have chosen to keep the patient at home with them. On average, three-quarters of the caregiver's day is devoted to the patient, a proportion that tends to increase linearly as the disease progresses. The primary aim of our study was to describe a group of Italian caregivers of patients with a diagnosis of dementia to assess their levels of stress. We then correlated these caregivers with a number of sociodemographic variables and the patients' degree of cognitive impairment and independence in daily life activities. The study was conducted on a sample group of 236 caregivers of patients with a diagnosis of Alzheimer's disease (AD) according to the DSM-IV criteria. Each caregiver took part in a sociodemographic interview and filled in two questionnaires: the Caregiver Burden Inventory (CBI), to quantify the caregiving workload and the Brief Symptom Inventory (BSI), to assess the level of anxiety and depression. Patients were administered the Mini-Mental State Examination (MMSE) to evaluate their level of cognitive impairment and the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) tests to quantify their level of independence. The analysis of the results shows that the average Italian caregiver of an AD patient is a woman, approximately 60 years old. The majority of caregivers are spouses, followed by children. In general, these caregivers work at home, are housewives or retired, and are personally involved in caring for the patients. The greater the level of a patient's cognitive impairment and the less independent they are, the greater amount of care and supervision they require, leaving less free time for the caregiver; this leads to higher levels of anxiety related to caregiving. Toward the final stages of the disease, patient care tasks take up nearly all of the caregiver's free time, leaving them only about two hours per week for themselves or their friends. In conclusion, the management of dementia patients places a particular burden on the caregiver and involves several economic and social costs. The burden becomes heavier as the disease progresses, since the increase of cognitive disorders and the resulting reduction of independence in daily life, together with the onset of behavioral symptoms, heighten the caregiver's distress, anxiety, and depression. Establishing a network of community services able to alleviate the burden on families is therefore a priority. Parallels can be drawn between the stresses documented for American caregivers and their Italian counterparts.

Frequency and Correlates of Behavioral and Psychological Symptoms in a Group of Iranian Patients with Dementia

“…This finding has been reported by other studies, which found strong a correlation between neuropsychiatry symptoms and total care giver distress score. Similarly, some sub-items of NPI, like night-time behavior, caused distress to both patients and care-givers (14,16,28).…”

Gender differences in anxiety and depression among the caregivers of patients with dementia

“…There is evidence of considerable physical and psychological morbidity like hypertension, anxiety and depression in caregivers of dementia patients which further reduces their work capacity with higher strain, increased burden and impaired quality of life [4][5][6][7][8]. Indian data also suggests high correlation between behavioural problems in patients with dementia and psychological distress and poor quality of life in their caregivers [9].…”

Caregivers burden in nursing homes for patients with dementia: the importance of psychological support

“…It is a self-report instrument consisting of 24 items scale type Likert 5 points where 0 indicates the absence of the burden and 4 the maximum of burden. The questionnaire is completed by the primary caregiver, is divided into 5 domains allowing to evaluate several factors of stress: objective burden [1], psychological burden [2], physical load [3], social care [4], emotional strain [5]. 1 -the objective burden (items 1-5), depending on the time required on hand describes the load associated with the restriction of time for the caregiver, the sense of failure on their hopes and expectations; 2 -the burden of evolution (items 6-10), assumed as the perception of the caregiver to feel cutting off from the expectations and opportunities of their peers; 3 -the physical burden (items [11][12][13][14] describes the feelings of chronic fatigue and somatic health problems; 4 -the social burden (items 15-19) on the possible presence of conflict within the family and work; 5 -the emotional burden (items 20-24) describes the negative emotions (embarrassment, resentment, etc.)…”

“…Such condition can worsen to the point of a total disability condition and to the full dependence on the caregiver. In Italy, probably due to the scarcity of formal structures and services, over 80% of people with dementia are attended in a family environment (primary caregiver) which performs this task without specific skills and usually without adequate knowledge of the disease (1)(2)(3). Taking care of elderly people with cognitive impairment often causes physical, psychological or emotional disturbances in these individuals and also social and financial discomfort ( Fig.…”