Stress on relative caregivers of dementia sufferers, and predictors of the breakdown of community care

Abstract

SUMMARYThe stress upon the principal relative caregivers of a series of dementia sufferers attending an assessment day hospital was studied. The main variables influencing stress levels were the caregiver's own health self-rating and a measure of behaviour and mood disturbance in the patient. Predictors of the breakdown of community care over a 1-year follow-up period were studied. At 12 months caregiver's 'caseness' on the GHQ was a highly significant predictor. Clinical work with dementia sufferers in the community should include an assessment of the health and psychological status of the caregiver. Future research should focus upon evaluating specifically targeted interventions aimed at reducing stress in caregivers.KEY WORDS-Dementia, stress, elderly mental illness teams, relatives, caregivers.The psychological and health impact upon relatives caring for dementia sufferers in the community has been extensively studied over the past 10 years. Research in the area can be divided into a number of conceptual themes. The first theme has been to define the nature of the burden and stress felt by relatives and to examine factors influencing levels of stress. Such work has been influenced by the separation made by Grad and Sainsbury (1965) of objective and subjective burden. Vitaliano et al. (1991) criticize burden measures that do not separate objective from subjective factors, and argue for the use of instruments which relate the two concepts, so that the sources of subjective burden are explained. Early work found that caring for a relative suffering from dementia is felt to be more stressful upon relatives than caring for a physically ill relative (Eagles et al., 1987;Poulshock and Deimling, 1984). Morris et al. (1988a) review nine studies which have investigated the mental health of relatives; seven have reported raised levels of depression or stress symptoms.Research has focused upon a number of themes relevant to the stress felt by relatives:-The severity of dementia and level of problem behaviour shown by the sufferer -The type of relationship between caregiver and sufferer (eg blood relative, spouse, etc) and the past quality of the relationship -The cognitive styles and coping mechanisms used by the relative -The impact of services and of social supports -The satisfactions derived from the caring roleThe severity of dementia has not been found to be simply related to levels of stress in family members. There is agreement about which behaviours relatives most often report as problems: incontinence, overdemanding behaviour and the need for continual supervision (Morris et al., 1988a). However, such problems are not reliably related to raised stress levels. Other factors clearly mediate

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