 |
|
Long-term Care Placement of Dementia Patients and Caregiver Health and Well-being
Richard Schulz, PhD;
Steven H. Belle, PhD;
Sara J. Czaja, PhD;
Kathleen A. McGinnis, MS;
Alan Stevens, PhD;
Song Zhang, MS
JAMA. 2004;292:961-967.
Context Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described.
Objective To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being.
Design, Setting, and Participants Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers.
Main Outcome Measures Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety.
Results Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P = .64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P = .21). These effects were most pronounced among caregivers who were married to the patient (P = .02 for depression), visited more frequently (P = .01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P = .003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P = .16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P = .02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative.
Conclusions The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.
Author Affiliations: Department of Psychiatry (Dr Schulz), Department of Epidemiology (Dr Belle and Ms Zhang), and University Center for Social and Urban Research (Dr Schulz and Ms McGinnis), University of Pittsburgh, Pittsburgh, Pa; Department of Psychiatry and Behavioral Sciences and Center on Aging, University of Miami, Miami, Fla (Dr Czaja); and Division of Gerontology/Geriatric Medicine, University of Alabama at Birmingham (Dr Stevens).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Can pharmacological treatment of behavioural disturbances in elderly patients with dementia lower the burden of their family caregiver?
Schoenmakers et al.
Fam Pract 2009;0:cmp024v1-cmp024.
ABSTRACT
| FULL TEXT
Wives and Daughters: The Differential Role of Day Care Use in the Nursing Home Placement of Cognitively Impaired Family Members
Cho et al.
The Gerontologist 2009;0:gnp010v1-gnp010.
ABSTRACT
| FULL TEXT
Telephone-delivered psychosocial intervention reduces burden in dementia caregivers
Tremont et al.
Dementia 2008;7:503-520.
ABSTRACT
Predictors of Satisfaction for African-American and White Family Caregivers of Adult Care Home Residents
Wallace Williams et al.
Journal of Applied Gerontology 2008;27:568-587.
ABSTRACT
Persisting Burden Predicts Depressive Symptoms in Dementia Caregivers
Epstein-Lubow et al.
J Geriatr Psychiatry Neurol 2008;21:198-203.
ABSTRACT
Emotional and Physical Health of Informal Caregivers of Residents at the End of Life: The Role of Social Support
Williams et al.
Journals of Gerontology Series B: Psychological Sciences and Social Science 2008;63:S171-S183.
ABSTRACT
| FULL TEXT
Long-Term Adaptation to Institutionalization in Dementia Caregivers
Gaugler et al.
Gerontologist 2007;47:730-740.
ABSTRACT
| FULL TEXT
Families and Assisted Living
Gaugler and Kane
Gerontologist 2007;47:83-99.
ABSTRACT
| FULL TEXT
Depressed Mood in Informal Caregivers of Individuals With Mild Cognitive Impairment
Lu et al.
AM J ALZHEIMERS DIS OTHER DEMEN 2007;22:273-285.
ABSTRACT
Patient Suffering and Caregiver Compassion: New Opportunities for Research, Practice, and Policy
Schulz et al.
Gerontologist 2007;47:4-13.
ABSTRACT
| FULL TEXT
Informal Caregiver Burden among Survivors of Prolonged Mechanical Ventilation
Van Pelt et al.
Am. J. Respir. Crit. Care Med. 2007;175:167-173.
ABSTRACT
| FULL TEXT
Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups: A Randomized, Controlled Trial.
Belle et al.
ANN INTERN MED 2006;145:727-738.
ABSTRACT
| FULL TEXT
Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease.
Mittelman et al.
Neurology 2006;67:1592-1599.
ABSTRACT
| FULL TEXT
Data and safety monitoring in social behavioral intervention trials: the REACH II experience
Czaja et al.
Clin Trials 2006;3:107-118.
ABSTRACT
Caregivers' Reasons for Nursing Home Placement: Clues for Improving Discussions With Families Prior to the Transition
Buhr et al.
Gerontologist 2006;46:52-61.
ABSTRACT
| FULL TEXT
|
