Selected Caregiver Assessment Measures A Resource Inventory for Practitioners Brief: Families provide the majority of care and support for the millions of adults in need of assistance. Likewise, the number of family caregivers is steadily increasing with many family caregivers having multiple, varied, and serious unmet financial, physical, emotional, and social needs. In order to continue providing care, family caregivers need assistance and support so that their physical and mental health needs are met rather than compromised. A systematic and well-designed assessment can help identify a caregiver's needs and strengths and, in turn, contribute to a plan of care that ensures the well-being of both the caregiver and care recipient. As health care continues to move into home setting, it is important to assess not only the knowledge, skills and capacity of the caregiver to provide care but also to address caregiver well-being and health in order to prevent more serious health problems for families in the long-term. Read more
Prevalence and predictors of depression, care-related strain, and unmet needs among caregivers of patients with dementia Read more
Negative Caregiving Effecs Among Caregivers of Veterans With Dementia Objectives: This investigation was guided by the stress process model and had two objectives: first, to describe the extent of negative caregiving effects for family caregivers of veterans with dementia, and second, to identify salient predictors of negative caregiving effects. Design: Data were obtained from baseline, structured telephone interviews with family caregivers of veterans enrolled in “Partners in Dementia Care,” a clinical trial testing a care coordination intervention. Participants: The study included 486 family caregivers of veterans with dementia who received primary care from the Department of Veterans Affairs healthcare system and lived at home. Measurement: Six negative caregiving effects were described as follows: unmet needs, four role and intrapsychic strains, and depression. Predictive factors included the following: cognitive impairment, behavior problems, personal care dependency, number of chronic conditions, and characteristics of the caregiving context. Results: Sizeable portions of caregivers experienced negative caregiving effects; most common were unmet needs, social isolation, and depression. Cognitive, behavioral, and functional symptoms of dementia and other coexisting chronic conditions explained significant variation in all negative caregiving effects. Caregiving context had little impact. Behavior problems were the most consistent predictor; personal care dependency and other chronic conditions were also important. Conclusions: Family caregivers, the foundation of long-term care for veterans with dementia who live at home, experience a variety of negative caregiving effects. Negative effects are greater when veterans exhibit behavior problems, require extensive assistance with personal care, and have a greater number of coexisting chronic conditions. Negative caregiving effects are an important target for interventions that support family caregivers and promote continued care at home. Read more
Understanding Discrepancy in Perceptions of Values Individuals With Mild to Moderate Dementia and Their Family Caregivers Purpose of the Study: We explore discrepancies in perceptions of values and care preferences between individuals with dementia (IWDs) and their family caregivers. Design and Methods: We interviewed 266 dyads consisting of an individual with mild to moderate dementia and his or her family caregiver to determine IWDs’ beliefs for 5 values related to care (autonomy, burden, control, family, and safety). We used multilevel modeling to investigate if there are dyadic level discrepancies in beliefs and what factors are associated with such discrepancies. Results: Caregivers consistently underestimated the IWD’s values for all five values. Discrepancies were associated primarily with caregivers’ beliefs about the IWD’s involvement in decision making. Race was also associated with the discrepancies for control and safety, whereas cognitive functioning of the IWD was associated with the discrepancy for burden. Implications: Many caregivers do not have an accurate depiction of the IWD’s values, yet, caregivers will become the surrogate decision makers for IWDs as dementia progresses. These findings indicate the need for assessments of values and preferences in care and to develop programs that assess values, consider the caregiver’s beliefs about care, and improve communication within the dyad in the early stages of dementia. Read more
Partners in Dementia Care A Care Coordination Intervention for Individuals with Dementia and their Family Caregivers Purpose: This article provides a detailed description of a telephone-based care coordination intervention, Partners in Dementia Care (PDC), for veterans with dementia and their family caregivers. Essential features of PDC included (a) formal partnerships between Veterans Affairs (VA) medical centers and Alzheimer’s Association Chapters; (b) a multidimensional assessment and treatment approach, (c) ongoing monitoring and long-term relationships with families, and (d) a computerized information system to guide service delivery and fidelity monitoring. Read more
Knowledge of Documented Dementia Diagnosis and Treatment in Veterans and Their Caregivers Design and Methods: Data illustrating the use of the intervention were displayed for 93 veterans and their caregivers after 12 months in PDC. Descriptive data were provided for each major component of the intervention protocol, including: initial assessment, goals, action steps, and on-going monitoring. Care coordinators completed a 12-item questionnaire ascertaining the acceptability and feasibility of implementing PDC. Read more
Existential Loss as a Determinant to Well-Being in the Dementia Caregiving Dyad A Conceptual Model The following describes a conceptual model for dementia caregiving. The interdisciplinary model proposes that a caregiver’s confrontation with existential loss plays a determining role in the wellbeing of the dementia care dyad. The paper describes how existential threats can affect a caregiver’s appraisal of the care situation, and thus how a caregiver copes. Still further, it is speculated that caregiver coping (as manifested primarily through avoidance or acceptance of loss) will influence behavioral interaction within the caregiving dyad, where communication and decision making between caregiver and the person with dementia is predominantly inequitable (e.g., authoritarian) or equitable (e.g., negotiated). Lastly, it is proposed that the type of dyadic behavior is an antecedent to dyadic well-being. In terms of intervention, as the model is centered on the intrapsychic threat posed by loss, particular emphasis is on both individual and social factors that negatively influence a caregiver’s ability to integrate the emotional costs related to dementia and its care. Read more
Applying a Strength-Based Intervetion for Dyads with Mild to Moderate Memory Loss Two Case Examples Managing and coping with the symptoms of dementia and memory loss is associated with negative psychosocial outcomes for both persons with dementia and their family caregivers. Research has indicated beneficial results in using dementia-management interventions to impact positively on mental health outcomes for caregivers and address cognitive and functional issues for persons with dementia. However, most intervention programmes to date have primarily worked with each care partner separately, rather than implementing a single intervention protocol that targets both members of the caregiving dyad. This article provides a description of a newly designed intervention that includes both care partners. Using a Strength-Based Approach, the dyadic intervention identifies and builds upon both care partners’ current abilities to address their specific care needs. Two case examples are presented to illustrate the flexibility and advantages of using a Strength-Based Approach. The discussion highlights the extent to which core intervention skills can be tailored to fit a range of care needs. Read more
Acceptability and Feasibility Results of a Strength-Based Skills Training Program for Dementia Caregiving Dyads Purpose: The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers. Using a strength-based approach, caregiving dyads received skills training across 5 key areas: (a) education regarding dementia and memory loss, (b) effective communication, (c) managing memory loss, (d) staying active, and (e) recognizing emotions and behaviors. Results of the acceptability and feasibility of the intervention protocols are also presented. Design and Methods: Caregiving dyads were randomly assigned to participate in the intervention. Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program. Data were also collected from the intervention specialists who implemented the protocols. Results: Overall, the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists. Implications: This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners. Furthermore, the intervention program was found to be highly acceptable and feasible, which is an important aspect of developing dyadic protocols. Read more
