Does Caregiver Burden Mediate the Effects of Behavioral Disturbances on Nursing Home Admission?

Objectives The primary objective of this study was to determine whether caregiving burden mediated the relationship between specific behavior disturbances and time to nursing home admission (NHA) for persons with dementia (i.e., Alzheimer disease or a related disorder). Design The study used seconda...

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Bibliographic Details
Published in:The American journal of geriatric psychiatry 2011-06, Vol.19 (6), p.497-506
Main Authors: Gaugler, Joseph E., Ph.D, Wall, Melanie M., Ph.D, Kane, Robert L., M.D, Menk, Jeremiah S., M.S, Sarsour, Khaled, Ph.D, Johnston, Joseph A., M.D, Schuh, Kory, Ph.D, Newcomer, Robert, Ph.D
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Behavioral Symptoms - psychology
Caregivers - psychology
Cost of Illness
Dementia - nursing
Dementia - psychology
Female
Humans
Internal Medicine
Male
Middle Aged
Nursing Homes - statistics & numerical data
Time Factors
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Summary:Objectives The primary objective of this study was to determine whether caregiving burden mediated the relationship between specific behavior disturbances and time to nursing home admission (NHA) for persons with dementia (i.e., Alzheimer disease or a related disorder). Design The study used secondary longitudinal data from the Medicare Alzheimer's Disease Demonstration, a Medicare-covered home care benefit and case management program for family caregivers of persons with dementia. Primary caregivers of persons with dementia were assessed via in-person and telephone interviews every 6 months over a 3-year period. Setting Dementia caregivers were recruited from eight catchment areas throughout the United States. Participants The baseline sample included 5,831 dementia caregivers. Just more than 40% (43.9%; N = 2,556) of persons with dementia permanently entered a nursing home during the 3-year study period. Measurements Individual behavior problems were measured with the Memory and Behavior Problem Checklist. Caregiving burden was assessed with a short version of the Zarit Burden Inventory. Key covariates, including sociodemographic background, functional status, and service utilization, were also considered. Results Event history analyses revealed that time-varying measures of caregiver burden fully mediated the relationship between four behavioral disturbances (episodes of combativeness, property destruction, repetitive questions, and reliving the past) and NHA. Conclusions The findings highlight the multifaceted, complex pathway to NHA for persons with dementia and their family caregivers. The results emphasize the need for comprehensive treatment approaches that incorporate the burden of caregivers and the behavioral/psychiatric symptoms of persons with dementia simultaneously.
ISSN:1064-7481
1545-7214
DOI:10.1097/JGP.0b013e31820d92cc