A Causal Model of Caregiving Burden among Dementia Caregivers
Keywords:Caregiving burden, Dementia caregivers, Causal model
In this study, a cross-sectional, predictive correlation design was used to identify and test a causal relationship between behavior disturbances, coping, family conflict, self-esteem and social support to caregiver burden among dementia caregivers. A total of 450 caregivers of dementia aged over 18 years were recruited from 4 hospitals in northern Thailand based on selected criteria. Demographic Questionnaire, Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD, The Family Conflict Scale, The Zarit Burden Interview Scale, The Perceived Social Support Questionnaire, The Brief COPE and The Rosenberg Self-Esteem with acceptable reliability coefficients were used to collect data. Data were analyzed using descriptive statistics, Pearson’s Product-Moment Correlation and path analysis by structural equation modeling.
Results showed that the modified model fitted with the data and explained 58 % of the variance in caregiving burden among dementia caregivers. Coping and family conflict had a positive direct effect on caregiving burden (p < 0.001), whereas self-esteem and social support had a direct negative effect on caregiving burden (p < 0.001). Behavior disturbance had a positive indirect effect caregiving burden (p < 0.001) via family conflict. Coping had a positive indirect effect on caregiving burden (p < 0.001) via behavior disturbance and family conflict. Social support had a negative indirect effect on caregiving burden (p < 0.001) via family conflict and self-esteem. The results of this study could be used as a guideline for psychiatric nurses in planning an appropriate intervention program to reduce burden of caregivers of dementia patients in Thailand.
Alzheimer’s Association. Alzheimer’s disease facts and figures. Alzheimers Dement. 2013; 9, 208-45.
A Wimo and M Prince. World Alzheimer Report 2010. The Global Economic Impact of Dementia. Alzheimer’s Disease International. 2010.
Department of Health. Living well with dementia. A National Dementia Strategy, Department of Health, London, UK, 2009.
M Prince, AGM Wimo, GC Ali, YT Wu and M Prina. World Alzheimer Report 2015: The Global Impact of Dementia: An Analysis of Prevalence, Incidence, Cost and Trends. Alzheimer’s Disease International, 2015.
V Senanarong, P Jamjumrus, K Harnphadungkit, S Vannasaeng, S Udompunthurak, N Prayoonwiwat and Poungvarin N. Risk factors for dementia and impaired cognitive status in Thai elderly. J. Med. Assoc. Thai 2001; 84, 468-74.
D Lasuka. Dementia in Thailand Current Situation in Global Collaboration Center. Osaka University Booklet, 2014, p. 43.
Alzheimer’s Association. Alzheimer’s disease facts and figures. Alzheimer’s And Dementia. Alzheimer Dementia 2016; 12, 459-509.
GR Oliveira, JF Neto, SM Camargo, AL Lucchetti, DC Espinha and G Lucchetti. Caregiving across the lifespan. Psychogeriatrics 2015; 15, 123-32.
National Health Examination Survey Office. The 4th National Health Examination Survey2008 -2009. Available from http://www.nheso.or.th/download_file.php?content_id=14&down_id=8, accessed March 2014.
E Papastavrou, A Kalokerinou, SS Papacostas, H Tsangari and P Sourtzi. Caring for a relative with dementia: Family caregiver burden. J. Adv. Nurs. 2007; 58, 446-457.
K Chwalisz and V Kisler. Perceive stress: A better measure of carer burden. Meas. Eval. Counsel. Dev. 1995; 28, 88-98.
SM Robertson, SH Zarit, LG Duncan, M Rovine and EE Femia. Family caregivers’ patterns of positive and negative affect. Fam. Relat. 2007; 56, 12-23.
L Barclay, A Zemcou, J Blass and J Sansone. Survival in Alzheimer's disease and vascular dementias. Neurology 1985; 35, 834-40.
JL Conde-Sala, J Garre-Olmo, O Turro-Garriga, J Vilalta-Franch and S Lopez-Pousa. Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer’s disease: an exploratory comparative design. Int. J. Nurs. Stud. 2010; 47, 1262-73.
S Andren and S Elmstahl. The relationship between caregiver burden, caregivers’ perceived health and their, sense of coherence in caring for elders with dementia. J. Clin. Nurs. 2008; 17, 790-9.
LI Pearlin, JT Mullan, Semple and MM Akaff. Caregiving and the stress process: An overview of concepts and their measures. Gerontologist 1990; 30, 583-94.
SI Finkel, J S Costa, G Cohen, S Miller and N Sartorius. Behavioral and psychological signs and symptoms of dementia: A consensus statement on current knowledge and implications for research and treatment. Int. Psychogeriatr. 1996; 3, 497-500.
SL Sample. Conflict in Alzheimer’s caregiving families: Its dimensions and consequences. Gerontologist 1992; 32, 648-55.
M Rosenberg. Society and the Adolescent Self-image. Princeton University Press, Princeton, NJ, 1965.
DG Dyck, R Short and PP Vitaliano. Predictor of burden and infectious illness in schizophrenia caregivers. Psychosom. Med. 1999; 61, 411-9.
CY Hsiao. Family demands, social support and caregiver burden in Taiwanese family caregivers living with mental illness: The role of family caregiver gender. J. Clin. Nurs. 2010; 19, 3494-503.
SH Zarit, KE Reever and J Bach-Peterson. Relatives of the impaired elderly: Correlates of feelings of burden. Geronotologist 1980; 20, 649-55.
JB Schreiber, FK Stage, J King, A Nora and EA Barlow. Reporting structural equation modeling and confirmatory factor analysis results: A review. J. Educ. Res. 2006; 99, 323-37.
JF Hair, WC Black, BJ Babin, RE Anderson and RT Tatham. Multivariate Data Analysis. 6th ed. Pearson Prentice Hall, New Jersey, 2006.
O Pankong. 2006, Effects of Self-help Group on Perceived Burden and Well-being of Caregivers of the Elderly Persons with Dementia. Master of Nursing Science Thesis, Burapha University, Bangkok, Thailand.
CS Carver, MF Scheier and JK Weintraub. Assessing coping strategies: A theoretically based approach. J. Pers. Soc. Psychol. 1989; 56, 267-83.
C Kritpracha. 2004, Influcences of Cognitive Representations of Breast Cancer on Emotional Responses and Coping in Thai Woman Newly Diagnosis with Breast Cancer. Doctoral Dissertation, The University of Michigan.
P Srimoragot. 1993, Effect of Supportive Counseling on Perceived Illness, Self- esteem, and Morale in Cervical Cancer Patients Undergoing Radiotherapy. Dissertation, Mahidol University, Bangkok, Thailand.
SJ Semple, TL Patterson, LR Temoshok, K Straits-Troster, JH Atkinson and W Koch and I Grant. Family conflict and depressive symptoms: A study of HIV-seropositive men. AIDS Behav. 1997; 1, 53-60.
C Schaefer, JC Coyne and R S Lazarus. The health related functions of social support. J. Behav. Med. 1981; 4, 381-406.
P Pipatananond. 2001, Caregiver Burden Predictive Model: An Empirical Test among Caregivers for the Schizophrenic. Doctoral Dissertation, Mahidol University, Bangkok, Thailand.
B Reisberg, SH Ferris, MJ de Leon and T Crook. The global deterioration Scale for assessment of primary degenerative dementia. Am. J. Psychiat. 1982, 139, 1136-9.
N Thavicachart, K Phanthumchinda, S Chankrachang, R Praditsuwan, S Nidhinandana, V Senanarong and N Poungvarin. Efficacy study of galantamine in possible Alzheimer’s disease with or without cerebrovascular disease and vascular dementia in Thai patients: A slow-titration regimen. Int. J. Clin. Pract. 2006; 60, 533-40.
H Kim, M Chang, K Rose and S Kim. Predictors of caregiver burden in caregivers of individuals with dementia. J. Adv. Nurs. 2011; 68, 846-55.
Y Arai, K Kumamoto, M Washio, T Ueda, H Miura and K Kudo. Factors related to feelings of burden among caregivers looking after impaired elderly in Japan under the Long-Term Care insurance system. Psychiat. Clin. Neurosci. 2004; 58, 396-402.
LD Clyburn, MJ Stones, T Hadjistavropoulos and H Tuokko. Predicting caregiver burden and depression in Alzheimer’s disease. J. Gerontol. B Psychol. Sci. Soc. Sci. 2000; 55, S2-S13
M Grafstrom, L Fratiglioni and B Winblad. Caring for an elderly person: Predictors of burden in dementia care. Int. J. Geriatr. Psychiatr. 2004; 9, 373-9.
W Black and O Almeida. A systematic review of the association between the behavioral and psychological symptoms of dementia and burden of care. Int. Psychogeriatr. 2004; 16, 295-315.
RM Van der Linde, T Dening, FE Matthews and C Brayne. Grouping of behavioural and psychological symptoms of dementia. Int. J. Geriatr. Psychiatr. 2014; 29, 562-8.
A Feast, M Orrell, G Charlesworth, N Melunsky, F Poland and E Moniz-Cook. Behavioural and psychological symptoms in dementia and the challenges for family carers: Systematic review. Br. J. Psychiatr. 2016; 208, 429-34.
S Andren and S Elmstahl. The relationship between caregiver burden, caregivers’ perceived health and there, sense of coherence in caring forelders with dementia. J. Clin. Nurs. 2008; 17, 790-9.
LE Valente, A Truzzi, WF Souza, GS Alves, CE Alves, FK Sudo, ME Lanna, DM Moreira, E Engelhardt and J Laks. Health self-perception by dementia family caregivers: Sociodemographic and clinical factors. Arq. Neuropsiquiatr. 2011; 69, 739-44.
MS Heinz. 2010, Dementia Caregiving Characteristics, Elder Impairment, and Caregiver Strain and Burden. Graduate Theses and Dissertations, Iowa State University, Ames, Iowa.
M Beyebach and MH Vega. 200 Tareas en Terapia Breve. Herder, Barcelona, 2010.
NL Chappell and RC Reid. Burden and well-being among caregivers: Examining the distinction. Gerontologist 2002; 42, 772-80.
SH Zarit and JM Zarit. Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. 2nd ed. The Guilford Press, New York, 2007.
LK George and L Gwyther. Caregiver well-being: A multidimensional examination of family caregivers of demented adults. Gerontologist 1986; 26, 253-9.
PP Vitaliano, J Russo, HM Young, L Teri and RD Maiuro. Predictors of burden in spouse caregivers of individuals with Alzheimer’s disease. Psychol. Aging 1991; 6, 392-402.
GR Shurgot and BG Knight. Influence of neuroticism, ethnicity, familism and social support on perceived burden in dementia caregivers: Pilot test of the transactional stress and social support model. J. Gerontol. B Psychol. Sci. Soc. Sci. 2005; 60, P331-P334.
How to Cite
Copyright (c) 2018 Walailak Journal of Science and Technology (WJST)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.