This study describes family caregiver perceptions of the experience of loss and grief as it occurs prior to and following the death of a relative with dementia. A content analysis was conducted of responses to open-ended questions by a sample of 82 primary caregivers participating in a longitudinal study who had experienced the death of their relative with dementia. Six themes were identified: loss of person and relationship, loss of hope, predeath grief, expectancy of death, post-death relief, and caregiving reflections. Implications for clinical practice and research are presented.

The experience of moving a relative with Alzheimer's disease (AD) to an assisted living facility (ALF) was examined in this secondary data analysts of 20 interviews with family caregivers. Crisis theory was used as guiding framework for the analysis. Findings indicate that all elements of a crisis were evident among caregivers in the process of moving their relative to an ALF. Dangerous behaviors resulting from the relative's cognitive decline led to caregiver fear and anxiety, which served as crisis precipitants. Perceived lack of family support in conjunction with physical and psychological exhaustion were crisis mediators. These factors, along with the caregiver's failed attempts to keep their relative at home, caused the crisis process to move toward the outcome of ALF placement. A better understanding of the crises that surround placement issues will assist nurses in planning interventions for the growing number of families faced with this issue.

Objective factors have traditionally been used to study service use. Difficulty in explaining variability in service use has resulted in suggestions that thought be given to subjective factors. Difficulty in isolating subjective factors led to this study of the types of values that influence the use of community services by caregivers of persons with dementing disease. Persons who care for family members who have dementing diseases face an arduous task that has been described as requiring a "36-hour day" but report low rates of community service use. A content analysis was conducted of interview responses of 34 caregivers of a relative with dementia. Three major value concepts were identified: family obligation, reciprocity, and the need for control. Matrices were then developed to explore potential links between expressed values and patterns of use of community services. Implications for clinical practice and research are presented.

Despite the stressors of caring for a relative with Alzheimer's disease (AD), families institutionalize their loved one only as a last resort. What constitutes this last resort? Predictors of and risks for institutionalization have been widely examined by researchers for two decades. To date, values underpinning the critical incident leading to institutionalization of a relative with AD have not been explored. The purpose of this secondary analysis of 20 interviews with family caregivers who had recently institutionalized their relative with AD was to examine underlying values that precipitated the move. Mitchell's definition, in 1983, of a critical incident was used as a guiding framework. Three major themes were identified: "I couldn't forgive myself if something happened," "It was ruining my life," and "I had no choice." The ability to identify underlying values precipitating critical events may help nurses plan interventions to assist increasing numbers of families faced with institutionalizing a relative with AD as our population ages.

Alzheimer’s disease (AD) is hallmarked by progressive cognitive impairment. As memory loss worsens and functional abilities decline, family caregivers may need additional communitybased support. In later stages of the disease, families must often consider institutional placement. Home care nurses are frequently put in the difficult position of approaching family caregivers about the need for supportive services and placement in a care facility. A better understanding of phase-based interventions will help home care nurses more effectively assist family caregivers of a relative with AD manage transitions and possible facility placement.