This descriptive study examined sleep and mental health variables in 37 older wife caregivers for spouses with dementia compared to 37 age-matched controls. The relationships among selected caregiving variables (behavioral problems, caregiving hours, and years of caregiving), appraisal of burden, self-reported sleep efficiency for the past week, and mental health outcomes were examined. Lazarus and Folkman's stress and coping framework guided the study. Mental health and sleep were poorer for caregivers. Caregiving and appraisal of burden variables showed direct and indirect effects on mental health. However, caregiving and appraisal of burden variables were not significant for predicting sleep efficiency. Sleep efficiency was a good predictor of mental health in this sample of wife caregivers.

Environmental changes to, between, or within institutional settings create stress and risk for illness or death in the elderly population. Persons who are given individualized preparation and as many choices as possible in relation to a move show fewer deleterious effects than those involved in involuntary relocations. Elderly persons moving to a more dependent living arrangement show more anxiety than those moving to a more independent arrangement. Comprehensive information should be provided to the personnel of the new facility, specifically about the older person's fears and losses.

1. Studies show that a high percentage of family caregivers of persons with Alzheimer's disease either do not use support services or are unaware of their availability. 2. Family caregivers in rural areas use proportionately more services than caregivers in urban areas. 3. Nursing will be an integral part in improving the quality of care and living for persons with Alzheimer's disease.

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