Do Trajectories of At-Home Dementia Caregiving Account for Burden After Nursing Home Placement? A Growth Curve Analysis

Abstract

Transitioning to the nursing home setting is a complex process for family caregivers of older adults with dementia. While nursing home placement (NHP) can alleviate certain caregiving responsibilities, new stressors can also emerge. In the present study, the researchers examined how care-related factors can change leading up to NHP and how these factors influence caregiver outcomes following NHP. A sample of 634 family dementia caregivers (N = 634) were surveyed at three six-month intervals prior to NHP and once during the 12 month period following institutionalization. Growth curve modeling revealed dynamic changes in certain factors leading up to NHP (e.g., caregivers' perceived health), while other factors remained stable (e.g., caregiver burden). Several factors emerged as significant predictors of caregiver burden following NHP, including pre-placement burden and adult day service utilization. For geriatric social workers, these findings may be useful in assessing family caregivers, and in the development and utilization of appropriate interventions. Keywords caregiver burden; nursing home placement; dementia; trajectoriesThe long-term nature of many dementia-related illnesses has led to the characterization of family caregiving as a 'career,' with transitions that occur as diseases progress, needs and capabilities change, and shifts occur in care settings (Aneshensel, et al., 1995;Gaugler, Anderson, Zarit, & Pearlin, 2004;Schulz et al., 2004). Nursing home placement (NHP) represents one key shift in the caregiving career as family members relinquish certain responsibilities, such as bathing and feeding, continue on with other duties, such as providing Correspondence to: Katherina A. Nikzad-Terhune, kanikz2@uky.edu; Keith A. Anderson, anderson.1630@osu.edu. NIH Public Access Author ManuscriptSoc Work Health Care. Author manuscript; available in PMC 2011 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript social support, and adopt new activities and roles, such as interacting with staff and advocating for the care recipient (Aneshensel, et al., 1995;Gaugler et al., 2007a;Schulz et al., 2004). These changes, however, do not necessarily result in the alleviation of stress and burden for caregivers. Former burdens may be reduced (e.g., physical care duties), while new sources of stress may arise (e.g., conflict with staff; Aneshensel et al., 1995). The present study utilizes longitudinal data in order to examine how pre-placement factors influence the burden that dementia caregivers experience following NHP. Understanding this key transition and how pre-placement factors impact post-placement caregiver adaptation is critical for social work professionals assisting families prior to, during, and following NHP. Transitions in CaregivingTransitions in caregiving have been conceptualized within the literature as complex and multidimensional processes. Meleis and colleagues (2000), in their conceptual model of health transitions, have identified five properties of the heal...

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