Finding fault: Criticism as a care management strategy and its impact on outcomes for dementia caregivers

Abstract

Background Despite a large literature on the stress process, little attention has focused on how caregivers for persons living with dementia (PLWDs) provide care and how this may impact care outcomes. Criticism is a management strategy caregivers may use to respond to behavioral symptoms. We consider whether criticism is associated with caregivers' mental health and service utilization. Methods Data are drawn from the Advancing Caregiver Training intervention study including 256 informal caregivers living with a PLWD. In multiple linear regressions controlling for caregivers' demographics and PLWDs' clinical factors, we consider criticism (criticism subscale of the Dementia Management Strategies Scale) as a predictor of caregiver burden, depressive symptoms, desire to institutionalize the PLWD, level of frustration with care, and the number of home‐based, social, and health services utilized. Results On average, 15% of the sample sometimes reported using criticism as a management strategy to manage the challenges of care. Greater use of criticism was associated with significantly more caregiver burden (β = 0.26, P < 0.001) and frustration with caregiving (β = 0.66, P < 0.001), but not depressive symptoms or a desire to institutionalize the PLWD. Criticism was also associated with significantly greater utilization of home‐based (β = 0.14, P < 0.05) and social services (β = 0.15, P < 0.05), but not health care services. Conclusion Criticism appears to be used by more burdened and frustrated caregivers. The association of criticism with social and home‐based services potentially reflects a need for greater support among this group of caregivers. Behavioral interventions that can help caregivers manage behavioral symptoms with positive, empirically validated strategies may be helpful.

Harsh communication: characteristics of caregivers and persons with dementia

“…In a study of 256 informal caregivers living with an individual with dementia, Leggett and colleagues found that 15% used harsh communications as a management strategy. Furthermore, greater use of harsh communications was associated with significantly more caregiver burden (β=.26, p<.001) and frustration with caregiving (β=.66, p<.001), but not depressive symptoms or a desire to institutionalize the person living with dementia (Leggett, Kales, & Gitlin, 2018). In addition, the use of these forms of communication by caregivers was associated with significantly greater utilization of home services (i.e.…”

“…adult day care, support groups, cleaning; β=.15, p<.05), but not health care services (i.e. use of hospital, rehabilitation facilities, physician visit, etc) (Leggett et al, 2018). Unfortunately, little research has examined the relationship between the use of negative or harsh communications and characteristics of persons with dementia and their caregivers.…”

An empowerment program for family caregivers of people with dementia

“…Dementia is a major health concern faced by older adults (Kim & Kim, ). When diagnosed with dementia, family caregivers experience depression (Choi, Budhathoki, & Gitlin, ), stress (Leggett, Kales, & Gitlin, ), burdens (Jo & Kim, ), grief (Lee, ), as well as severe psychological pain and various life‐related challenges (Vliet, Vugt, Bakker, Koopmans, & Verhey, ). Thus, there is a need for more proactive interventions that support family caregivers of individuals with early stage dementia (Sung, Kim, & Lee, ).…”

“…The increased prevalence of PWD has resulted in a need for coping and preparedness in families, and this has social implications that extend beyond personal and family concerns (National Academies of Sciences, Engineering, and Medicine, 2016). Research on family caregivers of PWD is steadily increasing, and caregivers have been shown to experience stress, depression, anxiety, and decreased self-efficacy and well-being (Choi et al, 2019;Leggett et al, 2018;Park & Park, 2015). Further, several studies have examined the maladaptive consequences between family member conflicts and economic burdens (Miranda-Castillo, Woods, & Orrell, 2013).…”

“…These findings emphasize the need for supportive interventions that help families appropriately care for PWD. Support programs for caregivers who take care of PWD have a positive effect on well-being and care outcomes and improvements in stress reduction and coping skills (Leggett et al, 2018). They also help families to more effectively manage the problems that they face during the course of dementia (Gitlin, Cigliana, Cigliana, & Pappa, 2017).…”