Predictors of Change and Continuity in Home Care for Dementia Patients

Abstract

Objective. To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design. A prospective longitudinal study with a follow‐up period of 10 months. Setting. Dementia patients living in the community selected by Dutch general practitioners. Subjects. Pairs of demented patients and their primary caregivers (N=138). Main outcome measures. Sense of competence: a 27‐item scale (α=0.79) based on issues derived from the family crisis model and the Burden Interview. Continuity in home care is determined by the number of patient's admissions to a nursing or retirement home. Results. Regression analysis revealed that a change in the caregiver's sense of competence was independently predicted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was associated with a longer duration of dementia and the patient's more agitated behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient. A positive influence on the change in the sense of competence was found when these females received a professional intervention consisting of support for the caregiver. Reporting to be a Catholic or a Protestant compared with not being religiously involved positively influenced the change in sense of competence. Logistic regression analysis identified that continuity in home care was predicted by characteristics of the demented patient and the professional social network of the patient. Predictors of continuation of home care were: lower severity of dementia, patient's higher ADL impairment, the intervention and involvement of regular home help. Institutionalization was more likely when the patient's behaviour was more apathetic and a district nurse was involved in the care. Conclusions. Caregiver characteristics influenced the change in sense of competence but did not influence the risk for institutionalization. Findings suggest that health professionals should pay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demented patient.

Predictors of outcomes from a ward for demented elderly: gender differences

“…Previous reports [11][12][13][14][15] regarding predictors of nursing home placement focused on the characteristics of both the patients and caregivers. Fisher and Lieberman 16 showed that families scoring high on emotional closeness, high on negative family feelings and low on family efficiency institutionalized their sick elderly at a significantly higher rate than other families, especially at low levels of patient severity.…”

The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners

“…Furthermore, it is known that caregivers continuing home care feel as burdened as their colleagues deciding to place their care needing relative (Lieberman and Kramer, 1991;Gold et al, 1995;Whitlatch et al, 2001). Beside, caregivers' feelings of control are changing during the period of home care but do not influence the final risk of definitive institutionalization (Vernooij-Dassen et al, 1997).…”

Sense of coherence, burden, and affective symptoms in family carers of people with dementia

“…functional health status, cognition, and activities of daily living), with less studies investigating the influence of personality factors, despite evidence showing that personality can play an important role in the development of both anxiety and depression (Matsudaira and Kitamura, 2006;Klein et al, 2011). Caregiver burden has been consistently linked to patient behavioral and psychological symptoms (Van Den Wijngaart et al, 2007;Machnicki et al, 2009), cognition, ability in activities of daily living (Covinsky et al, 2003;Papastavrou et al, 2007), and rates of institutionalization (Vernooij-Dassen et al, 1997;Gaugler et al, 2008). Caregiver characteristics, most likely to be associated with high levels of burden, are low levels of social support, decreasing physical health, and low socioeconomic status (Proctor et al, 2002;Mahoney et al, 2005).…”