6 Delirium and Caregivers Flashcards
Art11 Caregiver Burden (CB)
Caregiver Burden (CB) = ‘a multidimensional response to psychical, psychological, emotional, social and financial stressors associated with the caregiving experience’.
Art11
Caregiving
“Activities and experiences involved in providing help and assistance to relatives who are unable to provide for themselves”. The definition of caregiving doesn’t include the psychological distress.
Alzheimer’s Disease caregivers=
80% of Alzheimer’s Disease caregivers experience higher levels of stress than normal. 50% of them suffers from depression. CB is associated with=
Caregiver Burden (CB) is associated with poor outcomes for caregivers, like depression, illness and decreased quality of life. Caregiver burden also has a negative impact on patients, who also experience a poorer quality of life and earlier nursing home placement (NHP) (verpleeghuisplaatsing).
Art11
The characteristics of higher chance of NHP
- Female gender
- Not living in the same household
- No religion
- Greater than 16 hours away from caregiving
- Children initiate earlier NHP than spouse caregivers
When the severity of dementia increases, the amount of time spent on caregiving also increases.
Art11
Caregiver characteristics
In general, close kinship ties are associated with increased CB.
Age=
Gender influences the experience of CB.
o Female: show worsened health problems, worsened relationships with other family member.
o Male: lack of positive outlook, need for social support
Overall: females report more health problems and depressive symptoms in relation to CB.
Coping strategies=
Coping strategies influence the perception of CB.
o Females: more emotion-focussed coping strategies.
o Male: more problem-focussed coping strategies
The most effective coping style is problem-focussed coping or a combination of the two
Self-efficacy=
Stronger self-efficacy is associated with a decreased CB and a higher quality of life.
Culture=
Culture shapes the perceptions of familial responsibilities
o Caucasian caregivers: report greater depression and more stress of caregiving than African Americans, this could indicate that they express their CB differently.
o Asian cultures: show a great sense of familial responsibility and are also reluctant to discuss family problems, which leads to less social support for caregivers. Therefore, they show higher amounts of depression and CB.
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Patient characteristics
Dementia patients=
Behavioral disturbances are one of the largest factors contributing to CB. Behaviors that create physical stress on caregivers are predictors of NHP. Caregivers of mobile dementing patients report higher amounts of CB.
- The patient’s cognitive abilities don’t have a strong influence on CB.
Alzheimer’s disease=
Caregivers of AD patients report more disruptions in their personal life compared to FTD caregivers.
Frontotemporal Dementia=
Caregivers of FTD patients report less satisfaction with themselves as caregivers.
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Family Conflict
Arise because of caregiving situations itself, or because unresolved family issues continue in caregiving.
- When some gets assistance from family members in caregiving and encouragement or appreciation of family members, they report less CB.
- Family conflict is an important predictor of caregiver’s depression.
- When the family functioning prior to the caregiving was good: individuals experience less CB than when the functioning of the family was poor prior to the caregiving.
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Assessment of CB
- Zarit Burden Interview (ZBI)= Measures subjective burden.
- Caregiver Strain Index (CSI)= Quickly identifies those who are at risk for developing CB.
- Screening for Caregiver Burden (SCB)
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Interventions
Educating caregivers on environmental changes (for instance: at the home of the patient) that can improve care management.
- Helping caregivers assimilate a more clinical belief about their role as a caregiver.
- Family intervention programs, consisting pf psychoeducation, stress management and coping skills.
- Multiple component interventions are more effective than single component interventions, and are also related to delayed NHP.
- You can’t assume that the same intervention will work among all various caregivers
Lec
Caregivers and patients
Who are caregivers? - Nurses, Doctors, Family members (parents, children) Who are the patients? - Somatic disorder - Neurological/psy
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Dementia
- Cognitive symptoms
o Memory loss, executive dysfunction, Agnosia, etc. - Psychiatric and behavioral problems
o Apathy, Hallucinations, Depression, Aggression, Restlessness - Duration: few years - over a decade
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Caregivers - Hypotheses
- Wear-and-tear hypothesis
a. Over time caregivers functioning steadily declines as a result of prolonged stress - Adaption hypothesis
a. Caregivers adapt to the demands of caregiving over time and their physical and
mental health stabilizes or improves - Trait hypothesis
a. In spite of dementia progressing, caregivers function well because of individual
characteristics (e.g. personal resources, social support, coping skills)
Lec
Caregiver burden
Caregiver burden: a multidimensional response to physical, psychological, emotional, social and
financial stressors associated with the caregiving experience
- Caregivers burden can not be strictly tied to the severity of dementia or length of time
someone provided care
