Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!
The study Purpose
Related to the second research question, it is important to note that the caregiver reaction was more highly associated with caregiving impact than the actual frequency of behavior. The level of upset reaction to the care recipients' total, memory, disruption, and depression related behavior had even higher significant correlations with five of the six indicators for caregiving impact. These five indicators included: increased restrictions on caregivers activities, decline in physical and emotional health, increased economic costs, provoking nature of the care recipient, and the total impact score. Thus, the caregiver perception of the severity of the person's behavior is more important than the actual 'objective' frequency of impairment. This finding may have great implications for intervention programs. Caregivers must learn to understand depression and disruption in terms of symptoms of memory loss and gain knowledge about how to manage the behavior. Interventions designed for caregivers might include educational programs with content on knowledge about AD, understanding problem behaviors in terms of memory loss, and content on anger and frustration management (Gallagher-Thompson & DeVries 1994). Interventions designed for persons with AD would increase pleasurable and meaningful activities, and support previous skills and positive behaviors (Burgener et al. 1993). Thus, positive patient outcomes could be experienced with a decreased prevalence of depressive and disruptive symptoms. After caregiver education about management of the problem behaviors, possibly the reaction scores may decrease even through actual frequency of behaviors is expected to remain the same due to the progressive nature of the disease. Our findings support other research reports that some problem behaviors provoke greater caregiver reaction and impact than others (Pallett 1990, Miller et al. 1991). Numerous studies carried out over the past decade have addressed the impact on the health and well-being of the caregiver. In a review of the dementia caregiving literature, recipient behavior problems overwhelmingly predicted caregiver depression (Schulz et al. 1995, Schulz & Quittner 1998). Findings of this study suggest an explanation for these findings, as separate types of problem behavior was found to impact different aspects of the caregivers life (Davis et al. 1997). Perhaps dementia caregivers experience higher levels of strain because they have to more often cope with problem behaviors such as wandering, screaming, or destroying property.
Related to the demographic characteristic of gender, female caregivers experienced greater reaction to two problem behaviors (depression and disruptive behavior) when compared with male caregivers even though both genders reported similar frequencies of these behaviors. Examples of the depression behaviors included: appearing sad or depressed, crying, making comments about hopelessness, loneliness, death, being a burden, a failure, or threatening suicide. The other type of behavior that was most upsetting was disruptive behavior. Examples of disruption related behaviors include: arguing, talking loudly or rapidly, waking the caregiver up, verbal aggression, embarrassing behavior, dangerous behavior to self or others, and destroying property. These types of behaviors were associated with the most upset reaction in female caregivers. It is not surprising that these types of behaviors may be the most threatening. The female caregiver probably is concerned about her own safety or that of others and her ability to control the disruptive behavior. Thus caregiver knowledge and understanding about anger and frustration management may be important interventions for women.
Certain personal characteristics of the caregiver have been thought to contribute to the impact of family caregiving. Our findings are supportive of other research that suggests female caregivers experience a greater impact from caregiving. Females also had higher impact from caregiving in four of the six indicators when compared with men (restricted activity, decline in health, provoking nature of the care recipient, and total impact of care). The finding that women report a higher level of impact from caregiving than male caregivers do (Miller & Cafasso 1992) was interpreted in many ways, including the possibility that women assist in more personal aspects of caregiving such as toileting and bathing. Another interpretation was that females have more stress from multiple social roles than male caregivers do. Our findings add still another interpretation for increased impact: women may react more to depressed and disruptive care recipient behaviors, thus experiencing more negative consequences. Women's reaction to depressed and disruptive behaviors is an additional variable to be added to the study of gender differences that determine caregiving outcomes. Future interventions are also needed that promote a positive attitude toward use of respite and other community resources to decrease personal and social restrictions experienced by women caregivers (Robinson & Yates 1994).
Reflection Exercise #10