Coping in family supporters of elderly people with dementia.

Research into supporters of elderly people with dementia has a brief but significant history. Initially, research sought to establish the nature and extent of the distress that supporters endured in the fulfilment of their caring role. More recently, researchers have turned their attention towards the identification of coping techniques used by supporters in the community. The Dundee Study of Supporters and Dementia is concerned with factors associated with the maintenance and care of the demented elderly in the community, and with the impact of dementia on family supporters. A total of 228 family supporters of community-resident elderly (50 per cent of elders with dementia, 50 per cent without) were interviewed. Part of the interview focused on self-reported coping, and identified coping strategies using open-ended questions and a revised, 31-items Ways of Coping checklist. Findings indicated that the majority of supporters of community-resident elderly relatives reported coping well. Supporters predominantly used emotion-focused coping strategies as their main way of coping. However, those supporters who reported using a problem-focused strategy were found to score better on measures of coping than those supporters using an emotion-focused strategy. The supporters' main coping strategy was not associated with characteristics of the elder-supporter dyad. Factors derived from the Ways of Coping checklist produced a pattern of associations with characteristics of the elder-supporter dyad, but the same factors were largely not associated with other measures of coping. The implications of the findings are discussed with regard to coping research, and for interventions to improve the well-being of supporters of an elderly relative with dementia in the community.

Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters.

OBJECTIVE: To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. DESIGN: Comparison study of age and sex matched demented and non-demented elderly people and their supporters. SETTING: 25 primary health care teams in Dundee. SUBJECTS: 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person. MAIN OUTCOME MEASURES: Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care). RESULTS: Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person. CONCLUSION: Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.

Expressed emotion in caregivers of the dementing elderly.

This paper presents findings on the association between 'expressed emotion' (EE) and a number of factors previously investigated in relationship to caregivers of the dementing elderly. Frequency of critical comments (expressed emotion) was correlated with a number of supporter and dependent characteristics, variables within the relationship between caregivers and their dementing relatives, and help from professionals. The analysis revealed significant correlations between EE and sex of caregiver, caregivers' psychological well-being, contact with friends and the quality of the relationship between the caregiver and dementing relative. The dementing relatives' level of impairment, age and sex were not significantly correlated with EE, nor was help from the services. Also, those most critical of their dementing relatives were not more likely to express a preference for institutional care.

Dementia and mental handicap: attitudes, emotional distress and caregiving.

Against the current climate of hospital closure programmes and community care, attitudes to caregiving were examined in three groups of carers, namely mothers caring for a mentally handicapped child, mothers caring for a mentally handicapped adult and daughters caring for a parent with dementia. An 'attitude questionnaire' was developed by the author and administered, postally, to the three groups. Daughters were found to be more likely than the mothers to see their caring role in a negative way and were more inclined to favour institutional care. Possible reasons for this are discussed. The relationship between attitudes and emotional distress (as measured by the GHQ-30) were also examined for the sample as a whole. Negative and pro-institutional attitudes towards the caregiving situation were associated with elevated levels of emotional distress. Implications at both a local and a national level for all those involved with carers are discussed in the light of these findings.

Dementia and mental handicap: emotional distress in carers.

A postal survey was conducted to examine levels of emotional distress in three groups of carers, namely, daughters caring for a dementing parent, mothers caring for a mentally handicapped child and mothers caring for a mentally handicapped adult. Daughters caring for a dementing parent reported significantly higher levels of distress than both groups of mothers. Emotional distress for all groups was higher than found in the general population, although this difference was only significant for the group of daughters and the mothers with a mentally handicapped child. Findings are discussed in relation to service provision and level of disability.

Does the National Adult Reading Test hold in dementia?

Thirty elderly subjects with a clinical diagnosis of dementia were assessed using a neuropsychological test battery and were retested one year later. No significant deterioration in performance on the National Adult Reading Test (NART) was observed. A significant deterioration was noted in performance on the Mill Hill Vocabulary Scale synonym section (MHVS). Expected significant decrements in Clifton Assessment Procedures for the Elderly (CAPE) Information/Orientation and Physical disability scales were observed. The data provide supportive evidence for the view that performance on the NART remains relatively unaffected by the dementing process.

Impact of psychogeriatric day hospital care on the patient's family.

The supporters of 129 patients referred for psychogeriatric day hospital care were interviewed and followed-up after three and six months. The majority of their dependents suffered from dementia. Thirty-one per cent were still attending six months later, while 37% had been admitted to institutional care. The most positive effects of day hospital were associated with continued patient attendance, the number of distinct advantages foreseen by the supporter, and the lack of any negative expectations concerning their dependents' adjustment to day care. Positive benefits were also closely associated with reductions in the number of problems faced by the supporter.

Emotional distress amongst the supporters of the elderly mentally infirm.

Three samples of supporters of elderly infirm dependents who were either attending or about to attend day hospitals were given the 30-item General Health Questionnaire (GHQ) to complete. Prevalence levels of disturbance varied from 57% to 73%; female supporters (the majority) reported higher levels of distress. High scores were related to a diagnosable psychiatric condition, and were significantly associated with a combination of poor self-health ratings in the supporters, more frequent behaviour problems in the dependents and a more negative view of the premorbid relationship between supporter and dependent. Reported amount of contact time and levels of formal and informal outside support were not related to GHQ scores.