RESUMO
BACKGROUND: This study was carried out to determine why women caring for men report more burden than other caregivers, and to further examine the role of care-recipient problem behaviors as determinants of burden. METHOD: A sample of 557 primary caregivers of community-dwelling individuals referred to a memory clinic was used. All care-recipients had a diagnosis of Alzheimer's disease (NINCDS-ADRDA). Data on care-recipient function, caregiver attributes, external supports and caregiver burden were obtained on the first visit. Hierarchical regression models were used to determine the contribution of gender, after controlling for care-recipient status, caregiver attributes, and external supports. RESULTS: This model explained 46% of the variability in caregiver "role burden", with care-recipient problem behaviors and dependence in instrumental activities of daily living. The caregiver/care-recipient gender interaction explained an additional 4% of the variance (p = 0.001); women caring for men scored 5.61 higher on the burden scale than other caregivers. Specific problem behaviors (e.g., anger) were more problematic for women caregivers than men. CONCLUSION: These results indicate that the experience of men and women caregivers may be different despite seemingly identical circumstances, and highlight the need for interventions geared to the specific needs of women caregivers.
Assuntos
Doença de Alzheimer/psicologia , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Transtornos Mentais/etiologia , Idoso , Feminino , Humanos , Masculino , Fatores SexuaisRESUMO
The treatment of incompetent older people presents physicians and family members with complex medical, ethical, moral, and legal problems. This article explores the use of advance health care directives in the decision-making process, the qualities of the "ideal" directive, practical and legal issues relating to directives, and the role of the family physician in their implementation.
Assuntos
Diretivas Antecipadas , Idoso , Tomada de Decisões , Canadá , Eutanásia Passiva , Família , Medicina de Família e Comunidade , Humanos , Disseminação de Informação , Serviços de Informação , Jurisprudência , Competência Mental , Assistência ao Paciente , Participação do Paciente , Papel do Médico , Médicos , Padrões de Referência , Consentimento do Representante Legal , Recusa do Paciente ao Tratamento , Suspensão de TratamentoRESUMO
BACKGROUND: Alzheimer's disease (AD) is associated with dependence in activities of daily living (ADL). In addition to the cognitive impairment resulting from AD, the presence of psychotic symptoms may further increase this dependence. The objective of this study was to quantify the additional contribution of psychotic symptoms to dependence in ADL. METHOD: We analyzed data from 558 individuals with AD referred to a memory clinic. Information on ADL, psychotic symptoms, depression symptoms, and cognition was collected with standardized instruments. RESULTS: The frequency of psychotic symptoms was correlated with dependence in ADL (r = -.44, p < .001). The independent contribution of psychotic symptoms to ADL (basic and instrumental) after consideration for cognitive impairment and depression symptoms was assessed with hierarchical regression models. Twenty-five percent of basic ADL variance was explained by cognition; psychotic symptoms accounted for an additional 7% of the variance (b = -0.12, p < .001). Cognitive impairment explained 31% of instrumental ADL variance; psychotic symptoms accounted for an additional 6% (b = -0.21, p < .001). DISCUSSION: Psychotic symptoms are associated with dependence in ADL after controlling for cognitive impairment and depression symptoms. Future research should investigate possible causal linkages between psychotic symptoms and dependence in ADL. This may have implications regarding interventions to maintain independent living in people with AD.