[Caregiving relatives of people with dementia: which factors influence the transfer from home-care to nursing home?]. / Pflegende Angehörige von demenziell Erkrankten: Welche Faktoren beeinflussen den Transfer von der häuslichen in die stationäre Pflege?

Recent research on institutionalization of family members with dementia has shown caregiving-need, caregiver's burden and role conflicts as important influence factors. However, current knowledge is still superficial because most studies used highly aggregated indicators. Logistic regression was used to explore whether differentiated measures of caregiving-needs, caregiver-burden and role conflicts were risk factors for institutionalization of demented elderly people (N=373). A greater distance between households, increased need in housekeeping, a higher income, increased caregiver-burden and low self-evaluation of caregiving-quality are related to an increase in chance for institutionalization. A constant need for supervision and lack of social appreciation are associated with a smaller chance. The results illustrate the dilemma of many caregiving relatives. A future enhancement of the given regression model by including prior decline in caregiving-burden is discussed.

Berlin Inventory of Caregiver Stress-Dementia (BICS-D).

BACKGROUND AND OBJECTIVES: Dementia is becoming increasingly prevalent and family caregivers have been providing most of the care for persons with dementia. This caregiving is a mentally and physically demanding task. "The Berlin Inventory of Caregiver Stress-Dementia" (BICS-D) is a theory driven, multidimensional assessment which was developed as part of the Longitudinal Dementia Caregiver Stress Study (LEANDER). RESEARCH DESIGN AND METHODS: The inventory consists of 25 subscales with a total of 121 items. Analyses of the psychometric properties of the inventory were based on responses from 594 caregivers. RESULTS: Factor analyses confirm the multidimensionality of the inventory. The reliabilities of the subscales (Cronbach's α) are between .72 and .95. Validity and sensitivity of the inventory were also confirmed. Differing patterns of burden could be demonstrated for different relatives (partners, children, and daughters-in-law) as well as for different degrees of severity of dementia. DISCUSSION AND IMPLICATIONS: The scores derived for the instrument have support for reliability and validity, and sensitivity to change. It is suitable for the differential measurement of burden experienced by different subgroups of caregivers as well as for the evaluation of interventions. The different subscales of the battery can also be used separately, depending on the study's objectives.

Evaluation of geriatric day care units: effects on patients and caregivers.

The aim of this study was to evaluate the effects of geriatric day care on patients and caregivers. Day care patients (n = 43) were compared with an untreated matched control group (n = 40). Matching criteria were age, gender, physical and mental health status, and socioeconomic status. The mean age of both groups was 79.5 years. Data were collected at three measurement points: T1 took place during the first 10 days of service use, T2 was conducted 6 months later, and T3 took place 9 months after service use began. In addition, a short follow-up was conducted 6 months after T3. Well-being, dementia symptoms, health indicators, and activities of daily living were investigated. Individual growth curves of these patient variables were computed and analyzed with multivariate analyses of variance. The results show significant positive effects of day care on well-being and dementia symptoms. Patients in day care stabilized or improved on various measures, whereas the untreated control participants worsened. Follow-up data showed a significant decline in health in the control group in comparison with the day care users. Results concerning effects on caregivers were not that clear. Individual change parameters in subjective well-being and burden did not differ between the two groups of caregivers in the longitudinal follow-up. In a semistructured interview, however, caregivers of patients in the treatment group reported substantial positive change due to use of day care.

Personal growth and cognitive complexity in caregivers of patients with dementia.

According to several theoretical models, crises or demands can result in enhanced cognitive maturity. Two studies examined whether demands on caregivers provide an opportunity to experience increased cognitive maturity (e.g., cognitive complexity, personal growth through caregiving). In Study 1 (126 relatives of dementia patients; cross-sectional design), personal growth through caregiving was associated with two specific caregiving demands: duration of caregiving and lack of social acknowledgment. Cognitive complexity correlated with duration of caregiving and crystallized intelligence. The caregivers in the second study (N = 321) were participants in LEANDER, The Longitudinal Dementia Caregiver Stress Study. Caregivers were examined in four waves over 27 months. The results indicated an increase in personal growth over time. Using latent growth models, we found that increases in personal growth through caregiving were predicted by increases in the objective caregiving tasks. Cognitive processes (e.g., ruminative thoughts, life reflection) provide a possible explanation for an increase in cognitive maturity.