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Objectives: This study investigates the relationship between attitudes of care staff and social well-being and challenging behavior of residents in long-term dementia care. Methods: The study was based on a cross-sectional design using questionnaires. Care staff members (N = 291) of 15 long-term care facilities in the Netherlands completed the Approaches to Dementia Questionnaire. Additionally, the primary professional caregiver of each participating resident (N = 239) completed an observational questionnaire regarding that resident's behavior, which contained the scale for Social Wellbeing Of Nursing home residents and the Cohen-Mansfield Agitation Inventory. Data were analyzed using multilevel analyses, taking characteristics of residents into account. Results: Attitudes of care staff towards residents with dementia differed between facilities. Further, residents experienced more social well-being and displayed less challenging behavior in facilities where care staff had more hopeful attitudes. Conclusion: This study demonstrates a relationship between attitudes of care staff and resident well-being. The results indicate that it is important to address attitudes towards residents with dementia in the education of (future) care staff. Care processes may also be improved by focusing on the attitudes of care staff. In this way, the well-being of residents with dementia can potentially be improved as well.
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Actitud del Personal de Salud , Demencia/terapia , Casas de Salud , Adulto , Estudios Transversales , Demencia/psicología , Ajuste Emocional , Humanos , Masculino , Casas de Salud/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: People with dementia and their informal carers often do not receive appropriate professional support or it is not received at the right time. OBJECTIVES: Description and comparison of common pathways to formal community dementia care in eight European countries as a part of the transnational Actifcare project. MATERIALS AND METHODS: The German team was responsible for creating an individual case scenario as a starting point. The research teams in Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, and the United Kingdom were then asked to describe a common pathway to formal dementia care by writing their own vignette using the provided individual case scenario. RESULTS: A transnational qualitative content analysis was used to identify the following categories as being the most important: involved professionals, dementia-specific and team-based approaches, proactive roles, and financial aspects. General practitioners (GPs) are described as being the most important profession supporting the access to formal care in all the involved countries. In some countries other professionals take over responsibility for the access procedure. Dementia-specific approaches are rarely part of standard care; team-based approaches have differing significances in each of the countries. Informal carers are mainly proactive in seeking formal care. The Nordic countries demonstrate how financial support enhances access to the professional system. CONCLUSION: Enhanced cooperation between GPs and other professions might optimize access to formal dementia care. Team-based approaches focusing on dementia care should be developed further. Informal carers should be supported and relieved in their role. Financial barriers remain which should be further investigated and reduced.
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Cuidadores/psicología , Demencia/terapia , Accesibilidad a los Servicios de Salud , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Calidad de VidaRESUMEN
BACKGROUND: Cognitive reserve (CR) has been associated with better cognitive function and lower risk of depression in older people, yet it remains unclear whether CR moderates the association between mood and cognition. This study aimed to investigate whether a comprehensive indicator of CR, including education, occupation and engagement in cognitive and social activities, acts as a moderator of this association. METHODS: This was a cross-sectional study utilising baseline data from the Cognitive Function and Ageing Study II (CFAS II), a large population-based cohort of people aged 65+ in England. Complete data on the measures of CR, mood and cognition were available for 6565 dementia-free individuals. Linear regression models were used to investigate the potential modifying effect of CR on the association between cognition and mood with adjustment for age, sex and missing data. RESULTS: Levels of CR did moderate the negative association between mood and cognition; the difference in cognition between those with and without a clinical level mood disorder was significantly smaller in the middle (-2.28; 95% confidence interval (CI) -3.65 to -0.90) and higher (-1.30; 95% CI -2.46 to -0.15) CR groups compared with the lower CR group (-4.01; 95% CI -5.53 to -2.49). The individual components of CR did not significantly moderate the negative association between mood and cognition. CONCLUSION: These results demonstrate that CR, indexed by a composite score based on multiple indicators, can moderate the negative association between lowered mood and cognition, emphasising the importance of continuing to build CR across the lifespan in order to maintain cognitive health.
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Afecto , Envejecimiento/psicología , Ansiedad/epidemiología , Reserva Cognitiva , Depresión/epidemiología , Trastornos del Humor/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Escolaridad , Inglaterra/epidemiología , Femenino , Humanos , Modelos Lineales , Masculino , Ocupaciones , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: Malnutrition is prevalent in acute hospitals and malnourished patients have an increased risk of morbidity and mortality. Studies of malnutrition and quality of life (QoL) are generally limited by both the nutritional and QoL assessment methods employed. The present study aimed to evaluate the relationship between malnutrition, as assessed using a range of nutritional assessment methods, and QoL, as measured by EuroQol-5D-3L and Short-Form (SF)-36 questionnaires. METHODS: The study comprised a prospective cross-sectional study of malnutrition and QoL in 149 inpatients aged 65-99 years. Exclusion criteria were: terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Spearman's rank correlation coefficient was used to test the association between QoL indices and nutritional markers. QoL scores for those scoring above and below thresholds for nutritional risk were compared. Regression models were created to identify nutritional indices contributing to the variability of QoL. RESULTS: There were significant associations between QoL scores and the Mini Nutritional Assessment (MNA)-SF. Clear differences were evident between malnourished and well-nourished patients (on the MNA-SF), those with low and normal arm muscle circumference and those with good and poor physical function. Regression analysis showed that nutritional scores and functional status made independent contributions to the prediction of QoL. The effect on food intake, mobility and psychological stress/acute disease also had a significant influence. CONCLUSIONS: Malnutrition risk is linked to a poorer QoL in older people on admission to hospital. Functional status and eating-related factors are major influencers on QoL in this group. These findings reinforce the role of nutrition as a priority with respect to achieving improvements in QoL.
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Actividades Cotidianas , Evaluación Geriátrica , Hospitalización , Evaluación Nutricional , Estado Nutricional , Calidad de Vida , Anciano , Anciano de 80 o más Años , Estudios Transversales , Ingestión de Alimentos , Femenino , Humanos , Masculino , Músculos , Aptitud Física , Estudios Prospectivos , Calidad de Vida/psicología , Medición de Riesgo , Estrés Psicológico , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The aim of the REMiniscence groups for people with dementia and their family CAREgivers (REMCARE) study was to assess the effectiveness and cost-effectiveness of joint reminiscence groups for people with dementia and their family caregivers as compared with usual care. DESIGN: A multicentre, pragmatic randomised controlled trial with two parallel arms - an intervention group and a usual-care control group - was carried out. A restricted dynamic method of randomisation was used with an overall allocation ratio of 1 : 1, restricted to ensure intervention groups of a viable size. Assessments, blind to treatment allocation, were carried out at baseline, 3 months and 10 months (primary end point). SETTING: Most participants were recruited through NHS Memory Clinics and Community Mental Health Teams for older people. Assessments were usually carried out in the person's home, and treatment groups were held in a variety of community settings. PARTICIPANTS: A total of 488 individuals (mean age 77.5 years) with mild to moderate dementia (meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria), who were initially living in the community, and who had a relative or other caregiver maintaining regular contact, who could act as an informant and was willing and able to participate in the intervention, were recruited to the study. Most carers were spouses (71%). A total of 350 dyads completed the study. INTERVENTIONS: The intervention consisted of joint reminiscence groups held weekly for 12 consecutive weeks, followed by monthly maintenance sessions for a further 7 months. The sessions followed a treatment manual, and were led by two trained facilitators in each centre, supported by a number of volunteers. Up to 12 dyads were invited to attend each group. MAIN OUTCOME MEASURES: The primary outcome measures were self-reported quality of life for the person with dementia and psychological distress for the carer [General Health Questionnaire-28 item version (GHQ-28)]. Secondary outcome measures included autobiographical memory and activities of daily living for the person with dementia, carer stress for the carer and mood, relationship quality and service use and costs for both parties. RESULTS: The intention-to-treat analysis identified no differences in outcome between the intervention and control conditions on primary or secondary outcomes [self-reported quality of life in Alzheimer's disease: mean difference 0.07, standard error (SE) 0.65; F = 0.48; p = 0.53]. Carers of people with dementia allocated to the reminiscence intervention reported a significant increase in anxiety on a subscale of the GHQ-28 at the 10-month end point (mean difference 1.25, SE 0.5; F = 8.28; p = 0.04). Compliance analyses suggested some benefits for people with dementia who attended more reminiscence sessions; however, carers attending more groups showed increased caregiving stress. Use of health- and social-care services was modest, with no significant difference in service use between conditions. Owing to negligible difference in quality-adjusted life-year gains (derived from European Quality of Life-5 Dimensions) between the conditions the planned full economic analysis was curtailed. CONCLUSIONS: This trial does not provide support for the effectiveness or cost-effectiveness of joint reminiscence groups for people with dementia and their carers. Although there may be some beneficial effects for people with dementia who attend sessions as planned, this must be viewed in the context of raised anxiety and stress in their carers. The reasons for these discrepant outcomes need to be explored further, and may necessitate reappraisal of the movement towards joint interventions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42430123. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 16, No. 48. See the HTA programme website for further project information.
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Cuidadores/psicología , Demencia/enfermería , Recuerdo Mental , Evaluación de Resultado en la Atención de Salud , Psicoterapia de Grupo/economía , Psicoterapia de Grupo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución por Sexo , Encuestas y Cuestionarios , Reino Unido , Adulto JovenRESUMEN
OBJECTIVES: Subjective memory complaint (SMC) is central to the diagnosis of mild cognitive impairment (MCI). People with MCI are at a higher risk of progressing to dementia, and research on SMC is contradictory in terms of the accuracy of SMC and its predictive role for future dementia. One possible reason for these contradictory findings is that the level of awareness of memory function may vary among people with MCI. This review examines whether the level of awareness of memory functioning varies amongst people classified as having MCI and whether there is support for the suggestion that the level of awareness in MCI predicts future progression to dementia. METHOD: Sixteen studies were identified which evaluate the awareness level in people classified as having MCI in either a clinical or research setting. In addition to the outcome of each study, the conceptualization of awareness, 'object' of awareness and methodology were also considered. RESULTS: There is evidence to show that the level of awareness in MCI does vary, and this may have implications for future progression to dementia. CONCLUSIONS: Given the increased risk of progression to dementia for those identified as having MCI, the role of awareness should be explored further with due consideration given to the conceptualization of awareness and the methodology employed. The finding of variability in awareness has implications for the use of SMC in the diagnostic criteria for MCI.
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Trastornos del Conocimiento/psicología , Trastornos de la Memoria/psicología , Anciano , Concienciación , Progresión de la Enfermedad , Humanos , Percepción/fisiologíaRESUMEN
BACKGROUND: There is doubt about the value of training in dementia care in U.K. nursing homes. We decided to estimate the association between nursing staff's attitudes to dementia and dementia care and their recognition of cognitive impairment in residents and other indicators of care practice in nonspecialist nursing homes derived from a probability sample of 445 residents in South-East England, and to relate this to previous training. METHODS: Prospective survey. The most senior nurse on duty was interviewed about each resident sampled, about their own training and experience, their attitude to restriction of egress and covert medication use, and asked to complete the Attitudes to Dementia Questionnaire (ADQ) and the dementia Care Styles Questionnaire (CSQ). Nurses were also asked about care practices in relation to restriction of egress and covert medication use in the home. Residents were interviewed using the Mini-mental State Examination (MMSE). RESULTS: One hundred and fifty-eight nurses were interviewed. Increased person-centered attitudes seem to be associated with better recognition of cognitive impairment independent of training and experience. The espousal of restrictive practices was also associated with better recognition, but only when analysis included nurses reporting on only one impaired resident. CONCLUSIONS: More person-centered attitudes are associated with better recognition of cognitive impairment, despite perverse U.K. regulatory incentives; the need for training and support in developing person-centered dementia care for staff in "non-Elderly Mentally Infirm" ("non-EMI") care homes is supported by these results.
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Actitud del Personal de Salud , Demencia/enfermería , Personal de Enfermería/psicología , Anciano , Competencia Clínica , Trastornos del Conocimiento/enfermería , Trastornos del Conocimiento/psicología , Curriculum , Demencia/psicología , Inglaterra , Enfermería Geriátrica/educación , Hogares para Ancianos , Humanos , Escala del Estado Mental/estadística & datos numéricos , Relaciones Enfermero-Paciente , Diagnóstico de Enfermería , Casas de Salud , Supervisión de Enfermería , Estudios Prospectivos , PsicometríaRESUMEN
Quality of life (QoL) is becoming an increasingly used outcome measure in both clinical practice and research. There are now more than 1000 scales available to measure QoL, and it is important that they are assessed for reliability and validity. This study aims to assess the reliability and validity of the Quality of Life-Alzheimer's Disease (QoL-AD) scale, which is dementia specific and brief and uses the patient's own responses. Two separate samples of people with dementia (sample 1, n = 60; sample 2, n = 201) were assessed. Five focus groups were conducted involving both people with dementia and their caregivers; the focus groups showed that people with dementia had higher hopes for their QoL than their caregivers did for them. Questionnaires about the scale were completed by 71 health care professionals working with people with dementia. The scale was found to have good content validity with no additional items required and all items necessary. It also correlated well with the Dementia Quality of Life scale (0.69) and with the Euroqol-5D scale (0.54), indicating good criterion concurrent validity. Construct validity was also good with the principal components analysis showing all 13 items of the QoL-AD loaded on component 1. Interrater reliability was excellent with all Cohen's kappa values >0.70. Internal consistency was excellent with a Cronbach's alpha coefficient of 0.82. Some people with severe dementia and a Mini-Mental State Examination score as low as 3 were able to satisfactorily complete the QoL-AD. The QoL-AD has very good psychometric properties and can be completed with people with a wide range of severity of dementia.
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Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/psicología , Encuestas Epidemiológicas , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , MasculinoRESUMEN
BACKGROUND: Memory problems are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address everyday memory difficulties. OBJECTIVES: The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory functioning for people in the early stages of Alzheimer's disease or vascular dementia. The two types of intervention were considered separately. SEARCH STRATEGY: The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 9 April 2003. SELECTION CRITERIA: RCTs comparing cognitive rehabilitation or cognitive training interventions with comparison conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. DATA COLLECTION AND ANALYSIS: Six studies reporting cognitive training interventions were included. Statistical analyses were conducted to provide an indication of intervention effect sizes. Data from ordinal scales was treated as continuous, and a fixed effects model was applied in calculating weighted mean differences and 95% confidence intervals. No studies were found that reported a fully individualised cognitive rehabilitation approach. MAIN RESULTS: None of the six studies reporting cognitive training interventions demonstrated any statistically significant effects in any domain, although there were indications of some modest, non-significant effects in various domains of cognitive functioning. REVIEWER'S CONCLUSIONS: The present findings do not provide strong support for the use of cognitive training interventions for people with early-stage AD or vascular dementia, although these findings must be viewed with caution due to the limited number of RCTs available and to the methodological limitations identified, and further well-designed trials would help to provide more definitive evidence. Due to a complete absence of RCTs evaluating an individualised cognitive rehabilitation approach, It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, and further research is required in this area.
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Enfermedad de Alzheimer/rehabilitación , Terapia Cognitivo-Conductual/métodos , Demencia Vascular/rehabilitación , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The person-centred approach to dementia care emerges from a new emphasis on the experience of the person with dementia. The person is seen as attempting to manage and cope with their difficulties, through a variety of coping mechanisms. Some are able to seek to maximize their cognitive capacities, and there are a number of strategies now available to assist in this process. However, the emotional aspects merit increased attention, with more awareness needed of the range of powerful emotions that may be present, and of the possibility of therapeutic interventions to alleviate symptoms of anxiety and depression. Many of the difficult behaviours seen in dementia may be understood more fully with an appreciation of their emotional underpinning, in feelings of anger, fear, insecurity and hopelessness. The interaction between caregiver strain and challenging behaviour also merits further exploration. The person-centred approach has many implications for practice, as well as for research. The perspective of the person with dementia, and outcomes reflecting that perspective, must be represented in research studies in dementia care. Caregivers, whether family members or paid workers, require additional support in order to recognize the person's needs and to meet them in ways which enable the person's identity and full human value to be upheld.
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Síntomas Afectivos/diagnóstico , Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/diagnóstico , Síntomas Afectivos/psicología , Síntomas Afectivos/terapia , Anciano , Enfermedad de Alzheimer/psicología , Enfermedad de Alzheimer/terapia , Cuidadores/psicología , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Evaluación Geriátrica , Humanos , Evaluación de Necesidades , Grupo de Atención al PacienteRESUMEN
BACKGROUND: Intervention for challenging behaviour of residents living in care homes is a neglected area of research. Pharmacological methods of management are widespread, although support for their efficacy is, on the whole, poor. AIMS: There is little research on non-pharmacological methods of management and the present study aimed to add to the small literature in this area, by examining the meaning of behaviour for a given resident, within a functional analytic experimental framework. METHODS: The study involved a systematic manipulation of specific trigger situations to evaluate their influence on challenging behaviour, using a single case experimental design. RESULTS: Five residents with agitated and aggressive behaviour were successfully managed. The difficulties in engaging staff in the use of non-pharmacological, rather than pharmacological, methods and the scope for future randomised trials using psychological and environmental interventions to manage challenging behaviour, are discussed.
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Terapia Conductista , Demencia/terapia , Supersticiones/psicología , Anciano , Agresión , Demencia/psicología , Femenino , Humanos , Masculino , Casas de Salud , Agitación Psicomotora , Resultado del TratamientoRESUMEN
The person-centred approach to dementia care emerges from a new emphasis on the experience of the person with dementia. The person is seen as attempting to manage and cope with their difficulties, through a variety of coping mechanisms. Some are able to seek to maximize their cognitive capacities, and there are a number of strategies now available to assist in this process. However, the emotional aspects merit increased attention, with more awareness needed of the range of powerful emotions that may be present, and of the possibility of therapeutic interventions to alleviate symptoms of anxiety and depression. Many of the difficult behaviours seen in dementia may be understood more fully with an appreciation of their emotional underpinning, in feelings of anger, fear, insecurity and hopelessness. The interaction between caregiver strain and challenging behaviour also merits further exploration. The person-centred approach has many implications for practice, as well as for research. The perspective of the person with dementia, and outcomes reflecting that perspective, must be represented in research studies in dementia care. Caregivers, whether family members or paid workers, require additional support in order to recognize the person's needs and to meet them in ways which enable the person's identity and full human value to be upheld.
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BACKGROUND: Reminiscence Therapy (RT) has been defined as vocal or silent recall of events in a person's life, either alone, or with another person or group of people. It typically involves group meetings, at least once a week, in which participants are encouraged to talk about past events, often assisted by aids such as photos, music, objects and videos of the past. There is, often, little consistent application of psychological therapies in dementia services. A number of these 'therapies' were greeted with enthusiasm by health care practitioners in under stimulating care environments. They were expected to work miracles and their 'failure' to do this has led to their widespread disuse. A systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base. OBJECTIVES: RT involves groups of elderly people talking of past events, assisted by aids such as videos, pictures and archives, as a means of communicating and reflecting upon their life experiences. The objective of the review is to assess the effects of RT for dementia. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, PSYCHLIT, EMBASE, OMNI, BIDS, Dissertation Abstracts International, SIGLE and reference lists of relevant articles up to 1998, and we contacted specialists in the field. We also searched relevant Internet sites and we hand searched Aging and Mental Health, the Gerontologist, Journal of Gerontology, Current Opinion in Psychiatry, Current Research in Britain: Social Sciences, British Psychological Society conference proceedings and Reminiscence database. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised trials of RT for dementia in elderly people. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Two trials are included in the review, but only one trial with 15 participants had extractable data. The results were statistically non-significant for both cognition and behaviour. REVIEWER'S CONCLUSIONS: No firm conclusions could be reached regarding the effectiveness of RT for dementia. The review highlighted the urgent need for more systematic research in the area.
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Demencia/terapia , Recuerdo Mental , Psicoterapia de Grupo/métodos , Humanos , Orientación , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapia de la RealidadRESUMEN
BACKGROUND: Reminiscence Therapy (RT) has been defined as vocal or silent recall of events in a person's life, either alone, or with another person or group of people. It typically involves group meetings, at least once a week. in which participants are encouraged to talk about past events, often assisted by aids such as photos, music, objects and videos of the past. There is, often, little consistent application of psychological therapies in dementia services. A number of these 'therapies' were greeted with enthusiasm by health care practitioners in understimulating care environments. They were expected to work miracles and their 'failure' to do this has led to their widespread disuse. A systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base. OBJECTIVES: RT involves groups of elderly people talking of past events, assisted by aids such as videos, pictures and archives, as a means of communicating and reflecting upon their life experiences. The objective of the review is to assess the effects of RT for dementia. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, PSYCHLIT, EMBASE, OMNI, BIDS, Dissertation Abstracts International, SIGLE and reference lists of relevant articles up to 1998, and we contacted specialists in the field. We also searched relevant internet sites and we handsearched Aging and Mental Health, the Gerontologist, Journal of Gerontology, Current Opinion in Psychiatry, Current Research in Britain: Social Sciences, British Psychological Society conference proceedings and Reminiscence database. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised trials of RT for dementia in elderly people. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Two trials are included in the review, but only one trial with 15 participants had extractable data. The results were statistically non-significant for both cognition and behaviour. REVIEWER'S CONCLUSIONS: No firm conclusions could be reached regarding the effectiveness of RT for dementia. The review highlighted the urgent need for more systematic research in the area.
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Demencia/terapia , Memoria , Psicoterapia de Grupo/métodos , Humanos , Orientación , Terapia de la RealidadRESUMEN
Recent research shows that the demands of the caregiving role are experienced differently by men and women. Both the subjective and the objective strain and burden appear to be greater in female carers of dementia sufferers, and factors that influence this include differences in role expectations and coping strategies. These findings have implications for the provision of services for dementia sufferers and their carers.
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Adaptación Psicológica , Cuidadores/psicología , Demencia/psicología , Identidad de Género , Anciano , Demencia/terapia , Femenino , Humanos , Masculino , Inventario de Personalidad , Apoyo Social , Trastornos Somatomorfos/psicología , Carga de Trabajo/psicologíaRESUMEN
Twenty-five women who were the primary carers for a parent with dementia rated for expressed emotion (EE) and then divided into two groups: 11 with low-EE ratings and 14 with high-EE ratings. Although there were no differences between these groups in the levels of their parents' cognitive impairment, when such impairment was taken into account, high-EE subjects were found to report higher levels of strain and distress. More efficient coping strategies were reported by subjects who made fewer critical comments and more positive remarks. High-EE subjects more frequently had no living siblings, and were more likely to have had a respite break from caring. EE status was not associated with continuing care in the community at a nine-month follow-up.