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Spouse caregivers of the persons with Alzheimer's disease often suffer depression which influences their quality of life: Kuopio ALSOVA study
Poster Presentations P2 P2-381
DESCRIPTIVE ANALYSIS OF DEMENTIA CAREGIVERS IN THE PROVINCE OF ALICANTE SPAIN: MAIN CHARACTERISTICS OF THE PRINCIPAL CAREGIVER.
Elena Toribio-Diaz1, Jose Molto-Jorda2, Vicente Medrano Martinez3, Isabel Beltran Blasco4, Irene Perez-Cerda5, 1Hospital del Henares, Coslada (Madrid), Spain; 2Hospital Virgen de los Lirios, Alcoi (Alacant), Spain; 3Hospital Virgen de la Salud, Elda (Alacant), Spain; 4Clinica Benidorm, Benidorm, Spain; 5Hospital Sant Vicent, Sant Vicent del Raspeig, Spain. Background: In general relatives, as informal caregivers, represent the first step in looking after patients with dementia. Aims: To analyze the characteristics of patients with dementia in the province of Alicante, the characteristics and roles of their relatives as informal caregivers and the characteristics of their family nucleus. Methods: Multicentric and prospective study carried out in 4 hospitals in Alicante (June 2009/January 2010). Prospective inclusion of dementia patients and their caregivers. Variables analyzed: 1. Patient: age/sex/civil condition, studies, subtype of dementia/GDS.2. Family nucleus (FN): people who live with the patient (age/sex/kinship), place of residence (patient/relative home, rotation between relatives). 3. Principal Caregiver (PC): age/sex/civil condition, studies, kinship, reasons for care (moral obligation, personal satisfaction, gratefulness, social pressure, economic difficulty for institutionalization). 129 patients were included. Middle ages 80.7 6 5.9; 69.2 % women; 53.1% married. 56.2 % basic reading/writing skills. Alzheimer’sdisease 78.4%. GDS 4-5, 71.6%. FN: 74.8% lives in their own house, 91.4%accompanied: wife/husband 53.1 %; middle ages 75.2 + 7.8; 54.8% women. Characteristics FN: woman (71.3%), middle ages 59.4 6 13.3, son/daughter (63.8%), married (88.2%), primary studies (50%), worker (36.4%), housewife (27.1%). Reasons for caring:75% moral obligation, 73.3% personal satisfaction, 67.5% gratefulness, 25.4%social pressure, 15.3% economic difficulty for institutionalization. Conclusions: The principal caregiver is mainly a woman (daughter), married and working, with primary studies. The main reason for care is personal satisfaction or gratefulness. The knowledge of the caregiving network of the patient with dementia is fundamental to plan the social help in the area of the dementias.
P2-382
RELATIONSHIP BETWEEN EXPECTANCY/CREDIBILITY AND EARLY RESPONSE TO TELEPHONE-BASED DEMENTIA CAREGIVER INTERVENTIONS
Geoffrey Tremont1, Jennifer Davis1, Kelley O’Connor2, Christine Grover2, Duane Bishop2, Brian Ott3, George Papandonatos3, Richard Fortinsky4, 1 Alpert Medical School of Brown University, Providence, Rhode Island, United States; 2Rhode Island Hospital, Providence, Rhode Island, United States; 3Brown University, Providence, Rhode Island, United States; 4 University of Connecticut Health Center, Farmington, Connecticut, United States. Background: Mechanisms that account for the effectiveness of psychosocial interventions for dementia caregivers are poorly understood. Credibility of an intervention and an individual’s expectancy that the intervention will improve their distress are potentially important predictors of treatment response. This study explored whether specific dementia caregiver characteristics were related to credibility and expectancy. We also examined whether these variables were related to caregivers’ early response to two different telephone-based, psychosocial interventions. Methods: Participants were 133 dementia caregivers randomly assigned to receive 6 months of either an active, problem-solving intervention (Family Intervention: Telephone Tracking - Caregiver; FITT n ¼ 68) or nondirective Telephone Support (TS; n ¼ 65). They completed the Zarit Burden Interview, Center for Epidemiologic Studies Depression scale at baseline and after 2 months
S435
of the intervention (7 telephone calls). Caregivers completed the Credibility and Expectancy Questionnaire (CEQ) after 2 months of the intervention. Results: Age, education, gender, relationship type (spouse vs. other), or length of caregiving were not associated with any CEQ scores. For the FITT, higher levels of depression at the start of treatment were associated with lower expectancy scores, although this relationship was not seen in the TS group. Higher levels of self-efficacy for managing dementia symptoms and better caregiver-care recipient relationship at start of treatment were associated with greater expectancy in the TS condition, but not in FITT. At the 2-month assessment point, caregivers assigned to FITT showed significantly improved burden and depression scores compared to caregivers assigned to TS (p < .01 and p ¼ .05, respectively). There were no significant group differences in caregivers’ report of intervention credibility or expectation for improvement, with both groups reporting high levels. Change in depression and burden was also unrelated to CEQ scores in either intervention group. Conclusions: Even though the two interventions in the study had differential effects on caregiver burden and depression, we did not find any differences in caregivers’ beliefs about credibility of the intervention or expectancy for improvement. Caregiver distress, relationship satisfaction, and confidence in managing behaviors prior to initiating treatment are important predictors of whether an individual believes a treatment will be effective.
P2-384
SPOUSE CAREGIVERS OF THE PERSONS WITH ALZHEIMER’S DISEASE OFTEN SUFFER DEPRESSION WHICH INFLUENCES THEIR QUALITY OF LIFE: KUOPIO ALSOVA STUDY
Tarja V€alim€aki1, Katri Vehvil€ainen-Julkunen1, Anna-Maija Pietil€a1, Anne Koivisto1, 1University of Eastern Finland, Kuopio, Finland. Background: After Alzheimer’s disease (AD) has manifested the care of the patients requires adjusting from their caregivers- already at the early stage of the disease. The better the caregivers adjust to that situation the better are the possibilities to prolong homecare and maintain quality of life. Thus, we examined the factors which are related to the caregiver’s quality of life at the early phase of home care. Furthermore, we evaluated caregiver’s subjective experience of home care and find new methods clarify caregiver’s well being. Methods: This study is a part of ongoing five year follow-up ALSOVA study in Finland and includes 170 recently diagnosed AD patient-spouse caregiver pairs. Data collected included general information of the family caregivers and AD patient’s also physical health, subjective well-being, depression, and heath related quality of life (HRQoL) and recourse utilization. Data of cognitive and daily functioning were also collected. Caregivers wrote diaries in two weeks period soon after AD diagnosis. Results: The spouse caregivers’ mean age was 71.6 and the mean time of cohabitation was 44.0 years (range 0 - 61). The spouse caregivers were often depressed (37.6%, BDI>12) and 35.5% of them received no medication for depression. The severity of depressive symptoms correlated with distress, total amount of medication and low income. Female caregivers reported more depressive symptoms and distress than male caregivers. They had difficulties with sleeping. Caregivers’ HRQoL was high 0.8714. However, the main predictors for high HRQoL were female gender, low distress and lack of depressive symptoms. Caregivers used diaries as a means to reflect on their emotions and motivations to care after their spouses had been diagnosed with AD. Conclusions: Depression influenced spouse caregivers, especially females, quality of life. Despite that their HRQoL was high. Diaries as a tool to evaluate caregivers’ reflections after the AD diagnosis was interesting method to elucidate the inner feelings and to get more information of the situation they have faced with. To support homecare, health care systems should recognize the variations among caregivers by using traditional methods but also develop new ones. The attention should be directed to recognize the vulnerable group of caregivers.
DESCRIPTIVE ANALYSIS OF DEMENTIA CAREGIVERS IN THE PROVINCE OF ALICANTE SPAIN: MAIN CHARACTERISTICS OF THE PRINCIPAL CAREGIVER.
Elena Toribio-Diaz1, Jose Molto-Jorda2, Vicente Medrano Martinez3, Isabel Beltran Blasco4, Irene Perez-Cerda5, 1Hospital del Henares, Coslada (Madrid), Spain; 2Hospital Virgen de los Lirios, Alcoi (Alacant), Spain; 3Hospital Virgen de la Salud, Elda (Alacant), Spain; 4Clinica Benidorm, Benidorm, Spain; 5Hospital Sant Vicent, Sant Vicent del Raspeig, Spain. Background: In general relatives, as informal caregivers, represent the first step in looking after patients with dementia. Aims: To analyze the characteristics of patients with dementia in the province of Alicante, the characteristics and roles of their relatives as informal caregivers and the characteristics of their family nucleus. Methods: Multicentric and prospective study carried out in 4 hospitals in Alicante (June 2009/January 2010). Prospective inclusion of dementia patients and their caregivers. Variables analyzed: 1. Patient: age/sex/civil condition, studies, subtype of dementia/GDS.2. Family nucleus (FN): people who live with the patient (age/sex/kinship), place of residence (patient/relative home, rotation between relatives). 3. Principal Caregiver (PC): age/sex/civil condition, studies, kinship, reasons for care (moral obligation, personal satisfaction, gratefulness, social pressure, economic difficulty for institutionalization). 129 patients were included. Middle ages 80.7 6 5.9; 69.2 % women; 53.1% married. 56.2 % basic reading/writing skills. Alzheimer’sdisease 78.4%. GDS 4-5, 71.6%. FN: 74.8% lives in their own house, 91.4%accompanied: wife/husband 53.1 %; middle ages 75.2 + 7.8; 54.8% women. Characteristics FN: woman (71.3%), middle ages 59.4 6 13.3, son/daughter (63.8%), married (88.2%), primary studies (50%), worker (36.4%), housewife (27.1%). Reasons for caring:75% moral obligation, 73.3% personal satisfaction, 67.5% gratefulness, 25.4%social pressure, 15.3% economic difficulty for institutionalization. Conclusions: The principal caregiver is mainly a woman (daughter), married and working, with primary studies. The main reason for care is personal satisfaction or gratefulness. The knowledge of the caregiving network of the patient with dementia is fundamental to plan the social help in the area of the dementias.
P2-382
RELATIONSHIP BETWEEN EXPECTANCY/CREDIBILITY AND EARLY RESPONSE TO TELEPHONE-BASED DEMENTIA CAREGIVER INTERVENTIONS
Geoffrey Tremont1, Jennifer Davis1, Kelley O’Connor2, Christine Grover2, Duane Bishop2, Brian Ott3, George Papandonatos3, Richard Fortinsky4, 1 Alpert Medical School of Brown University, Providence, Rhode Island, United States; 2Rhode Island Hospital, Providence, Rhode Island, United States; 3Brown University, Providence, Rhode Island, United States; 4 University of Connecticut Health Center, Farmington, Connecticut, United States. Background: Mechanisms that account for the effectiveness of psychosocial interventions for dementia caregivers are poorly understood. Credibility of an intervention and an individual’s expectancy that the intervention will improve their distress are potentially important predictors of treatment response. This study explored whether specific dementia caregiver characteristics were related to credibility and expectancy. We also examined whether these variables were related to caregivers’ early response to two different telephone-based, psychosocial interventions. Methods: Participants were 133 dementia caregivers randomly assigned to receive 6 months of either an active, problem-solving intervention (Family Intervention: Telephone Tracking - Caregiver; FITT n ¼ 68) or nondirective Telephone Support (TS; n ¼ 65). They completed the Zarit Burden Interview, Center for Epidemiologic Studies Depression scale at baseline and after 2 months
S435
of the intervention (7 telephone calls). Caregivers completed the Credibility and Expectancy Questionnaire (CEQ) after 2 months of the intervention. Results: Age, education, gender, relationship type (spouse vs. other), or length of caregiving were not associated with any CEQ scores. For the FITT, higher levels of depression at the start of treatment were associated with lower expectancy scores, although this relationship was not seen in the TS group. Higher levels of self-efficacy for managing dementia symptoms and better caregiver-care recipient relationship at start of treatment were associated with greater expectancy in the TS condition, but not in FITT. At the 2-month assessment point, caregivers assigned to FITT showed significantly improved burden and depression scores compared to caregivers assigned to TS (p < .01 and p ¼ .05, respectively). There were no significant group differences in caregivers’ report of intervention credibility or expectation for improvement, with both groups reporting high levels. Change in depression and burden was also unrelated to CEQ scores in either intervention group. Conclusions: Even though the two interventions in the study had differential effects on caregiver burden and depression, we did not find any differences in caregivers’ beliefs about credibility of the intervention or expectancy for improvement. Caregiver distress, relationship satisfaction, and confidence in managing behaviors prior to initiating treatment are important predictors of whether an individual believes a treatment will be effective.
P2-384
SPOUSE CAREGIVERS OF THE PERSONS WITH ALZHEIMER’S DISEASE OFTEN SUFFER DEPRESSION WHICH INFLUENCES THEIR QUALITY OF LIFE: KUOPIO ALSOVA STUDY
Tarja V€alim€aki1, Katri Vehvil€ainen-Julkunen1, Anna-Maija Pietil€a1, Anne Koivisto1, 1University of Eastern Finland, Kuopio, Finland. Background: After Alzheimer’s disease (AD) has manifested the care of the patients requires adjusting from their caregivers- already at the early stage of the disease. The better the caregivers adjust to that situation the better are the possibilities to prolong homecare and maintain quality of life. Thus, we examined the factors which are related to the caregiver’s quality of life at the early phase of home care. Furthermore, we evaluated caregiver’s subjective experience of home care and find new methods clarify caregiver’s well being. Methods: This study is a part of ongoing five year follow-up ALSOVA study in Finland and includes 170 recently diagnosed AD patient-spouse caregiver pairs. Data collected included general information of the family caregivers and AD patient’s also physical health, subjective well-being, depression, and heath related quality of life (HRQoL) and recourse utilization. Data of cognitive and daily functioning were also collected. Caregivers wrote diaries in two weeks period soon after AD diagnosis. Results: The spouse caregivers’ mean age was 71.6 and the mean time of cohabitation was 44.0 years (range 0 - 61). The spouse caregivers were often depressed (37.6%, BDI>12) and 35.5% of them received no medication for depression. The severity of depressive symptoms correlated with distress, total amount of medication and low income. Female caregivers reported more depressive symptoms and distress than male caregivers. They had difficulties with sleeping. Caregivers’ HRQoL was high 0.8714. However, the main predictors for high HRQoL were female gender, low distress and lack of depressive symptoms. Caregivers used diaries as a means to reflect on their emotions and motivations to care after their spouses had been diagnosed with AD. Conclusions: Depression influenced spouse caregivers, especially females, quality of life. Despite that their HRQoL was high. Diaries as a tool to evaluate caregivers’ reflections after the AD diagnosis was interesting method to elucidate the inner feelings and to get more information of the situation they have faced with. To support homecare, health care systems should recognize the variations among caregivers by using traditional methods but also develop new ones. The attention should be directed to recognize the vulnerable group of caregivers.