The Dementia Caregiver—A Primary Care Approach

Geriatric Research, Education, and Clinical Center and Extended Care and Research Services, VA Healthcare System, Miami, FL 33125, USA.
Southern medical journal (Impact Factor: 0.93). 12/2008; 101(12):1246-51. DOI: 10.1097/SMJ.0b013e318187cccc
Source: PubMed


Caring for loved ones with dementia is challenging and stressful for family members who have to provide the home care. The responsibility takes a huge physical, emotional, and financial toll on the caregivers, which is known as caregiver burden. The survival and quality of life of the dementia patient have been shown to be related to the well-being of the caregiver. An overwhelmed caregiver can result in premature institutionalization and increased health-care utilization, by both the patients and the caregivers. The physician should periodically assess caregivers for the level of perceived burden, presence of depression and anxiety, social support, behavioral problems in the care recipient, and coping strategies and help the patient and caregiver with advance care planning. Strategies that meld support, education, and practical counseling about common caregiving stresses and community resources seem to mitigate caregiver burden and depression.

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    • "Successful treatment of agitation using non-pharmacological approaches is associated with improved quality of life for patients (Cohen-Mansfield and Jensen, 2008; Howland, 2008; Kverno et al., 2008; Zec and Burkett, 2008) and reduced carer burden (Dang et al., 2008) and antipsychotic drug use is associated with adverse events, reduced well-being and increased mortality (Schneider et al., 2006; Salzman et al., 2008; Ballard et al., 2009). Thus, one interpretation of our findings suggest that by lowering the patient–staff ratio and by providing additional training, i.e. increased funding and appreciation of nursing home staff, improved care and well-being of residents with dementia can be achieved. "

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    ABSTRACT: Understanding the underlying mechanisms and risk factors leading to agitation is crucial to reduce the severity of agitation and increase quality of life. International comparative studies offer special advantages in elucidating environmental risk factors by providing a wider diversity of environmental exposures such as nursing home structures, health care systems and genetic diversity. Baseline data for three different intervention studies in Austria (n = 38), England (n = 302) and Norway (n = 163) were combined posthoc. Patients were grouped according to their dementia severity using the global deterioration scale (GDS), functional assessment staging (FAST) and clinical dementia rating (CDR) scales. For the measurement of agitation, the Cohen-Mansfield Agitation Inventory (CMAI) was used. Data analysis was performed using one-way ANOVA, multivariate and linear regression analysis. CMAI scores were available for 503 subjects with dementia. There were significant differences between the nursing home residents in the three countries regarding age, gender and dementia severity (all p values < 0.001). In the multivariate analyses, the level of agitation differed with higher mean scores in the Austrian (mean (SD) score 51.9(21.8)) compared to UK (43.3(16.1)) and Norwegian (41.6(13.2)) nursing homes (p = 0.002). Similarly, the use of psychotropic drugs differed significantly, with a higher proportion of neuroleptics in UK (48%, p < 0.001) and Austrian (52.6%; p = 0.001) compared to Norwegian (19%) nursing homes. We found differences in agitation and antipsychotic drug use which are likely related to structural and cultural differences in nursing homes in three European countries. These findings suggest that structural changes can improve quality of care and quality of life for nursing home residents.
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    ABSTRACT: Health professionals have varying levels of knowledge about, and interest in, providing dementia services. This article compares patient experiences in dealing with dementia with the perceived role of health care providers in providing dementia care. Qualitative data from interviews of patients with dementia and their carers was compared with quantitative data from health professional surveys, where health professionals described their knowledge of dementia and their attitudes toward, and roles in, management. Patients often notice dementia symptoms before their general practitioner and seek diagnosis and support. Not all GPs wish to provide dementia services and many are unaware of the benefits of early diagnosis and dementia care guidelines. Dementia forums attract older health professionals, suggesting younger members are less engaged in dementia care. Older patients tend to consult with older GPs, but older GPs are less aware of dementia diagnosis and management guidelines. Patients turn to their GP for help with dementia but may find most benefit from the assistance and advice of people who have already negotiated the pathways to care. Health professionals who fail to investigate patients presenting with dementia symptoms can delay diagnosis, denying patients and carers early intervention that could improve quality of life for both patient and carer.
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