Vugt ME, Stevens F, Aalten P, et al. Do caregiver management strategies influence patient behaviour in dementia

Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands.
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 01/2004; 19(1):85-92. DOI: 10.1002/gps.1044
Source: PubMed


Little is known about the effectiveness of caregiver management strategies on the functioning of the demented patient. However, identification of specific caregiver strategies may provide useful information on the management and manifestation of behavioural problems in dementia.
Ninety-nine patients with dementia and their informal caregivers were followed up for one year. Interviews were used to assess differences in caregiver management strategies. Behavioural disturbances in the patient were measured with the Neuropsychiatric Inventory (NPI). Repeated measures analysis were carried out to investigate the relationship between caregiver management strategies and patient behaviour.
Three caregiver management strategies were identified, based on whether caregivers accepted, or not, the caregiving situation and dementia related problems. Caregivers characterized by non-acceptance were typified as 'Non-adapters'; caregivers characterized by acceptance were further subdivided into two groups typified as 'Nurturers' and 'Supporters'. Caregiver characteristics such as sex, education and personality were important determinants of management strategies. MANOVA showed that non-adapters reported significantly more hyperactivity symptoms in patients and felt less competent than did supporters.
Caregiver management strategies would appear to be associated with behavioural problems in dementia, and are important in predicting patient behaviour and caregiver burden. Intervention programmes should aim at teaching caregivers adequate management strategies.

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Available from: Marjolein E de Vugt
    • "If caregivers are 70 years or older, the risk of being stressed is much higher compared to younger caregivers (Rinaldi et al., 2005). Furthermore, high education leads to lower levels of subjective burden in caregivers (Sink, Covinsky, Barnes, Newcomer, & Yaffe, 2006); education determines the strategies the caregiver chooses to manage the patient's functioning (De Vugt et al., 2004). "
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    ABSTRACT: Objectives: Caring for a patient with dementia is a real challenge and can have considerable psychological consequences in the long run. Many caregivers, mostly relatives, feel highly burdened. To develop effective caregiver support to prevent caregivers from getting overburdened, insight is needed into the determinants of burden. The objective of this study is to explore which patient and caregiver characteristics determine the different kinds of caregiver burden over time, both in the short and in the long run. Method: The study was longitudinal. Data on patients and caregivers, general burden and emotional distress were collected at three times: at baseline, at the end of treatment and at nine months. The study was conducted in a psychiatric skilled nursing home with a unit for integrative reactivation and rehabilitation (IRR) and at different sites of home-/day care, assisted living arrangements and nursing home wards (usual care). Results: General burden is shown to be determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, health-related quality of life. Emotional distress is determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, high affiliation and patient gender. Conclusion: In preventing or treating caregiver burden, professional interventions need to aim specifically at diminishing the neuropsychiatric symptoms in dementia patients and improving the sense of competence in caregivers.
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    • "life of both the caregiver and care-recipient, as dealing with the burden might be reflected through cultural and social norms (De Vugt et al., 2005). It seems that the impact of caregiving on the caregivers depends on how they maintain a balance between caregiving activities and personal tasks. "
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    ABSTRACT: The aim of the study was to conduct in-depth analyses of the lived experiences of the caregivers of dementia and their maladaptive thinking patterns and how their physical health was influenced and compromised. The main method used was interpretative phenomenological analysis and involved in-depth analysis of eight participants screened through homogenous purposive sampling. After taking written consent from the participants, semi-structured interviews were conducted to gather the data that were transcribed later on to carry out free textual analysis. The themes were generated from the transcripts through the funneling approach in order to arrive at the themes that were common, frequent, and reflected the experiences shared by the participants. The verification was done through peer review and rich thick description. The most significant themes regarding maladaptive cognitions were catastrophizing, overgeneralizing, and blaming, whereas fatigue and sleep disturbances were the most significant themes regarding physical health. The emergent themes point towards a need to devise indigenous therapeutic intervention for the caregivers of dementia in the Pakistani sociocultural context as the literature available on caregiving is quite scanty in our culture.
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    • "improved behaviour and mood) also influence results in the carer (e.g. improved feelings of competence and burden) and vice versa (de Vugt et al., 2004; van der Lee et al., 2014). The combined support programme of MCSP consists of a varied activity programme for people with dementia, including recreational and creative activities, cognitively stimulating activities and psychomotor therapy. "
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