Background: The desire to institutionalize is an important predictor of future institutionalization. Few studies have examined potentially modifiable caregiver characteristics which might be the focus of future interventional strategies. Methods: A total of 102 patient/caregiver dyads with Alzheimer’s disease (n = 84) or mild cognitive impairment were recruited through a memory clinic. Cross-sectional analyses of a range of patients, caregivers, and context of care-related characteristics were conducted. Results: Caregiver desire to institutionalize was significantly associated with a number of potentially modifiable variables including caregiver coping style, self-efficacy, depression, burden, and the presence of an unmet service need. In a multivariate analysis, caregiver burden, depression, and nonspousal status were the only significant independent predictors of caregiver desire to institutionalize in a model which correctly classified 80.4% of caregivers. Conclusions: Interventions which seek to reduce caregiver desire to institutionalize should adopt a multifactorial approach to reduce symptoms of burden and depression in caregivers.
Aguero-Torres H., von Strauss E., Viitanen M., Winblad B., Fratiglioni L.Institutionalization in the elderly: the role of chronic diseases and dementia. Cross-sectional and longitudinal data from a population-based study. J Clin Epidemiol. 2001;54(8):795-801.
2.
Luppa M., Luck T., Brahler E., Konig HH, Riedel-Heller SGPrediction of institutionalisation in dementia. A systematic review . Dement Geriatr Cogn Disord. 2008;26(1):65-78.
3.
Aneshensel CS , Pearlin LI, Levy-Storms L., Schuler RHThe transition from home to nursing home mortality among people with dementia. J Gerontol B Psychol Sci Soc Sci . 2000;55(3): S152-S162.
4.
O’Shea E., O’Reilly S.The economic and social cost of dementia in Ireland. Int J Geriatr Psychiatry. 2000;15(3):208-218.
5.
Pruchno RA, Michaels JE, Potashnik SLPredictors of institutionalization among Alzheimer disease victims with caregiving spouses. J Gerontol. 1990;45(6):S259-S266.
6.
Spruytte N., Van Audenhove C., Lammertyn F.Predictors of institutionalization of cognitively-impaired elderly cared for by their relatives. Int J Geriatr Psychiatry. 2001;16(12):1119-1128.
7.
Hebert R., Dubois MF, Wolfson C., Chambers L., Cohen C.Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging. J Gerontol A Biol Sci Med Sci. 2001;56(11):M693-M699.
8.
Morycz RKCaregiving strain and the desire to institutionalize family members with Alzheimer’s disease. Possible predictors and model development. Res Aging . 1985;7(3):329-361.
9.
Bandura A.Self Efficacy: The Exercise of Control. New York : Freedman Press; 1997.
10.
Clark NM, Dodge JAExploring self-efficacy as a predictor of disease management. Health Educ Behav. 1999;26(1):72-89.
11.
King DK, Glasgow RE, Toobert DJ, et al. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care.2010;33(4):751-753.
12.
Gallagher D. , NiMhaolain A., Crosby L., et al. Self-Efficacy, Ways of Coping and Burden in Caregivers of Patients With Alzheimer’s Disease and Mild Cognitive Impairment. Santiago de Compostela: International Psychogeriatric Association;2010.
13.
Spitznagel MB, Tremont G., Davis JD, Foster SMPsychosocial predictors of dementia caregiver desire to institutionalize: caregiver, care recipient, and family relationship factors. J Geriatr Psychiatry Neurol. 2006 ;19(1):16-20.
14.
Wells Y., Over R.Institutional placement of a dementing spouse: the influence of appraisal, coping strategies and social support. Aust J Psychol. 1998;50(2):100-105.
15.
Gaugler JE, Kane RL, Kane RA, Clay T., Newcomer R.Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change. Gerontologist . 2003;43(2):219-229.
16.
Gaugler JE, Kane RL, Kane RA, Newcomer R.Unmet care needs and key outcomes in dementia. J Am Geriatr Soc. 2005;53(12): 2098-2105.
17.
APA.Diagnostic and Statistical Manual of Mental Disorders-RevisedIV ed. Washington DC: American Psychiatric Press; 1994.
18.
McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan EMClinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939-944.
19.
Winblad B., Palmer K., Kivipelto M., et al. Mild cognitive impairment- beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240-246.
20.
Gallagher D. , Mhaolain AN, Coen R., et al. Detecting prodromal Alzheimer’s disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors. Int J Geriatr Psychiatry.2010 ;25(12):1280-1287.
21.
Folstein MF , Folstein SE, McHugh PR‘‘Mini-mental state’’. A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12(3):189-198.
22.
Eysenck S.A revised version of the psychoticism scale. Person individ Diff. 1985;6(1):21-29.
23.
Lubben J., Blozik E., Gillmann G., et al. Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist. 2006;46(4):503-513.
24.
Cummings JL , Mega M., Gray K., Rosenberg-Thompson S., Carusi DA, Gornbein J.The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308-2314.
25.
Gelinas I., Gauthier L., McIntyre M., Gauthier S.Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther. 1999;53(5):471-481.
26.
Wimo A., Winblad B.Resource utilization in dementia: RUD Lite. Brain Aging. 2003;3:48-59.
27.
Hodgson C., Higginson I., Jeffreys P.Carers’ Checklist: An Outcome Measure for People With Dementia and Their Carers. London: The Mental Health Foundation; 1998.
28.
Zarit SH, Reever KE, Bach-Peterson J.Relatives of the impaired elderly: correlates of feelings of burden . Gerontologist. 1980;20(6):649-655.
29.
Andresen EM , Malmgren JA, Carter WB, Patrick DLScreening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med . 1994;10(2):77-84.
30.
Carver CSYou want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100.
31.
Cooper C., Katona C., Livingston G.Validity and reliability of the brief COPE in carers of people with dementia: the LASER-AD Study. J Nerv Ment Dis. 2008;196(11):838-843.
32.
Fortinsky RH , Kercher K., Burant CJMeasurement and correlates of family caregiver self-efficacy for managing dementia. Aging Ment Health. 2002;6(2):153-160.
33.
Scott WK, Edwards KB, Davis DR, Cornman CB, Macera CARisk of institutionalization among community long-term care clients with dementia . Gerontologist. 1997;37(1):46-51.
34.
Cuijpers P.Depressive disorders in caregivers of dementia patients: a systematic review. Aging Ment Health. 2005;9(4): 325-330.
35.
Epstein-Lubow G., Davis JD, Miller IW, Tremont G.Persisting burden predicts depressive symptoms in dementia caregivers. J Geriatr Psychiatry Neurol. 2008;21(3):198-203.
36.
Stommel M., Given CW, Given B.Depression as an overriding variable explaining caregiver burdens . J Aging Health. 1990;2(1):81-102.
37.
Gallagher D. , NiMhaolain A., Crosby L., et al. Self-efficacy for managing dementia may protect against burden and depression in Alzheimer’s caregivers . Aging Ment Health. 2011 (IN PRESS).
38.
Gallagher D. , NiMhaolain A., Crosby L., et al. Dependence and caregiver burden in Alzheimer’s disease and mild cognitive impairment . Am J Alzheimers Dis Other Demen. 2011 (IN PRESS).
39.
Cooper C., Katona C., Orrell M., Livingston G.Coping strategies, anxiety and depression in caregivers of people with Alzheimer’s disease. Int J Geriatr Psychiatry. 2008;23(9): 929-936.
