Academic journal article Research and Theory for Nursing Practice

A Model of Consequences of Dementia Caregivers' Stress Process: Influence on Behavioral Symptoms of Dementia and Caregivers' Behavior-Related Reactions

Academic journal article Research and Theory for Nursing Practice

A Model of Consequences of Dementia Caregivers' Stress Process: Influence on Behavioral Symptoms of Dementia and Caregivers' Behavior-Related Reactions

Article excerpt

The purpose of this article is to extend the Schultz and Martire Caregiver Stress- Health Model by explaining consequences of the stress process beyond those related to health in dementia caregivers, including consequences for caregivers and the dyadic unit, and to highlight the dynamic that exists between caregivers' stress, behavioral symptoms of dementia, and behavior-related reactions of caregivers. The relevant literature is reviewed, establishing the pervasive effects of caregivers' stress within a care dyad. Primary informal caregivers play a predominant role in managing environmental stimuli and providing for needs, in particular adjusting their own approaches and demeanor to enhance the care environment. Thus, behavioral symptoms of dementia and the behavior-related reactions of caregivers are conceptualized as a dyadic consequence of the caregivers' stress process. This model presents an extended view of the consequences of caregivers' stress and provides a more holistic, dyadic approach to the issues these vulnerable dyads face. Behavioral symptoms of dementia and behavior-related reactions are seen as amenable to caregiver- or dyad-directed interventions that target stress reduction. This conceptualization may provide support for research, clinical, or policy initiatives that include caregiver-directed or dyadic interventions for these important behavior-related outcomes.

Keywords : dementia; caregiving; stress process; dyad; behavioral symptoms

Approximately 13.2 million Americans are expected to have dementia by the year 2050 (Hebert, Scherr, Bienias, Bennett, & Evans, 2003a). The large majority of those with dementia remain in the community (Czaja, Eisdorfer, & Schulz, 2000) with the assistance of informal caregivers (CG; Riggs, 2001). Indeed, CG within these community-based dyads may be characterized as a sizeable piece of the health care system for those with dementia, absorbing much of the direct costs, including formal monetary costs and informal, uncompensated care (Coon & Edgerly, 1999).

Many dementia CG report positive aspects of providing such care (Cohen, Colantonio, & Vernich, 2002) and with assistance, dementia care dyads have been able to develop quality of life within the care relationship (Quayhagen & Quayhagen, 1996). One study showed that the majority (81%) of dementia CG experienced both strains and gains (Sanders, 2005). Thus, even when dementia caregiving is deemed rewarding or satisfying, coexisting burdens are often described (Andren & Elmstahl, 2005; Gold et al., 1995; Lawton, Moss, Kleban, Glicksman, & Rovine, 1991; Narayan, Lewis, Tornatore, Hepburn, & Corcoran-Perry, 2001). While burdens have been linked to depression in spouses and adult child CG, satisfaction was associated with positive affect only in spouse CG; adult child CG did not have positive affect with satisfaction (Lawton et al., 1991). In a more recent meta-analysis, uplifts of caregiving were more closely associated with CG's feelings of well-being, while stressors are more closely associated with depression (Pinquart & Sörensen, 2004).

Regardless of the positive aspects, informal caregiving for persons with dementia (PWD) is generally characterized as uniquely challenging among caregiving situations, with greater stress and more problems associated with duties (Bertrand, Fredman, & Saczynski, 2006; Ory, Hoffman, Yee, Tennstedt, & Schulz, 1999). The stress of caregiving in dementia has been highlighted in numerous studies, often described as an on-going stress process (Pearlin, Mullan, Semple, & Skaff, 1990; Schulz & Martire, 2004). While care factors have historically been implicated as the source of CG stress, it is now recognized that CG's own characteristics play a large role in the caregiving experience (Donaldson & Burns, 1999) as well.

Community-based dementia care dyads are susceptible to negative outcomes when CG experience heightened stress. …

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