Wives, Husbands, and Daughters of Dementia Patients: Predictors of Caregivers' Mental and Physical Health
Sparks, Martha B. PhD, Rn, Farran, Carol J. DNSc, Rn, Faan, Donner, Edward PhD, Keane-Hagerty, Eleanora Ma, Scholarly Inquiry for Nursing Practice
The purpose of this study was to investigate differences in and predictors of mental and physical health among wife, husband, and daughter caregivers of dementia patients using a stress and coping framework. The sample of 151 caregivers consisted of 55 wives, 43 husbands, and 53 daughters and was recruited from multiple community-based sources. Variables addressed were caregiver age, social position, years spent in caregiving, dementia severity, burden, worry, physical health, and mental health. Analysis of variance demonstrated gender-specific, kinship group differences in burden (F = 8.09, p = .000), worry (F = 6.287, p = .002), and age (F = 55.27, p = .000). Post hoc comparisons indicated that wives reported worrying most, while husbands were oldest and reported the least burden. Health predictors differed by group, with wives' mental health being predicted by severity of dementia, age, and worry (R2 = .16), husbands' mental health was predicted by burden and worry (R2 = .18); and worry was the only significant predictor of daughters' mental health (R2 = .33). Wives' physical health was predicted by years of caregiving and age (R2 = .10); husbands' physical health was predicted by age and worry (R2 - .24); and daughters' physical health was predicted by years spent in caregiving and burden (R2 = .27). Findings suggest that a stress and coping framework is a better predictive model for daughters' mental and physical health than for health of wives and husbands. Findings further indicate that different health-related nursing interventions may be required for different caregiver groups.
According to the 1990 U.S. Census, 8.2 million noninstitutionalized persons needed personal assistance with one or more of five major categories of everyday activities. Most assistance was provided by unpaid caregivers. Approximately 5.8 million persons provided assistance to a household member and 15.1 million persons provided care to one or more persons who lived outside their household (U. S. Bureau of the Census, 1990). Although physical and mental health is essential for continued fulfillment of the caregiving role, multiple studies indicate that the financial, emotional, and physical stress of the caregiving experience places the caregiver's health at risk (Fuller-Jonap & Haley, 1995; Mastrian, Ritter, & Deimling, 1996; Schulz & Williamson, 1991).
The purpose of this cross-sectional field study was to investigate differences in and predictors of mental and physical health among husband, wife, and daughter caregivers of dementia patients using a stress and coping framework (Lazarus & Folkman, 1984). Although stress has been defined as either stimulus (environment) or response (person), Lazarus and Folkman's (1984) definition of stress "emphasizes the relationship between the person and the environment. . ." (p. 21). Cognitive appraisal and the coping process are vital to the outcomes. "Psychological stress, therefore, is a relationship between the person and the environment that is appraisal by the person as taxing or exceeding his or her resources and endangering his or her well-being" (Lazarus & Folkman, 1984, p. 21). Major concepts are person factors influencing appraisal, situation/environment factors influencing appraisal, cognitive appraisal, coping, and outcomes or manifestations of stress.
REVIEW OF LITERATURE
Background literature is organized into two categories: (1) predictors of caregiver mental and physical health, and (2) gender and relationship differences relative to caregiver mental and physical health. The review included studies about caregivers of chronically ill adults. Studies have addressed person factors, situation factors, and appraisal variables as predictors of health changes.
In the extensive caregiver literature, numerous variables have been associated with mental and physical health of caregivers. Mental health alterations have been related to the younger age of caregivers (Given, Stommel, Collins, King, & Given, 1990), female caregivers (Draper, Poulos, Poulos, & Ehrlich, 1996; Reis, Gold, Andres, Markiewicz, & Gaughier, 1994; Wright, Clipp, & George, 1993), and lower social position (Russo & Vitaliano, 1995; Schulz, O'Brien, Bookwala, & Fleissner, 1995; Wright, Clipp, & George, 1993). …