Caregiver coping with dementia: relationships among patient characteristics, caregiver coping styles, and consequences of caregiving
Although little is known about how the changes that accompany Alzheimer's disease (DAT) affect caregiver coping, depression, and burden, interventions focused on improving caregiver coping with DAT are strategies widely used by gerontologists. This study reports relationships among DAT patient's need for assistance, supervision, or vigilance, rate of DAT patient decline in cognition, functional health, and physical health, and caregiver coping, depression, and burden. Data were drawn from a 1984 to 1987 longitudinal study of 59 DAT patients and their caregivers. Fourteen subjects were still caregiving and willing to be re-interviewed in 1989 in order to describe caregiver coping qualitatively, with special attention to the effectiveness and stability of their coping responses and religious coping activities. Although findings are descriptive in nature and limited by small sample size, results suggest patients' need for assistance is linked to increases in problem-focused coping (p $<$.01) and burden (p $<$.001) in caregivers. Patients' need for supervision is associated with increases in caregivers' problem-focused coping (p $<$.001) and burden (p $<$.001). Rapid patient functional health decline is associated with increases in caregivers burden (p $<$.01). Results suggest it is the "here and now" DAT patient problems experienced by the caregiver, rather than rates of change in symptoms, that influence caregiver coping and burden, while caregivers' depression is unrelated to DAT patient characteristics. Relationships between coping styles and depression and burden partially support previous caregiver coping studies. Caregivers' emotion-focused coping is associated with more depression (p $<$.01) and subjective burden (p $<$.001). Caregivers' problem-focused coping is related to more subjective burden (p $<$.001) and unrelated to depression. Qualitative results suggest that these caregivers cope in diverse ways. Their most frequently reported coping strategies are religious coping activities. These caregivers judge their coping strategies to be effective and stable over time. Caregivers' comments suggest that acceptance should be conceptualized as an outcome of successful adaptation rather than as a way of coping. Results are related to a suggested model of caregiver stress and coping. Implications for social welfare policy and practice, with suggestions for future study, are discussed.
- Social welfare