Thursday, 21 August 2003
This presentation is part of : The Impact of Caregiving Across Different Dementia Diagnosis: Differences and Similarities

S085-004 Do Caregiver Management Strategies Influence Patient Behavior in Dementia?

Marjolein De Vugt1, Fred Stevens2, Pauline Aalten1, Richel Lousberg3, Jelle Jolles1, and Frans Verhey1. (1) Psychiatry and Neuropsychology, Brain and Behaviour Institute, University of Maastricht, Maastricht, Netherlands, (2) Medical Sociology, University of Maastricht, Maastricht, Netherlands, (3) Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands

Objective: Little is known about the effectiveness of caregiver management strategies on patient functioning. However, identification of specific caregiver strategies may provide useful information on the manifestation of behavioral problems in dementia. The Maastricht study of behavior in dementia (abbreviated as MAASBED) focuses on the course and risk factors of behavioral and psychological symptoms of dementia (BPSD). MAASBED consists of two parts: part 1 focuses on predictors of BPSD in the patient, and part 2 examines the relationship between BPSD and caregiver characteristics. This paper presents results on the relationship between caregiver management strategies and patient behavioral problems.

Design: A two-year follow-up study was performed including 199 patients with dementia as well as 119 informal caregivers. Results are presented of the 1-year follow up of 99 dementia patients and their informal caregivers.

Materials and Methods:Qualitative methods were used to examine differences in caregiver management strategies. Behavioral disturbances in the patient were measured with the NeuroPsychiatric Inventory (NPI). Repeated measures analysis was used to investigate the relationship between caregiver management strategies and BPSD.

Results: We were able to identify three caregiver management strategies. Reproducibility of the results was checked by an independent observer (kappa=0.62). The most important key theme in differentiating between caregiver strategies was the acceptance or non-acceptance of the caregiving situation and dementia related problems. Caregiver strategies characterized by non-acceptance were typified as ‘Non-adapters’. Non-adapters approach the patient with impatience, irritation or anger. Caregivers characterized by acceptance were further subdivided in two groups typified as ‘Nurturers’ and ‘Supporters’. Nurturers do no longer regard the patient as equal. They are primarily worried and trying to protect the patient or focused on personal care tasks. Supporters try to adapt to the patient’s level of functioning and promote existing abilities in the patient. MANOVA results across these 3 groups showed that non-adapters reported significantly more behavioral problems in the patient (p=0.050), in particular hyperactivity (p=0.007), than supporters. Post-hoc comparisons revealed significantly higher levels of hyperactivity in non-adapters at 6 months (p=0.008) and at 12 months (p=0.046) follow up. There were no significant differences in BPSD between patients of nurturing caregivers versus supporters and non-adapters.

Conclusion: The hypothesis that caregiver management strategies are associated with BPSD was supported. Caregivers who used a non-adapting strategy reported more behavioral problems in the patient, in particular hyperactivity. These findings suggest that caregiver strategies to cope with dementia-related problems with the patient are important in predicting patient behavior.

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