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Protective preparation: a process central to family caregivers of persons with mild cognitive impairment

  • Ching-Lin Wang (a1) (a2), Li-Min Kuo (a3), Yi-Chen Chiu (a1) (a4), Hsiu-Li Huang (a5), Huei-Ling Huang (a6) (a7), Wen-Chuin Hsu (a4) (a8), Cheng-Hsien Lu (a9) (a10) (a11) (a12), Tzu-Hsin Huang (a7), Shan Huang (a13) and Yea-Ing Lotus Shyu (a1) (a6) (a14) (a15)...



To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.


A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.


One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.


Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.


Corresponding author

Correspondence should be addressed to: Yea-Ing Lotus Shyu, School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan City 33302, Taiwan. Phone: +886-3-2118800; Fax: +886-3-2118400. Email:


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Li-Min Kuo is co-first author who contributed equally to this paper.



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Adams, K. B. (2006). The transition to caregiving: the experience of family members embarking on the dementia caregiving career. Journal of Gerontological Social Work, 47, 329. doi:10.1300/J083v47n03_02.
Alzheimer's Association (1998). Alzheimer's association releases state estimates of boomers by 2050. Aging Research Training News, 21, 3839.
Berger, G., Bernhardt, T., Weimer, E., Peters, J., Kratzsch, T. and Frolich, L. (2005). Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. Journal Geriatric Psychiatry Neurology, 18, 119128. doi:10.1177/0891988704273375.
Burns, A. and Zaudig, M. (2002). Mild cognitive impairment in older people. Lancet, 360, 19631965. doi:10.1016/S0140-6736(02)11920-9.
Chao, H. C., Kaas, M., Su, Y. H., Lin, M. F., Huang, M. C. and Wang, J. J. (2016). Effects of the advanced innovative internet-based communication education program on promoting communication between nurses and patients with dementia. Journal of Nursing Research, 24, 163172. doi:10.1097/jnr.0000000000000109.
Chertkow, H. et al. (2008). Diagnosis and treatment of dementia: 3. Mild cognitive impairment and cognitive impairment without dementia. Canadian Medical Association Journal, 178, 12731285. doi:10.1503/cmaj.070797.
Corbin, J. and Strauss, A. (1991). A nursing model for chronic illness management based upon the trajectory framework. Scholarly Inquiry for Nursing Practice: An international Journal, 5, 155174.
Dai, Y. T. and Dimond, M. F. (1998). A cross-cultural comparison and its implications for the well-being of older parents. Journal of Gerontological Nursing, 24, 1318.
Di Iulio, F. et al. (2010). Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes. International Psychogeriatrics, 22, 629640. doi:10.1017/S1041610210000281.
Garand, L. et al. (2012). Anticipatory grief in new family caregivers of persons with mild cognitive impairment and dementia. Alzheimer's Disease Association Disorder, 26, 159165. doi:10.1097/WAD.0b013e31822f9051.
Garand, L., Dew, M. A., Eazor, L. R., DeKosky, S. T. and Reynolds, C. F. III. (2005). Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. International Journal of Geriatric Psychiatry, 20, 512522. doi:10.1002/gps.1318.
Gauthier, S. et al. (2006). Mild cognitive impairment. Lancet, 367, 12621270. doi:10.1016/S0140-6736(06)68542-5.
Geslani, D. M., Tierney, M. C., Herrmann, N. and Szalai, J. P. (2005). Mild cognitive impairment: an operational definition and its conversion rate to Alzheimer's disease. Dement Geriatric Cognitive Disorders, 19, 383389. doi:10.1159/000084709.
Glaser, B. G. (1978). Theoretical Sensitivity. Mill Valley, CA: Sociology Press.
Glaser, B. G. (1992). Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press.
Glaser, B. G. and Strauss, A. L. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. New York, NY: Aldine de Gruyter.
Heath, H. and Cowley, S. (2004). Developing a grounded theory approach: a comparison of Glaser and Strauss. International Journal of Nursing Studies, 41, 141150. doi:10.1016/S0020-7489(03)00113-5.
Hsu, F. L. K. (1971). Psychosocial homeostasis and Jen: conceptual tools for advancing psychological anthropology. American Anthropologist, 73, 2344. doi:10.1525/aa.1971.73.1.02a00030.
Hsu, F. L. K. (1978). Passage to understanding. In Spindler, G. (ed.), The Making of Psychological Anthropology (pp. 140173). Berkeley, CA: University of California Press.
Huang, H. L. et al. (2015). Family caregivers’ role implementation at different stages of dementia. Clinical Interventions in Aging, 10, 135146. doi:10.2147/CIA.S60574.
Kuo, L. M. and Shyu, Y. I. L. (2010). Process of ambivalent normalisation: experience of family caregivers of elders with mild cognitive impairment in Taiwan. Journal of Clinical Nursing, 19, 34773484. doi:10.1111/j.1365-2702.2010.03240.x.
Lincoln, Y. S. and Guba, E. G. (1985). Naturalistic Inquiry (pp. 289331). Newbury Park, CA: Sage.
Liu, H. C. et al. (1991). Impact of demented patients on their family members and caregivers in Taiwan. Neuroepidemiology, 10, 143149. doi:10.1159/000110260.
Lonie, J. A., Herrmann, L. L., Donaghey, C., O'Carroll, R. E. and Ebmeier, K. P. (2010). Predicting outcome in mild cognitive impairment: 4-year follow-up study. The British Journal of Psychiatry, 197, 135140. doi:10.1192/bjp.bp.110.077958.
Lu, Y. F. and Haase, J. E. (2009). Experience and perspectives of caregivers of spouse with mild cognitive impairment. Current Alzheimer Research, 6, 384391. doi:10.2174/156720509788929309.
Muangpaisan, W., Intalapaporn, S. and Assantachai, P. (2008). Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors. International Journal of Geriatric Psychiatry, 23, 699703. doi:10.1002/gps.1963.
Rozzini, L. et al. (2007). Neuropsychiatric symptoms in amnestic and nonamnestic mild cognitive impairment. Dementia & Geriatric Cognitive Disorders, 25, 3236. doi:10.1159/000111133.
Strauss, A. and Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (2nd edn). Newbury Park, CA: Sage.
Strauss, A. L. and Corbin, J. M. (2008). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory (3rd edn). London: Sage.
Taiwan Alzheimer's Disease Association (2010). Learn About Dementia. Taiwan: TADA. Available at:
Tiang, L. Y., Mao, C.L., Chou, C. F., Chen, R. C. and Liu, H. C. (1992). Caregiver burden of demented elderly and related factors: an exploratory study. Journal of Nursing, 39, 8998.



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