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As a degenerative disease, the progression of dementia needs continued care provision and poses both psychological and financial burden for family caregivers of persons with dementia (PWD). This study seeks to compare predictors of care costs and caregiver burden, and to identify modifiable factors that could alleviate the burden faced by dementia caregivers.
This study interviewed 231 PWD–caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan in 2013. A follow-up study was conducted a year later, and 167 dyads completed the second interview. Data collected included PWD characteristics, caregiver characteristics, relationship to PWD, and social support to caregivers. Caregiver burden was measured with the Zarit Burden Interview instrument. The association between each predictor variable and cost of care and caregiver burden scores was examined using linear mixed models.
Predictors of care costs were found to be different from predictors of caregiver burden: functional declines measured by Katz’s activities of daily living (ADL) scale were associated with total cost as compared to behavioral disturbance measured by Neuropsychiatric Inventory (NPI), which showed no impact on care costs. However, NPI was a significant predictor of caregiver burden. Caregivers who were better-off financially also reported significantly lower caregiver burden.
Since predictors of care costs were different from the predictors of caregiver burden, providing training to caregivers in addressing PWD’s behavioral disturbance and proving financial assistance to low income caregivers could be effective in reducing caregiver burden.
The Zarit Burden Interview (ZBI) is a commonly used self-report to assess caregiver burden. A 12-item short form of the ZBI has been developed; however, its measurement invariance has not been examined across some different demographics. It is unclear whether different genders and educational levels of a population interpret the ZBI items similarly. Therefore, this study aimed to examine the measurement invariance of the 12-item ZBI across gender and educational levels in a Taiwanese sample.
Caregivers who had a family member with dementia (n = 270) completed the ZBI through telephone interviews. Three confirmatory factor analysis (CFA) models were conducted: Model 1 was the configural model, Model 2 constrained all factor loadings, Model 3 constrained all factor loadings and item intercepts. Multiple group CFAs and the differential item functioning (DIF) contrast under Rasch analyses were used to detect measurement invariance across males (n = 100) and females (n = 170) and across educational levels of junior high schools and below (n = 86) and senior high schools and above (n = 183).
The fit index differences between models supported the measurement invariance across gender and across educational levels (∆ comparative fit index (CFI) = −0.010 and 0.003; ∆ root mean square error of approximation (RMSEA) = −0.006 to 0.004). No substantial DIF contrast was found across gender and educational levels (value = −0.36 to 0.29).
The ZBI is appropriate for combined use and for comparisons in caregivers across gender and different educational levels in Taiwan.
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