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Caregivers of demented patients are under significant stress along with physical, psychological or social problems. Standardized and validated instruments are required for measuring consequences of caregiving or efficacy of support interventions. Reliability of French translation of these instruments has to be verified in order to confirm their psychometric properties. The goal of the present study is to assess reliability of the French translation of three instruments designed for evaluation of caregivers of demented patients. The Zarit's Burden Interview (BI) is a 22-items scale measuring the subjective burden of the caregiver. The Revised Memory and Behavior Problems Checklist (RMBPC), a 53 item scale, measures frequency of memory and behaviour problems of demented patients and the caregiver's reaction to these problems, which is another mean of burden assessment. The Alzheimer's Disease Knowledge Test (ADKT) assesses knowledge of caregivers about demented diseases and resources available using 20 multiple choice questions. A reliability study was conducted on a sample of 40 caregivers. The caregivers were questioned twice, the second time after one (N = 26) or eight (N = 14) weeks. The BI internal consistency (Cronbach alpha) yielded a coefficient of 0.85 and test-retest reliability (intra-class correlation coefficient) was 0.89. The RMBPC's Cronbach Alpha was 0.93 for frequency and 0.94 for reaction. Intra-class correlation coefficients were 0.77 (frequency) and 0.90 (reaction) for RMBPC and 0.71 for ADKT.
This paper discusses different dimensions of social support which can be examined in the context of family care of the elderly. It calls for a greater measure of theoretical and empirical precision in relating specific types and sources of actual and perceived support to the particular demands and burdens faced by family caregivers at different stages in the course of caregiving. In addition, it spotlights three critical topics for future research: (1) analysis of the ways in which social support affects and is affected by chronic stressors; (2) examination of the determinants of actual and perceived support; and (3) the design and evaluation of interventions aimed to mobilize or augment the support provided to family caregivers.
The goodness-of-fit hypothesis contends that distress results due to incongruence between choice of coping strategies and perceived ability to change stressful stimuli. Goal-directed or active coping responses are believed to be most efficacious when the individual believes s/he can change or control perceived threats (i.e., problem-focused coping). Instances in which stressors must be accepted, however, would dictate reliance upon strategies to regulate distress (i.e., emotion-focused coping). Inconsistent support for this facet of Lazarus and Folkman's cognitive phenomenological model was obtained in this study of spouses of suspected dementia patients. The distinction between emotion- and problem-focused coping appears less germane than overall coping efforts relative to perceived control and caregiver burden. In addition, perceived ability to control dementia-related stressors appears to be somewhat independent of coping by caregivers. These findings are discussed in terms of the unique and chronic demands faced by spouses of persons with dementia.
Assessing the burden linked to caring for the frail elderly is becoming an important issue in rehabilitation. The purpose of this study was to translate/validate the Montgomery Borgatta Caregiver Burden Scale into French for use in Canada. This easy-to-use questionnaire evaluates aspects of burden such as objective, subjective stress and subjective demand burden. The instrument underwent: 1) parallel translation/back-translation; 2) expert's committee review leading to an experimental version; 3) pre-test to ensure wording clarity; and 4) study of psychometric properties with bilingual subjects (n = 27) and French-speaking subjects (n = 18). Results suggest that convergence between the original and the French versions is satisfactory for two of the three sub-scales of the MBCBS (ICC 0.83 et 0.96). The test-retest stability coefficients are also very good (ICC of 0.92 et 0.91), as is internal consistency (0.90, 0.66). The objective burden sub-scale correlates moderately with a measure of functional autonomy (SMAF). Results for the subjective burden scale linked to demand are, however, inadequate. All in all, two of the three sub-scales of the French-Canadian version of the Montgomery Borgatta Caregiver Burden Scale demonstrate adequate psychometric properties, thereby favouring its use in geriatric rehabilitation.
The growth of research knowledge on culturally diverse family caregivers for the aging population lags behind the increase of culturally diverse populations in Canada. This study examines the effects of culture, as manifested through cultural variables, on the caregiving burden of family caregivers in a Chinese-Canadian community. A random sample of 339 Chinese-Canadian caregivers for elderly relatives completed a telephone survey. Results of hierarchical stepwise multiple regression analysis reported the predicting effects of culture-related variables on caregiving burden. The findings indicated that being an immigrant, having a Western or non-Western religion as compared to having no religion, and having a lower level of filial piety, predicted a higher level of caregiving burden. Chinese tradition does not exempt the caregivers from being burdened. Policies and practices should address the needs of family caregivers according to the intra-cultural variations identified in this study.
Zarit Burden Interview (ZBI) is the most widely used instrument for assessing the burden experienced by the caregivers of persons with dementia. As part of the Canadian Study of Health and Aging, the 22-item ZBI was administered to a representative sample of 312 informal caregivers of community-dwelling subjects with dementia. The mean score was 22.4 out of 88 (sd: 16.2) and the median score was 18.5, which is far lower than those reported in previous studies using this instrument with convenience samples. There was no significant difference in the burden score according to the age, gender, living arrangement, marital status or employment status of the caregiver. The ZBI score was more strongly correlated to the depressive mood of the caregivers (r = 0.59) and the behaviour problems of the care recipients (r = 0.64) than their cognitive (r = 0.32) and functional (r = 0.31) status. Following a factor analysis, a 12-item short version of the instrument is proposed with two factors: personal strain (3 items) and role strain (9 items).
Recent research suggests that the single strongest predictor of burden among dementia caregivers is a measure of marital aggrandizement (Marital Conventionalization Scale). The current study corroborates the significant inverse relation between these constructs. In addition, there appears to be little association between this response style and more standard social desirability constructs (i.e. self-deception, impression management). Furthermore, the tendency to discount negative experience in one's marital history appears distinct from emotion- and problem-focussed coping as defined within Lazarus and Folkman's cognitive phenomenological model. The propensity to idealize one's spouse and marriage is discussed relative to the reconstructionist theory of memory and social exchange theory.
Burden among caregivers has consistently been recognized as a function of both subjective and objective variables. In addition to concrete role demands, caregivers' perceptions and appraisal strongly contribute to perceived burden. At present, however, the relative contribution of objective and subjective factors remains unclear. This question was addressed among 70 spousal caregivers recruited within a dementia assessment clinic. Subsequent to adjustment for socially desirable responding, both groupings of variables significantly contribute to the prediction of burden scores. These findings are discussed in the context of the hopelessness theory of depression. Demographic similarity between these caregivers and a corresponding sample of randomly derived spousal caregivers recruited as part of the Canadian Study of Health and Aging (CSHA) suggest the results of this study may be generalized with greater confidence.
Studies on informal caregiving in institutional settings are rare. The impact on their burden of 197 caregivers' perceptions of their elderly dependents' autonomy was investigated. The results of previous research on caregivers' burden in non-institutional contexts were used to provide an empirical starting point for the research. The results of regression analysis show that help for bathing and concurrent demands have an impact on objective burden, but caregivers' perceptions of their elderly dependents and the social support they receive affect subjective burden.
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