Abstract

The placement of a relative with dementia into a long-term care facility is common practice for many caregivers. This study investigates the characteristics associated with institutionalizing a relative with dementia, and further examines the effect of facility placement on the health and well being of the family caregiver. Race and ethnicity, caregiver burden, and negative experiences with care provision are factors that affect facility placement. There was an increase in depression and the use of anti-anxiety drugs for caregivers married to the care recipients. This research is useful in determining interventions, which can help family members emotionally and physically deal with the placement of a relative into a long-term care facility. Background: Much research examining the relationship between home care provision and caregiver burden, distress, and psychiatric and physiological morbidities has been published. However, there have been little measuring of effects of institutionalization of an individual on their family caregivers. Given the increasing complexity of issues associated with caring for an individual with dementia, more are being admitted to a long-term care facility. To date, there has been little work done on identifying effects of an individual's institutionalization on their family members. This study examined the characteristics associated with and impacts of placing a relative with dementia in a long-term care facility on the health and well being of the family caregiver.

Methods: Caregivers enrolled in the Resources for Enhancing Alzheimer's Caregiver Health study, which examines the impact of family caregiving for an individual with dementia were studied from 1996 to 2000. Data for 1,222 caregiver and care recipient pairs were collected from six sites across the United States. First, caregiver co-morbidities, depressive symptoms and satisfaction with the help received from family and friends were assessed upon entering the study, and then again in at six, twelve and eighteen months. Second, caregivers of the 180 institutionalized care recipients were assessed for outcomes such as anxiety, depression, and satisfaction with help from others. Information taken prior to placement was compared with assessments following placement and again one year later. Data were analyzed to ascertain factors associated with placement, the nature of contact between caregivers and the care recipient, and the relation of these factors to health outcomes of family dementia caregivers.

Results: For the first part of the study, it was reported that race and ethnicity affect institutionalization, as Hispanic and black family caregivers were less likely to place their relatives in a facility as compared to white caregivers. Caregivers who reported a greater burden of care were more likely to place their family member in a long-term care facility. Caregivers who reported that providing help made them feel important institutionalized the care recipients less. In the second part, it was observed that family caregivers whose care recipient with dementia entered a long-term care facility were found to have depressive symptoms and anxiety equal to while they were in-home caregivers. There was a greater increase in both depression and anxiety before and after facility placement among caregivers that were married to the care recipient, who visited more frequently, and who were less satisfied with the help that they received from others. Use of anti-depressants by the caregivers did not change before and after facility placement, however the use of medication for anxiety did increase significantly.

Conclusion: This study examined the predictors associated with placing a relative with dementia into a long-term care facility as well as the effects of such placement on the family caregiver's health and wellbeing. Given that more individuals with dementia are entering long-term facilities, it is important to ascertain factors that might help determine placement and the effects of this placement on family members. Very little research to date has been conducted that examines effects of institutionalization of a relative on family caregivers. This study may suggest directions on policies that may help ease the transition and help deal with depression and anxiety following the placement of a relative into a longterm care facility.

Reference: Schulz R., Belle H., Czaja S, McGinnis K., Stevens A., Zhang S. "Long-term Care Placement of Dementia Patients and Caregiver Health and Well-being." Journal of the American Medical Association, 2004; 292(8), 961-967.