TY - JOUR
T1 - Relationship between the number of behavioral symptoms in dementia and caregiver distress
T2 - What is the tipping point?
AU - Arthur, Paul B.
AU - Gitlin, Laura N.
AU - Kairalla, John A.
AU - Mann, William C.
N1 - Funding Information:
The research question for this paper was developed from the primary author's doctoral dissertation. While some dissertation committee members are co-authors, we would like to acknowledge additional committee members including Dr.Mary Ellen Young, Dr. Orit Shechtman, and Dr. Jamie Pomeranz, all distinguished faculty members in the Department of Occupational Therapy at the University of Florida. Additionally, much of this work was completed while the first author was a faculty member at the University of Florida. Analyzed studies were funded by the National Institute on Aging and the National Institute on Nursing Research grant R01AG22254, the Pennsylvania Department of Health, Tobacco Funds grant 2401000272, and the National Institute of Mental Health grant R21MH069425 in which Dr. Gitlin was the principal investigator. Dr. Gitlin was further supported in part in the conduct of this study from the National Institute on Aging grants # R01AG041781; R01AG049692; P30AG048773.
Publisher Copyright:
© 2017 International Psychogeriatric Association.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. Methods: Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. Results: Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). Conclusions: Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
AB - Background: Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. Methods: Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. Results: Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). Conclusions: Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
KW - Alzheimer's disease
KW - behavioral and psychological symptoms of dementia (BPSD)
KW - carers
KW - dementia
KW - neuropsychiatric symptoms
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U2 - 10.1017/S104161021700237X
DO - 10.1017/S104161021700237X
M3 - Article
C2 - 29143722
AN - SCOPUS:85034586271
SN - 1041-6102
VL - 30
SP - 1099
EP - 1107
JO - International psychogeriatrics
JF - International psychogeriatrics
IS - 8
ER -