Does caregiver burden mediate the effects of behavioral disturbances on nursing home admission?

Joseph E. Gaugler, Melanie M. Wall, Robert L. Kane, Jeremiah S. Menk, Khaled Sarsour, Joseph A. Johnston, Kory Schuh, Robert Newcomer

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42 Scopus citations


OBJECTIVES: The primary objective of this study was to determine whether caregiving burden mediated the relationship between specific behavior disturbances and time to nursing home admission (NHA) for persons with dementia (i.e., Alzheimer disease or a related disorder). DESIGN: The study used secondary longitudinal data from the Medicare Alzheimer's Disease Demonstration, a Medicare-covered home care benefit and case management program for family caregivers of persons with dementia. Primary caregivers of persons with dementia were assessed via in-person and telephone interviews every 6 months over a 3-year period. SETTING: Dementia caregivers were recruited from eight catchment areas throughout the United States. PARTICIPANTS: The baseline sample included 5,831 dementia caregivers. Just more than 40% (43.9%; N = 2,556) of persons with dementia permanently entered a nursing home during the 3-year study period. MEASUREMENTS: Individual behavior problems were measured with the Memory and Behavior Problem Checklist. Caregiving burden was assessed with a short version of the Zarit Burden Inventory. Key covariates, including sociodemographic background, functional status, and service utilization, were also considered. RESULTS: Event history analyses revealed that time-varying measures of caregiver burden fully mediated the relationship between four behavioral disturbances (episodes of combativeness, property destruction, repetitive questions, and reliving the past) and NHA. CONCLUSIONS: The findings highlight the multifaceted, complex pathway to NHA for persons with dementia and their family caregivers. The results emphasize the need for comprehensive treatment approaches that incorporate the burden of caregivers and the behavioral/psychiatric symptoms of persons with dementia simultaneously.

Original languageEnglish (US)
Pages (from-to)497-506
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Issue number6
StatePublished - Jun 2011

Bibliographical note

Funding Information:
This research was supported by a grant from the Eli Lilly Company to the School of Nursing, University of Minnesota (Total = $109,205; Dates: 28 May, 2009–30 April, 2010). This grant supported salary effort of Dr. Gaugler (principal investigator), Dr. Wall (coinvestigator), Dr. Kane (coinvestigator), and Mr. Menk (research assistant). Dr. Newcomer was consultant on this project. Dr. Sarsour, Dr. Johnston, and Dr. Schuh are the employees of the Global Health Outcomes Division of Eli Lilly and collaborated with the University of Minnesota research team in the conceptualization, interpretation, and dissemination of the findings reported in this article.


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