Caregiver Burden of Dementia Patient in China

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Caregiver Burden of Dementia Patient in China

• Yu Liu, MSN RN

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Background

• Aging is a big problem for most countries in the
  world.
• In China, 104.82 million people are at 65 years
  of age or older and account for 8.16 of the
  population in 2003. It is predicted that there
  will be 167 million people who are at the 65
  years of age or older in China, and account for
  24 of older people in the world in 2020 (Xu,
  2005).

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Background

• Dementia
• Based on 2000 census data, there are 4.5 million
  people in the United States with AD (Morris,
  2005).
• In China, the prevalence varies among different
  cities, generally affects 8.59 to 9.0 of people
  aged 60 and over (Tian, 2003). As life expectancy
  increases, the prevalence of dementia will
  continue to increase.

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Background

• Caring for dementia patient in China
• Chinese culture
• Familism, is high valued in Chinese culture and
  most Chinese believe that the family is most
  important. So each family member contributes
  his/her efforts in order to achieve familys
  harmony.
• Filial piety from Confucian doctrine, a duty of
  obedience, devotion and care for elder family
  members.
• (Purnell
  Paulanka, 2003 Yang, 2005 )
• Under this culture, family plays a key role in
  coping and help-seeking when a member becomes
  mentally sick and tries to take good care of
  patient in home.

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Background

• Caregiver burden of dementia patient
• The progressive degeneration of neuroses leads to
  multiple cognitive deficits of patient and
  results in patients disability and dependency.
  As the disease advances, more and more care is
  required by dementia patients.
• Zarit (1985) has mentioned that the patient is
  not the only victim of this disease. There are
  probably no other diseases that involve families
  so much or have such devastating effects.

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Background

• Caregiver burden of dementia patient
• Definition of caregiver burden
• It was first introduced into the literature by
  Grad and Sainsbury (1966) in an examination of
  community care for the mentally ill.
• Zarit and his colleagues (1980) were among the
  first researchers to study burden in caregivers
  of patients with dementia. --- persistent
  hardships, stress, reactions of caring, or as the
  physical and psychological, financial, and social
  problems experienced by family members providing
  care in the home.

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Background

• Caregiver burden of dementia patient
• Definition of caregiver burden
• the more accepted definition of caregiver burden
  for dementia patient is that burden is a
  perceived complex and multidimensional construct,
  which includes the physical, psychological or
  emotional, social and financial consequences that
  can be experienced by family members caring for
  dementia patients (George Gwyther, 1986
  Given, Collins, Given, 1988 Zarit, et al.,
  1980 Ankri et al., 2005).

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Background

• Caregiver burden of dementia patient
• Burden did exist among caregivers of dementia
  patients at physical, psychological or emotional,
  social, and economical aspects.
• Deterioration in physical health status
• Occurrence of psychological problems
• Restrictions in social activities
• Family conflict
• Financial cost
• (Schulz Beach, 1999Zarit, Reever
  Batch-Peterson, 1980 Stone, Cafferate, Samgle,
  1987 Given Given, 1991 Dunkin
  Anderson-hanley, 1998 Torti, et al., 2004 Zarit
  Zarit, 2007 )

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Background

• Caregiver burden of dementia patient
• Some factors predict caregiver burden
• Patient characteristics
• Severity of dementia, behavioral disturbances,
  age, gender
• Caregiver characteristics
• Gender, age, duration of caregiving, relationship
  to patient, socioeconomic status, self-efficacy,
  coping strategies
• Filial piety
• Available care services
• Formal care service include community agencies
  and the health care system
• Informal care service includes the assistance
  from other family members, relatives, and
  friends.

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Background

• Caregiver burden of dementia patient
• Torti, F.M., Gwyther, L.P., Reed, S.D., Friedman,
  J.Y., Schulman, K.A. (2004). A multinational
  review of recent trends and reports in dementia
  caregiver burden. Alzheimer Disease and
  Associated Disorder, 18 (2), 99-109.
• This review focuses on the influence of ethnic,
  cultural, and geographic factors on the
  caregivers of patients with dementia.
• North America, Asia, Europe/Australia
• Taiwan (1), Korea (4), Japan (3)

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Background

• Caregiver burden of dementia patient
• Consistent findings
• ---Severe behavioral disturbances, female and
  young caregivers, low level of socioeconomic
  status, and low self-efficacy predict higher
  level of burden
• Different findings
• ---less severe (Asia, Europe/Austrilia), more
  severe (North America)
• ---Daughter-in-law (Asia), Daughtersgtspouses
  (North America),
• Spousegtchildren (Europe/Austrilia)
• The adaptation to the caregiver role and the
  lessening of caregiver burden over time, the
  substantial magnitude of burden early in the
  disease, as well the consistently augmented
  stresses of women in these roles, particularly in
  Asia, are all significant results which may be
  related to geographic regions, cultural
  differences, and healthcare delivery systems.

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Background

• Caregiver burden of dementia patients in China
• Negative consequences of caregiving have been
  documented
• ---deterioration of the caregivers physical and
  mental health
• ---restriction of time and freedom
• ---isolation of social activity
• ---economic strains
• (Wu, et al., 1995 zhang, et al., 2001 Meng, et
  al., 2007)

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Background

• Caregiver burden of dementia patients in China
• Limitation
• ---small sample size
• ---self-designed questionnaire without testing
  construct validity

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Background

• Caregiver burden of dementia patients in Taiwan
• Chou, K.R., LaMontagne, L.L., Hepworth, J.T.
  (1999). Burden experienced by caregivers of
  relatives with dementia in Taiwan. Nursing
  Research, 48(4), 206-214.
• Established a structural equation model of
  caregiver burden

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Gaps

• Systematic study
• Representative sample size
• Consistent measurements
• Difference between Taiwan and mainland of China
• Political system/healthcare delivery
  system/population
• Lack of available care services in Chous model

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Research Purposes

• To describe the burden of caregivers of dementia
  patients in China.
• To explore the factors which predict burden among
  caregivers of dementia patients in China.
• To test (or construct) the model of caregiver
  burden for Chinese population.

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Research Design

• Descriptive cross-sectional design

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Significance

• Enrich nurses knowledge and understanding about
  the caregiver burden of dementia patients in
  China.
• Help nurses to develop focused and useful
  interventions in order to reduce caregiver
  burden, and delay patient institutionalization.