ReviewFactors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review
Introduction
Caring for elderly patients in their home environment seriously burdens all persons involved [1]. Caregivers of home-dwelling elderly patients with dementia report more physical and psychosocial burden than their peers of the same age and in the same living circumstances. Research shows that these caregivers suffer from depression more often, perceive their workload as heavier and are in less good health, taking more medication than their peers. Moreover, caregivers report feeling isolated and experiencing pressure on their socio-economic life.
At the root of this psychosocial and physical burden lies the invasive character of dementia. The disease not only has an invasive effect on the patient, but when a member of the family shows signs of dementia role patterns and relationships in the patient's home environment are also thoroughly shaken and rearranged [2], [3].
The aim of this systematic literature review was to analyse what factors determine the development of depression in caregivers of elderly patients with dementia. Depression was taken as primary outcome as it is shown to be the main reason for caregivers to abandon home care [4], [5].
Section snippets
Literature
We searched for studies using Medline and Embase, Psyclit, Cinahl, EBM Reviews (Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Controlled Trials Register) and publications from the grey circuit (primarily graduate theses and policy reports). Because society has undergone important changes both in ways that people live together and in professional care provision over the last few decades, the search was
Selection of articles
Table 1 gives an overview of the initial batch of articles (n = 817) resulting from a search for which there was only a limitation on publication date (1990–2009) and on type of publication (interventional study, observational study).
After selecting articles based on title and abstract and after removing doubles we retained a total of 207 articles from the databases consulted (Fig. 1).
A manual search through reference lists and journals yielded an extra 10 studies, of which only 1 was new. In an
Summary of main findings
A lot of research has been devoted to the impact of care-giving to home-dwelling elderly patients with dementia. Because studies in this field are hard to fit in an experimental design, they often show much incongruence among them [6], [28].
Depression occurs in one in three of caregivers and it occurs more frequently in those who care for patients with dementia than in caregivers of patients with other chronic illnesses. Changing role patterns, the continuous mourning process of the caregiver
Conclusion
In accordance with other reviews on this topic, also our results on the impact of care-giving remained inconclusive [1], [46], [47]. A substantial population bias is likely to be responsible for this observation. Remarkably, the impact of care-giving is strongly related to the characteristics of the population included. Both physically and psychosocially caregivers are less healthy than their peers or than colleague-caregivers of a chronically ill, non-dementia relative. However, a further
Contributors
The authors declare that they participated in the co-writing of the manuscript and that they have seen and approved the final version.
Competing interests
This study was funded by the National Social Security Board in the framework of a population based survey on the needs of community dwelling dementia patients and their carers. The project was by public tender assigned to the Academic Centre of General Practice of the Catholic University of Leuven and the Department of Clinical Psychology in Aging of Liege. The authors and researchers were not involved in any competing interests. The medical Ethical Board of the Medical School of the Catholic
Ethical adherence
The medical Ethical Board of the Medical School of the Catholic University of Leuven granted formal permission for this trial on 27 January 2005.
Provenance and peer review
Commissioned and externally peer reviewed.
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