Elsevier

Maturitas

Volume 66, Issue 2, June 2010, Pages 191-200
Maturitas

Review
Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review

https://doi.org/10.1016/j.maturitas.2010.02.009Get rights and content

Abstract

Introduction

Dementia caregivers suffer a considerable care burden. More than in comparable groups of caregivers or peers, they are confronted with feelings of depression and decreased physical health. Although many studies are set up to determine the link between the stressors in dementia care-giving and the impact on the family caregiver, the results remained inconclusive. Others, depression in caregivers remains the main cause of a premature or acute ending of home care.

Method

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.

Results

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.

Conclusion

Caregiver characteristics rather than objective care needs of the patients tend to be responsible for the onset of depression. Future research should concentrate on demonstrating links between negative feelings in caregivers and the way the care situation evolves. This can have important implications in home care support.

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.

References (59)

  • M. Crespo et al.

    Depression and anxiety in primary caregivers: a comparative study of caregivers of demented and nondemented older persons

    Int J Geriatr Psychiatry

    (2005)
  • R.J. Ham

    Alzheimer's disease and the family: a challenge of the new millennium

    Adv Exp Med Biol

    (1990)
  • G. Livingston et al.

    Depression and other psychiatric morbidity in carers of elderly people living at home

    BMJ

    (1996)
  • P.V. Rabins

    The caregiver's role in Alzheimer's disease

    Dement Geriatr Cogn Disord

    (1998)
  • G. Meshefedjian et al.

    Factors associated with symptoms of depression among informal caregivers of demented elders in the community

    Gerontologist

    (1998)
  • J.R. Shua-Haim et al.

    Depression among Alzheimer's caregivers: identifying risk factors

    Am J Alzheimers Dis Other Demen

    (2001)
  • L. Gallicchio et al.

    Gender differences in burden and depression among informal caregivers of demented elders in the community

    Int J Geriatr Psychiatry

    (2002)
  • S.H. Croog et al.

    Vulnerability of husband and wife caregivers of Alzheimer disease patients to caregiving stressors

    Alzheimer Dis Assoc Disord

    (2001)
  • H. Brodaty et al.

    Psychological morbidity in caregivers is associated with depression in patients with dementia

    Alzheimer Dis Assoc Disord

    (1998)
  • D.G. Harwood et al.

    Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: a cross-ethnic comparison

    Alzheimer Dis Assoc Disord

    (1998)
  • I.C. Williams

    Emotional health of black and white dementia caregivers: a contextual examination

    J Gerontol Ser B-Psychol Sci Soc Sci

    (2005)
  • R.F. Coen et al.

    Behaviour disturbance and other predictors of carer burden in Alzheimer's disease

    Int J Geriatr Psychiatry

    (1997)
  • P. Rinaldi et al.

    Predictors of high level of burden and distress in caregivers of demented patients: results of an Italian multicenter study

    Int J Geriatr Psychiatry

    (2005)
  • K.E. Covinsky et al.

    Patient and caregiver characteristics associated with depression in caregivers of patients with dementia

    J Gen Intern Med

    (2003)
  • O. Zanetti et al.

    Depressive symptoms of Alzheimer caregivers are mainly due to personal rather than patient factors

    Int J Geriatr Psychiatry

    (1998)
  • M.J. Bauer et al.

    Progressive dementia: personal and relational impact on caregiving wives

    Am J Alzheimers Dis Other Demen

    (2001)
  • R.M. Bertrand et al.

    Are all caregivers created equal? Stress in caregivers to adults with and without dementia

    J Aging Health

    (2006)
  • P. Thomas et al.

    Dementia patients caregivers quality of life: the PIXEL study

    Int J Geriatr Psychiatry

    (2006)
  • R.C. Dillehay et al.

    Caregivers for Alzheimer's patients: what we are learning from research

    Int J Aging Hum Dev

    (1990)
  • Cited by (0)

    View full text