Perceived stress factors of adult caregivers related to institutionalization of a relative with Alzheimer's disease
Authors: Norman Gwendolyn Mack , Calico Patricia A. , Krebs Judith Ann 
Published: June 2007

The progressive cognitive, behavioral and social losses experienced by the individual with Alzheimer's disease severely impact the family unit. These losses also influence the duration of home care and contribute to caregiver burden.

Most studies lack specific descriptive data on caregiver stressors in home care giving which precipitate institutionalization of the individual with Alzheimer's disease. The purposes of this study were to identify selected caregiver stressors according to the Social Behavior Assessment Schedule (SBAS) and to determine the caregiver stressors precipitating the institutionalization of a family member with Alzheimer's disease.

Theoretically, describing and clarifying caregiver burden develops the burden construct and identifies family behavior patterns. Clinically, the study provides direction to nurses in providing anticipatory guidance, direct care interventions, and supportive services to family caregivers. Crisis intervention was used as the theoretical framework. A convenience sample of six primary caregivers participated in this descriptive study. Inclusion criteria included:

Having a relative institutionalized with Alzheimer's disease;

Being identified as the primary caregiver of the relative prior to the institutionalization;

Living in the same household with the relative prior to institutionalization.

A retrospective chart review was conducted at a large Midwestern Veteran's Affairs (V.A.) nursing home to identify residents with a diagnosis of Alzheimer's disease. The primary family caregiver was then asked to participate in the study. The study instrument was the SBAS. Inter-rater reliability for the instrument ranges from 0.92-0.99. The SBAS is divided into six sections which measure a patient's disturbed behavior, the patient's social performance, and the adverse effects on the household. Primary family caregivers consented to participate in a semi-structured interview (SBAS) conducted by nurse researchers at the V.A. nursing home. All primary caregivers were female spouses with a mean age of 68.2 years. The care recipients were all men with an average age of 69.54 years. Most care recipients initially had trouble for five to 10 years, but the onset of behaviors which actually precipitated nursing home placement was two years prior to institutionalization. Twelve of the 22 instrument behaviors were descriptive of care recipient behavior. Five behaviors (withdrawal, slowness, indecisiveness, self-neglect, underactivity) were displayed by 100 percent of care recipients. Three other behaviors (odd ideas, misery, forgetfulness) were reported by 83 percent of the caregivers. Obsessionality, odd behavior, unpredictability and irritability were reported by 66 percent of caregivers. Seven behaviors resulted in severe caregiver stress and eight resulted in moderate stress. Over 50 percent of caregivers experienced emotional ill health. Findings indicate that Alzheimer caregivers have multiple stressors for long periods of time which provide opportunities for therapeutic intervention by nurses.