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Open Access Research article

Clinically significant changes in burden and depression among dementia caregivers following nursing home admission

Joseph E Gaugler1*, Mary S Mittelman2, Kenneth Hepburn3 and Robert Newcomer4

Author Affiliations

1 School of Nursing, Center on Aging, University of Minnesota, Minneapolis, MN, USA

2 Department of Psychiatry, New York University Langone Medical Center, New York, NY, USA

3 School of Nursing, Emory University, Atlanta, GA, USA

4 Department of Social and Behavioral Science, University of California, San Francisco, CA, USA

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BMC Medicine 2010, 8:85  doi:10.1186/1741-7015-8-85

Published: 17 December 2010

Abstract

Background

Although extensive research exists on informal long-term care, little work has examined the clinical significance of transitions in family caregiving due to a lack of established clinical cut-points on key measures. The objectives of this study were to determine whether clinically significant changes in symptoms of burden and depression occur among caregivers within 12 months of nursing home admission (NHA) of their relatives with dementia, and to identify key predictors of clinically persistent burden and depression in the first year after institutionalization.

Methods

Secondary longitudinal analysis of dementia caregivers were recruited from eight catchment areas in the United States with 6- and 12-month post-placement follow-up data. The sample included data on 1,610 dementia caregivers with pre- and six-month post-placement data and 1,116 with pre-placement, six-month, and 12-month post-placement data. Burden was measured with a modified version of the Zarit Burden Inventory. Depressive symptoms were assessed with the Geriatric Depression Scale.

Results

Chi-square analyses found significant (P < .05) reductions in the number of caregivers who reported clinically significant burden and depressive symptoms after NHA compared to pre-placement. Logistic regression models revealed that wives and daughters were most likely to experience clinically persistent burden and husbands were most likely to experience clinically significant depression after NHA.

Conclusions

In addition to suggesting that clinically significant decreases in caregiver burden and depression are likely to occur following institutionalization, the results reveal particular subsets of caregivers who are at continued risk of distress. Such findings can facilitate development of screening processes to identify families at-risk following institutionalization.