Studies have focused forward the ef...

Studies have focused forward the effects of caring for a family member in succession the caregiver. Studies also have focused onward the response of caregivers to the death of the care recipient. moreover little is known of the impact upon the caregiver of the transition of a care recipient from to one's home to an institution. In this situation, the caregiver continues in the caregiving part Schulz and colleagues sought to determine the conditions that lead to placement, the interaction of the caregiver with the care recipient and the care recipient's environment after placement, and the general intent of these factors on the caregiver's health after the transition has taken place.

The reflection draws its information from data garner uped in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) investigation which included 1,222 caregiver--care recipient pairs at multiple sites. In addition to collecting scrutinize data, the study randomized pairs to a social/behavioral intervention or to usual care. Although the treatment collection did better in this aspect of the trial, this conclusion was not relevant to the findings in the not away analysis. Recipient cognitive and physical functioning and health were assessed, as were caregiver load mental health, and satisfaction with help from family and friends. Information also was scrape togethered on the frequency of visits to the recipient's facility, satisfaction with the facility, and the kind of help the recipient continued to provide.

Of the 1222 caregiver and recipient pairs, 180 institutionalized their relative, with those reporting greater caregiver tonnage being more likely to take this grade and those reporting greater satisfaction with their caregiver part being less likely to do in such a manner Less severely demented patients and black and Hispanic patients were more likely to stay in the to one's home Almost all caregivers visited their relative in the institution at least one time per week, more than the same half of them helped with physical patient care, and almost single half were very satisfied with various aspects of the facility.

Indicators of depression did not change with placement after a median 12-week postplacement time. Depression and anxiety keeped to be higher in caregivers who visited at least daily and who were les satisfied with help from others. A longer period of follow-up revealed no significant difference in caregiver depression after institutionalization, although there was les anxiety. No predictors of change in depression or anxiety were identified. Of note, postplacement satisfaction with social activities and the percentage of caregivers who were satisfied with the help they received from others did increase after placement.

Ethnicity, caregiver freight and degree of dementia predicted institutionalization in this contemplation Caregiver burden was greater for spouses than for nonspouses. Interestingly, caregivers have a decrease in depression after the death of a relative for whom they have been caring. In this close attention institutional placement did not have a similarly positive power On the contrary, the quality of depression and anxiety in the caregiver was relatively unchanged when the relative was institutionalized. The authors speculate that this lack of improvement may be related to the continued demands of visiting the facility and taking in succession new managerial responsibilities, as well as the emotional demands of witnessing the many times more rapid decline of the institutionalized relative, and dealing with feelings of guilt.

CAROLINE WELLBERY, MD

Schulz R et al. Long-term care placement of dementia patients and caregiver health and well-being. JAMA August 25 2004;292:961-7

COPYRIGHT 2005 American Academy of Family Physicians

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