RISK APPRAISAL OF ALZHEIMER’S CAREGIVERS: THE Poster...

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POSTER NO.POSTER NO.P2P2--061061

RISK APPRAISAL OF ALZHEIMERRISK APPRAISAL OF ALZHEIMER’’S CAREGIVERS: THES CAREGIVERS: THEDEPRESSION CONNECTIONDEPRESSION CONNECTION

ZeldeZelde EspinelEspinel MD MA MPH,MD MA MPH,11 Elizabeth A.Elizabeth A. CroccoCrocco MD,MD,11 Janice Rios MD,Janice Rios MD,11 Ivan Escobar,Ivan Escobar,22 JehanJehan HelmiHelmiMD,MD,11 DavidDavid LoewensteinLoewenstein PHDPHD11

1: University of Miami Memory Disorders Clinic (UM1: University of Miami Memory Disorders Clinic (UM--MDC), Department of Psychiatry and Behavioral Sciences, UniversiMDC), Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami FL, USA; 2: Universty of Miami Miller School of Medicine, Miami FL, USA; 2: Universidadidaddel Valle, Cali, Colombiadel Valle, Cali, Colombia

The UMThe UM--MDC is partly supported by the State of Florida Department of ElMDC is partly supported by the State of Florida Department of Elder Affairs (der Affairs (XZ203),, AlzheimerAlzheimer’’s Disease Initiative (ADI)s Disease Initiative (ADI)

Introduction. The role of caregivers for patients with Alzheimer’s disease andrelated dementias (ADRD) is life-changing and frequently associated with anegative impact on caregiver physical and psychological health, includingsymptoms of clinical depression.1-5 Given the intensity and chronicity of demandsplaced on the caregiver, some ADRD patients may be neglected, leftunsupervised and at risk of harm, or abused by caregivers.2 This study examinescaregiver symptom levels of depression in relation to 1) perceived stress andstrain, 2) temptation to abuse, and 3) neglect of care receiver safety.

Methods. Surveys were conducted with 77 caregivers of ADRD patientsevaluated at the University of Miami Memory Disorders Clinic in Miami, Florida.Caregivers completed the Center for Epidemiological Studies Depression Scale(CES-D) to assess symptoms of depression and a risk appraisal instrumentdescribing care recipient characteristics. Three risk appraisal items assessedcaregiver stress and strain (Figure 1), 2 items measured temptation to abuse(Figure 2), and 2 items examined neglect of care recipient safety (Figure 3). CES-Ddepression symptoms were examined in relation to 1) temptation to abuse, 2)neglect of care recipient safety, and 3) caregiver stress and strain (Table 2).Caregiver stress and strain were examined in relation to 1) temptation to abuseand 2) neglect of care recipient safety (Table 2).

Results. The rate of caregiver depression, assessed by CES-D > 16, was found tobe 34% in our study sample. Caregiver depression and caregiver stress and strainwere positively correlated (r= 0.42; p<.001). Both caregiver depression andcaregiver stress and strain independently predicted temptation to abuse (r=0.39; p < .001 and r=0.47; p < .001) but were not related to neglect of carerecipient safety.

Discussion. In the United States, 15 million adults are providing care for a personwith ADRD.1 Caregiving for Alzheimer’s patients becomes increasinglyburdensome with time.4,5 As Alzheimer’s symptoms progress, caregiving tasksbecome more frequent, time consuming, and physically demanding.2 Cognitivedeterioration, often accompanied by lack of recognition of caregiver identity,compounded by verbal and physical aggression, intensifies caregiver stress.1,5

Not surprisingly, caregivers frequently develop symptoms of depression andexperience stress and strain.1,4,5 In this study, caregiver depression symptomsand caregiver stress and strain were strongly associated and these two measureswere positively associated with elevated risk for temptation to abuse asmeasured by caregiver self-reports.

Conclusions. The current study suggests that caregivers of ADRD patients are atrisk for role-related depression symptoms and perceived stress and strain; inturn, both measures predict higher likelihood that the caregivers reporttemptation to abuse the care recipient.

Introduction.Introduction. The role of caregivers for patients with AlzheimerThe role of caregivers for patients with Alzheimer’’s disease ands disease andrelated dementias (ADRD) is liferelated dementias (ADRD) is life--changing and frequently associated with achanging and frequently associated with anegative impact on caregiver physical and psychological health,negative impact on caregiver physical and psychological health, includingincludingsymptoms of clinical depression.symptoms of clinical depression.11--55 Given the intensity andGiven the intensity and chronicitychronicity of demandsof demandsplaced on the caregiver, some ADRD patients may be neglected, leplaced on the caregiver, some ADRD patients may be neglected, leftftunsupervised and at risk of harm, or abused by caregivers.unsupervised and at risk of harm, or abused by caregivers.22 This study examinesThis study examinescaregiver symptom levels of depression in relation to 1) perceivcaregiver symptom levels of depression in relation to 1) perceived stress anded stress andstrain, 2) temptation to abuse, and 3) neglect of care receiverstrain, 2) temptation to abuse, and 3) neglect of care receiver safety.safety.

Methods.Methods. Surveys were conducted with 77 caregivers of ADRD patientsSurveys were conducted with 77 caregivers of ADRD patientsevaluated at the University of Miami Memory Disorders Clinic inevaluated at the University of Miami Memory Disorders Clinic in Miami, Florida.Miami, Florida.Caregivers completed the Center for Epidemiological Studies DeprCaregivers completed the Center for Epidemiological Studies Depression Scaleession Scale(CES(CES--D) to assess symptoms of depression and a risk appraisal instrumD) to assess symptoms of depression and a risk appraisal instrumententdescribing care recipient characteristics. Three risk appraisaldescribing care recipient characteristics. Three risk appraisal items assesseditems assessedcaregiver stress and strain (Figure 1), 2 items measured temptatcaregiver stress and strain (Figure 1), 2 items measured temptation to abuseion to abuse(Figure 2), and 2 items examined neglect of care recipient safet(Figure 2), and 2 items examined neglect of care recipient safety (Figure 3). CESy (Figure 3). CES--DDdepression symptoms were examined in relation to 1) temptation tdepression symptoms were examined in relation to 1) temptation to abuse, 2)o abuse, 2)neglect of care recipient safety, and 3) caregiver stress and stneglect of care recipient safety, and 3) caregiver stress and strain (Table 2).rain (Table 2).Caregiver stress and strain were examined in relation to 1) tempCaregiver stress and strain were examined in relation to 1) temptation to abusetation to abuseand 2) neglect of care recipient safety (Table 2).and 2) neglect of care recipient safety (Table 2).

Results.Results. The rate of caregiver depression, assessed by CESThe rate of caregiver depression, assessed by CES--D > 16, was found toD > 16, was found tobe 34% in our study sample. Caregiver depression and caregiver sbe 34% in our study sample. Caregiver depression and caregiver stress and straintress and strainwere positively correlated (r= 0.42; p<.001). Both caregiver depwere positively correlated (r= 0.42; p<.001). Both caregiver depression andression andcaregiver stress and strain independently predicted temptation tcaregiver stress and strain independently predicted temptation to abuse (r=o abuse (r=0.39; p < .001 and r=0.47; p < .001) but were not related to neg0.39; p < .001 and r=0.47; p < .001) but were not related to neglect of carelect of carerecipient safety.recipient safety.

Discussion.Discussion. In the United States, 15 million adults are providing care for aIn the United States, 15 million adults are providing care for a personpersonwith ADRD.with ADRD.11 CaregivingCaregiving for Alzheimerfor Alzheimer’’s patients becomes increasinglys patients becomes increasinglyburdensome with time.burdensome with time.4,54,5 As AlzheimerAs Alzheimer’’s symptoms progress,s symptoms progress, caregivingcaregiving taskstasksbecome more frequent, time consuming, and physically demanding.become more frequent, time consuming, and physically demanding.22 CognitiveCognitivedeterioration, often accompanied by lack of recognition of caregdeterioration, often accompanied by lack of recognition of caregiver identity,iver identity,compounded by verbal and physical aggression, intensifies caregicompounded by verbal and physical aggression, intensifies caregiver stress.ver stress.1,51,5

Not surprisingly, caregivers frequently develop symptoms of deprNot surprisingly, caregivers frequently develop symptoms of depression andession andexperience stress and strain.experience stress and strain.1,4,51,4,5 In this study, caregiver depression symptomsIn this study, caregiver depression symptomsand caregiver stress and strain were strongly associated and theand caregiver stress and strain were strongly associated and these two measuresse two measureswere positively associated with elevated risk for temptation towere positively associated with elevated risk for temptation to abuse asabuse asmeasured by caregiver selfmeasured by caregiver self--reports.reports.

Conclusions.Conclusions. The current study suggests that caregivers of ADRD patients areThe current study suggests that caregivers of ADRD patients are atatrisk for rolerisk for role--related depression symptoms and perceived stress and strain; inrelated depression symptoms and perceived stress and strain; inturn, both measures predict higher likelihood that the caregiverturn, both measures predict higher likelihood that the caregivers reports reporttemptation to abuse the care recipient.temptation to abuse the care recipient.

Abstract 2455Abstract 2455 Table 1: ADRD Caregivers:Table 1: ADRD Caregivers:Demographic CharacteristicsDemographic Characteristics (n=77)(n=77)

Demographic CharacteristicDemographic Characteristic No.No. %%

CaregiverCaregiverRelationshipRelationshipto Careto CareRecipientRecipient

ChildChild 3838 49%49%

SpouseSpouse 3030 39%39%

SiblingSibling 33 4%4%

OtherOther 66 8%8%

Living with Care RecipientLiving with Care Recipient 5353 69%69%

CaregiverCaregiverRace/ethnicityRace/ethnicity

HispanicHispanic 4949 58%58%

White, NonWhite, Non--HispanicHispanic

2222 29%29%

AfroAfro--AmericanAmerican 44 5%5%

OtherOther 66 8%8%

Caregiver AgeCaregiver Age Mean:Mean:76.376.3

SD:SD:8.38.3

Range:Range:5656--9191

Table 2: Correlations amongTable 2: Correlations amongScaled MeasuresScaled Measures (n=77)(n=77)

CaregiverCaregiverStress &Stress &

StrainStrain

TemptationTemptationto Abuseto Abuse

Neglect ofNeglect ofPatientPatientSafetySafety

CESCES--D ScoreD Score 0.42***0.42*** 0.39***0.39*** --0.1230.123 NSNS

CaregiverCaregiverStress &Stress &StrainStrain

NANA 0.47***0.47*** 0.050.05 NSNS

*** p<.001*** p<.001NS: Not significantNS: Not significant

Figure 1: Caregiver Stress & StrainFigure 1: Caregiver Stress & Strain

3 items, Maximum Range: 03 items, Maximum Range: 0--1010Mean (SD): 3.0 (2.1) Actual Range: 0Mean (SD): 3.0 (2.1) Actual Range: 0--88

Caregiver Stress &Caregiver Stress &Strain: FrequenciesStrain: Frequencies

11 Do you feel stressed between caring for Care Recipient and trying to meet otherresponsibilities (work/family)?

22 Do you feel strained when you are around Care Recipient?

33 Is it hard or stressful for you to help Care Receiver in basic daily activities likebathing, changing clothes, brushing teeth, or shaving?

Figure 2: Temptation to AbuseFigure 2: Temptation to Abuse

2 items, Maximum Range: 02 items, Maximum Range: 0--66Mean (SD): 0.89 (0.9) Actual Range: 0Mean (SD): 0.89 (0.9) Actual Range: 0--66

Temptation toTemptation toAbuse:Abuse:

FrequenciesFrequencies

11 How often in the past 6 months have you felt like yelling or screaming at CareRecipient because of the way he/she behaved?

22 How often in the past 6 months have you had to keep yourself from hitting orslapping Care Recipient because of the way he/she behaved?

Figure 3: Neglect of Care Recipient SafetyFigure 3: Neglect of Care Recipient Safety

2 items, Maximum Range: 02 items, Maximum Range: 0--33Mean (SD): 1.69 (1.2) Actual Range: 0Mean (SD): 1.69 (1.2) Actual Range: 0--33

Neglect of CRNeglect of CRSafety: FrequenciesSafety: Frequencies

11 Can Care Recipient get to dangerous objects (e.g. gun, knife, or other sharp objects)?

22 Do you ever leave Care Recipient alone or unsupervised at home?

ReferencesReferences1. Alzheimer’s Association. 2015 Alzheimer’s Disease Facts and Figures. Alzheimer’s & Dementia 2015;11(3)332.2. Cooper C, Blanchard M, Selwood A, Walker Z, Livingston G. Family Carers' Distress and Abusive Behavior: Longitudinal Study. The British Journal of Psychiatry.2010;196(6):480-485.3. Czaja S, Gitlin L, Schulz R, Zhang S, Burgio LD Stevens A et al. Development of the Risk Appraisal Measure: A Brief Screen to Identify Risk Areas and GuideInterventions for Dementia Caregivers. Journal of the American Geriatrics Society. 2009;57(6):1064-1072.4. Ornstein K, Gaugler JE, Zahodne L, Stern Y. The Heterogeneous Course of Depressive Symptoms for the Dementia Caregiver. The International Journal of Aging andHuman Development. 2014;78(2):133-148.5. Smith G, Williamson G, Miller L, Schulz R. Depression and Quality of Informal Care: A Longitudinal Investigation of Caregiving Stressors. Psychology and Aging.2011;26(3):584-591.