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Resilience and Transitions from Dementia Caregiving

Joseph E. Gaugler, Ph.D.Assistant Professor

Center on Aging, Center for Gerontological NursingThe University of Minnesota

April 20, 2006

Acknowledgements

Collaborators

• Robert L. Kane, M.D., Minnesota Chair in Long-Term Care and Aging, University of Minnesota

• Robert Newcomer, Ph.D., Professor, Department of Social and Behavioral Science and Institute for Health and Aging, The University of San Francisco

Funding Support

• The Alzheimer’s Association, NIRG-2249

• Health Care Financing Administration, 509-89-0069

Background

Resilience as a concept• Child development and developmental psychopathology

• Processes that may encompass resilience (Masten et al., 1990; Wyman et al., 1999)

– Positive outcomes despite negative circumstance; resilience as “overcoming the odds”

– Sustained competence of positive development while facing continual threat or stress: resilience as “stress resistance”

– Recovery from negative life experience or trauma: resilience as “recovery”

Resilience in aging

Resilience in Dementia Caregiving

Cross-sectional vs. longitudinal research

• The “wear and tear hypothesis”

Uplifts and rewards of dementia caregiving

Small-scale descriptive reports of resilience (Garity, 1997; Ross et al., 2003)

Conceptual Model

Conceptual overlap of resilience with similar constructs

Resilience in dementia caregiving as “stress resilience”

Research question and hypothesis What factors are associated with resilience among dementia

caregivers?

Dementia caregivers who indicate low resilience at baseline will be less likely to remain in their caregiving roles when compared to the high resilience group.

Individual, Family, and Community Resources

Secondary support, community -based

services, caregiver function

Care Recipient Status

Cognitive impairment, unmet care needs,

primary caregiving hours

Context of Care

Age, race, kin relationship, duration of

care, gender, socioeconomic status

Stress Resistance as Resilience

Low resilience (high burden, low care

demands) High resilience (low burden, high care

demands)

Transitions from Dementia Caregiving

Institutionalization

Care recipient death

Loss to follow -up

Methods

Medicare Alzheimer’s Disease Demonstration

Measures: Resilience• Burden

• Care Demands

• Construction of resilience measure– High resilience vs. low resilience

Measures: Covariates• Context of care

• Care recipient function and cognitive status

• Resources

Analysis• Correlates of resilience: Logistic regression

• Resilience as a predictor of transitions from dementia caregiving: Multinomial logistic regression

Table 2. Correlates of Baseline Resilience (N = 1,979; High resilience is the reference category ).

Variable

B

Odds Ratio

Context of Care

Florida -.73*** .48

Care recipient gender (female) .58** 1.78

Race of care recipient ( Caucasian) -.45** .64

Medicaid -eligible -.26* .78

Care recipient lived with caregiver -.57*** .57

Duration of care (in months) .00* 1.00

Caregiver income -.07** .93

Caregiver education -.13** .88

Care Recipient Func tional and Cognitive Status

Mini-Mental Status Examination score -.11*** .90

Primary caregiving hours .01*** 1.01

Resources

In-home help services .00*** 1.00

Overnight hospital services used .04*** 1.04

Second ary caregiving hours, typical week .02*** 1.02

Caregiver instrumental activities of daily living -.12** .89 Cox and Snell R2 = .29; ***p < .001; **p < .01; * p < .05

Effects of Baseline Resilience (N = 1,979) and Change in Resilience (N = 1556) on Transitions

Variable

Baseline Resilience

Change in Resilience

Death NH

LTFU

Death

NH

LTFU

Resilience Baseline resilience (low re silience)

.62** 1.87*** 1.77* - - -

Change in resilience a Stability -low resilience

- - - 2.46* .43* .34

High resilience -low care demand/low burden

- - - 11.52*** 1.36 4.14**

Low resilience -low care d emand/low burden

- - - 10.42*** 3.31*** 8.90***

NOTE: *** p < .01; ** p < .01; * p < .05 aHigh resilience -low resilience is the reference category Cox and Snell pseudo R2 = .28 and .33 for baseline resilience and change in resilience models, respective ly

Discussion

Care recipient function and sociodemographic context associated with resilience

Complex effects of baseline resilience

• Low resilience as predictive of institutionalization and loss to follow-up

• Low resilience negatively associated with care recipient death

Complex effects of change in resilience

• Anticipation of the termination of at-home care

Implications

Limitations

Capturing heterogeneity of dementia caregivers

• A typology approach

Assessment strategies

Incorporation of intrinsic dimensions of resilience