This is an article critique examining the study findings of a research carried out to identify the burden of the caregivers specifically narrowing the study down to the burden of caring for a relative with dementia. This article is authored by five professionals who are highly qualified to carry out a research in this field. One of them (Haritini Tsangari PhD) is an assistant professor of statistics: with the other four being from the medical field this balances the team and makes it capable of handling the statistics logistics of carrying out a research study.
The study used a volunteer sample of 172 caregivers. The study took place in Cyprus between 2004 and 2005. Data collection was done through four methods
Memory and Behavior problem checklist,
Centre for epidemiological studies depression scale
Ways of coping questionnaires.
The findings showed that a large percentage of the caregivers were burdened and showed depressed. It was found out that the caregiver burden was related to four factors: the patient psychopathology; income: caregiver sex; and level of education. The study also showed that there was no difference in the level of burden for the cases of patients being hosted in the community or institutions (Papastavrou et al., 2007, p.446).
The study explored the burden of dementia within the general stress disorder framework. Caregiver burden is viewed as the reaction severe reaction towards the provision of care which are brought about by increased demand for attention either due to changes in cares requirements or simply due to the intensification of the existing requirements. To alleviate the burden the caregivers have developed strategies to help them meet the demands of taking care of patients. The caregivers who are not able to meet the challenges through adaptation often fall to the care giving burden. The article reviews the dimensions of care giving stress: this is done in four domains. These domains are:
This encompasses the characteristics of the caregivers the type of dyadic relationship and the presence of any social support. Any social support given to the care givers is likely to help them to cope with emotional stresses thus alleviating their burden.
The article views this as basic cause of the care giver burden. This may in the form of a problematic behavior exhibited by the patient. This can also be secondary in nature in the form of, for instance, the commitment of the care giver.
There exist other factors which also make a contribution to the burden of a care give: factors such as coping strategies and the care management. These also make a contribution to the burden of a care giver through the perception created of the stress and consequences.
As reviewed above the article has made an attempt to explain the background of the care giving burden. It has shown exclusively how first and most importantly the framework of care does affect the care giver. Equally important is the care giving situation indicated by the patient behavior and the commitment of the care giver. The article next reviews the variables which are associated with the caregiver burden particularly in the case of a dementia patient (Papastavrou et al., 2007, p. 446).
These are the individual characteristic of both the patient and the care giver which expose the caregiver to burden.
Studies are quoted in this article implicating the role of the patient in care giver burden in a multiple of ways. First implicated is the ability of the patient to adapt to the daily activities. A patient who is able to easily adapt to this situation will lessen the amount of duties for the care giver and make his/her life less burdening (Papastavrou et al., 2007, p. 446).
Another factor reviewed is specific patient characteristics. This may take the form of the patient age, or even the presence of a disease. The article quotes more research showing that physical dependency is also a good contributor towards the care giver burden. For the case of patients suffering from dementia characteristics like, "aggressiveness, wandering and disorientation," (p. 2) are primary over all the others (Papastavrou et al., 2007, p. 446).
In this section the article has given the variables which trigger the burden on the part of the care giver. The article as laid much weight on the patient as t he cause of this burden. It should be noted that the article fails to mention cultural variables whereby the caregivers are expected to take care of patients no what kind of a situation they might be in. such kind of value though they might be rare tend to favor the patient side at the expense of the care givers. Next the article moves on to examine the impacts of this burden (Papastavrou et al., 2007, p. 446).
Studies implicate family caregivers of patients with dementia with the likelihood of experiencing increased physical and psychological morbidity. When a relative is diagnosed with dementia it becomes quite stressing to the caregivers. The articles symbolizes the sorrow of this burden with that of death. The article uses the term, "disenfranchised grief" (Papastavrou et al., 2007, p. 447). This section brings out the seriousness of the challenges with which care givers views the care giving services. It shows a great challenge which needs to be taken care of. The article next discusses another variable affecting the burden of the caregiver.
Women caregivers have been implicated with vulnerability as compared to their male caregivers counterparts. This article claims that a great portion of caregivers for patients with dementia are women and as such they are more prone to be depressed. The women in addition are said to have lower mastery skills on adapting to the situation. Men are assumed to cope easily with the situation of a caregiver's situation. The article quotes some other studies claiming that men are likely to receive more informal support than women.
This research used a cross -sectional descriptive study. In this design several methods were used to select and analyse data. The collection of the data took place between 2004 and 2005. The use of many methods in data collection helps to collect reliable information and reduces the biases involved in research.
The study made use 172 patients primary caregiver dyads. The participation was on a voluntary basis with 130 of the participants being drawn from the community residents. The rest were drawn from long term institutions specifically to answer the research question. The inclusion criteria for the caregivers who were included were the frequency with which they got in touch with patients. Other limits were that the caregivers at least must have had an experience of at least one year with the patients. The caregiver had to be free of any mental illness. The patient to the caregiver relationship which existed was mainly that of son, daughter (Papastavrou et al., 2007, p. 448).
The criterion used is sufficient to eliminate any bias from the research.
By ensuring that the caregivers who could participate in the research had a more than one year contact with the patient would ensure that the results and opinions gathered would be from real life experience and which do real take place.
Data collection was mainly done by the use four instruments. The instruments measured were directed to measure patient cognitive and behavioral status, and the burden level on the part of the caregiver. The methods were also meant to expose the symptoms of depression by the caregivers and find out how the caregiver coped with the stressors and burdens associated with the caregivers (Papastavrou et al., 2007, p. 448).
The researchers were excellent at picking the instruments which could specifically help them to specially pick the right information required to carry out the research. The instruments used in the data collection are reviewed as below:
This instrument was used to check the cognitive and behavioral status of the patient. Specifically the instrument determined how frequent patients with dementia engaged in problematic behaviors with special attention being given to those which particularly upset family members. The instrument had two parts consisting of 26 items. The first part was to determine the frequency, with which common problems took place. A Likert scale was used to measure this. The scale ran from 0 to 4: 4 meaning happening daily and 0 meaning never happening. The second part of was to measure the level to which the caregiver was bothered by the patient behavior (Papastavrou et al., 2007, p. 448).
The reliability of the study was quite recommendable (as high as 0.85 on Cronbach's alpha). This was for the, 'frequency of problem behaviors and caregiver reaction to problem behaviors' (Papastavrou et al., 2007, p. 449). This instrument assisted in explaining 62.7 percent of the variations. This instrument was quite helpful and strategically chosen to help out in the research. Another instrument used was the Burden Interview (BI).
This instrument was used to asses the care giver burden. The instrument was specifically designed to give an assessment of the stress undergone by the family caregivers of disabled and older persons. The instrument had 22 questions to which the caregivers were to respond to. The questions were on the impact of a patient's disabilities on the life of a caregiver. The Cronbach's alpha was found to be 0.93 which is quite high. Four factors were revealed to explain variations. The explanation was to 63.92%. The explanation factors were: role strain, personal strain, management of care and relational deprivation. This document was equally helpful as the first as it gave more insight into the caregiver's burden. Its reliability measure was quite high showing that it could be relied on. Another instrument used was the Depression scale (Papastavrou et al., 2007, p. 449).
To measure the overall depression experienced by the caregivers in a past one week the centre for epidemiological studies-depression scale was used. The scale is itemized with 20 items. The article does not explain how this tool was used though it gives its reliability measure to be 0.69 on Cronbach's alpha (Papastavrou et al., 2007, p. 449).
The other last instrument used in the data collection was used to collect data on how the caregivers coped with the burden. This was done by 'the ways of coping questionnaire instrument.' This instrument gave five factors that explained variation to 32.2%. The factors included positive approach, wishful thinking, seeking social support, avoidance strategies and assertiveness. Next the ethical consideration for this research is considered (Papastavrou et al., 2007, p. 449).
The researchers took the necessary steps to ensure that the research adhered to the set standards. The study got an approval from the research committee of the Institute of Neurology and genetics. The ministry of health also approved the study. Concerning the caregivers, they were well informed on the purpose of the study having being given the necessary details on what the research was about and which institutions and who were carrying out the research. The researchers took an initiative to give contacts to the caregivers. The caregivers had sign consent in order to proceed with the research. This study was carried out within the boundaries of the set ethical standards of research work (Papastavrou et al., 2007, p. 449).
The analysis of data was done by the use of independent samples of t-test, one way ANOVA with post hoc adjustments and correlation analysis. The results which were obtained are obtained as shown below:
The most number of caregivers were daughters, then husbands or wives, sons and others in the order of 48.3%, 41.3%, 5.8%, and 4.1%. It was revealed that the caregivers averaged at a mean age of 56.80 years while the patients being care for averaged 75.52. The care recipients who were at institutions had a high average age wise than those who were being cared for at the community. The articles used tables to give more of the research findings. The article clearly explains the research terms used (Papastavrou et al., 2007, p. 450).
A number of variables were found to be related to the caregivers' burden. These are analyzed as below:
The research showed in an overwhelming manner that the majority of the caregivers experienced high levels of burdens. The articles also revealed that this was the case for the care givers of patients with dementia (Papastavrou et al., 2007, p. 451). The research revealed that aggression was most related to the caregivers burden. This was in agreement to what other reports mentioned. The research showed that anger was related to terms such as: "anger, aggressive talk, and threatening manner" (p. 7). The research also attaches vigilance imposed to the caregiver with the burden. The research also shows a weak cognitive impairment association with the burden of care giving. This was done by assessing the patient memory through asking of some questions in a repeated manner (Papastavrou et al., 2007, p. 452).
This research showed that the place of patient was not of any significance when the question of the caregiver burden was the factor. It was shown that the level of burden does not change significantly by raising the patient in institutions or in a community. The article cites other article which claim that some caregivers are drawn more to give care to the patient because of the strong bond of love (Papastavrou et al., 2007, p. 452).
It was shown that the level of the caregiver's education and sex. High education and better remuneration seemed to buffer the care giving burden. The article makes a suggestion that there is a possibility that the education might be contributor in making the caregiver adaptive to the stressful situation. The sex was another factor: women were found to be more affected by the care giving burden as compared to men. This finding is a said to be dependent of the place in question. For instance, in Cypriot care giving is socially ascribed to women therefore they are expected to engage in care giving though they might not be prepared psychologically and otherwise to carry out the care giving service.
T the research findings showed that incase the caregiver was male then always there was another member of the family who offered assistance. This is seen to one of the causes why men register few symptoms of burden (Papastavrou et al., 2007, p. 452).
It was also revealed that though both men and female suffer from burden, they did not suffer in the same way. For the women the suffering was from social relational deprivation otherwise referred to as isolation factor or restriction in life (Papastavrou et al., 2007, p. 452).
The research showed that the caregivers were more likely to be exposed to clinical depression development. The article attributes this to the long caregiver career which stretches up to 13 years taking into consideration the tensions involved in this activity. The articles claims that though there is a debate whether the burden precedes depressive symptoms, for the case of dementia caregiving, the patient behavior are viewed as predicting the caregiver depression. The research also proved the theory of attribution: it becomes less stressing if the depressive symptoms of a person with dementia are associated with the person and not the disease (Papastavrou et al., 2007, p. 453).
The research revealed that burden depended on some specific strategies with positive coping having a negative correlation and emotional coping being correlated positively. The article showed that at the initial stages of the disease are countered by avoidance but as the disease advances avoidance becomes ineffective. The use of avoidance and coping strategies was associated with the women leading to high degrees of stresses manifested in them (Papastavrou et al., 2007, p. 453).
The first weakness which comes out clearly is the use of volunteers: this limits the general grasp of the study as well as encouraging possible self selection bias. There are possibilities that those who volunteered were those who experienced the burden well above the average caregiver. The use of structured questions in the research did not give a chance for the caregivers' views.
The caregivers who participated are likely to have a more understanding of the topic on which the research was based on.
Families are very important source of information on the issue of caregiver burden due to the role they play in taking care of their loved ones. The caregivers experience a lot of burden which is quite persistent even after the death of the patient. Burden has been to be correlated with the caregiver characteristics. The patient also makes a contribution to the whole issue.
This research has brought to light the fact that caregivers who are women show high scores for depression symptoms. The behavioral problems of patients impacted greatly on the caregivers and are more likely to influence the relatives to opt for a long term residential care for the patient. Healthcare workers need to understand and recognize the expectations of the caregivers in order to develop coping strategies which will work out well.