Mohammed T. Abou-Saleh

760 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYWhen caregivers lack the necessary skills to manageproblematic behaviors effectively, care recipient behaviorsoften escalate, leading to increased levels of confusion andagitation 23,103 that have been cited as the primary reasons forinstitutionalizing a family member with dementia 46,119,120 . Consideringthe psychological and financial expense associated withplacing a person with dementia in an institutional setting,interventions which help caregivers in the prevention and/ormanagement of behavioral problems are both timely andsignificant. In support of this position, the 1993 Report of theAdvisory Panel on Alzheimer’s Disease recommends thatemphasis be directed toward health services research thatfocuses on reducing the burdens of care for family membersof persons with dementia.Although our understanding of the dementias and the severenegative consequences of caregiving for this population hasgrown, too little research has focused on the development,implementation and evaluation of interventions, especially forfamily caregivers. The American Association for GeriatricPsychiatry, the Alzheimer’s Association and the AmericanGeriatrics Society, in consensus, state: ‘‘Interventions thatreduce the risk of caregiver depression and improve toleranceand the capacity to care for patients in the home, includingeducational materials, counseling support groups, day care andrespite care, are among the most promising areas for futureresearch’’ 121 .CONCLUSIONCaring for a person with cognitive impairment is chronicallystressful. For persons with dementia, caregiving can last anaverage of 15 years, with the task being a demanding and oftenoverwhelming experience 62 . This chapter has summarized theresearch on family caregiving of persons with dementia in thecommunity setting. Informal caregiving, mostly by familymembers, of elders with chronic illnesses and disabilities hasincreased during the past two decades due to growth in theproportion of elders in the population, shorter hospital stays,advancing technologies that forestall mortality, and continuinghigher costs of health care, with limited reimbursement ofcaregiving by professionals in the home. As a result, the impactof informal caring on family members quickly became a concernof health professionals and social and behavioral researchers,especially in the context of dementia caregiving. 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