The experiences needs and outcomes for carers of people with dementia

Full Report
high intensity caregiving situations, with long
hours of care and co-residence, had more disrupted
cortisol patterns that are common in people who are
chronically stressed.
Risk of developing dementia
In addition to these health risks, research has explored
the increased risk for caregivers of developing dementia
themselves. Vitaliano, et al. (2011) reviewed literature
on relationships between caregiver status and risk
of dementia in the context of a theoretical model of
chronic stress. They found that the increased risk to
caregivers of people with dementia in relation to noncaregivers
may be a response to a range of different
mediators. These include psychological factors such
as depression, loneliness, social isolation and sleep
problems, behavioural factors related to exercise and
diet, and physiological factors related to metabolic
syndrome and inflammation.
Relationship, Social Support and Familial Factors
Familism
Losada, et al.’s (2010) Spanish/US study aimed to
examine cultural impact on the degree to which
caregiving stressors affect caregiver outcomes. They
refer to theories that culture may have a beneficial
impact on well-being ‘through its influence on the
appraisal of stressors and the perception of social
support’ (p.193), using the concept of ‘familism’ as a
basis for their study. They define ‘familism’ as ‘a strong
identification and attachment of individuals and their
families (nuclear and extended), and strong feelings of
loyalty, reciprocity, and solidarity among members of
the same family’ (p.194). They examined the influence
on depression of both familism and dysfunctional
thoughts specific to caregiving. ‘Familism’ was found
to have both positive and negative influences. On
the one hand, the family may provide a source of
support; on the other hand there could be pressures
to adhere to family values of obligation to provide
support and family pressures regarding behaviour and
attitudes that could affect emotional distress through
dysfunctional thoughts. They suggest that it may be
useful to include both cultural and cognitive factors in
assessment for interventions. They posit the problem
that those caregivers with strong familism values as
well as dysfunctional thoughts about caregiving may
be difficult to reach although possibly the most in
need, and argue there is a need for approaches that
take into account the caregivers’ varying profiles in
order to tailor or adapt interventions to be more
suitable for them.
Quality of the Relationship
Quinn, et al. (2009) completed a systematic review
exploring the impact of the quality of the relationship
on dementia caregiving. Similarly, Ablitt, et al. (2009)
also considered the impact of relationship factors.
Quinn, et al. indicated that some caregivers found
dementia to impact upon relationship quality, and
that both the previous and current relationship
quality impacted upon carer wellbeing. Ablitt, et al.
(2009) found that those family caregivers whose
relationships were previously good tended to cope
better with caregiving than those whose relationship
was of poor quality. These family caregivers tended
to experience higher levels of distress and burden.
However both Ablitt, et al. (2009) and Fauth, et al.
(2012) have cautioned against the assumption that
positive relationships are always associated with better
outcomes. They have found differences with some
family caregivers with a previously positive relationship
experiencing higher levels of distress. Indeed Fauth,
et al. (2012) suggest that learning to detach from
the relationship is associated with better caregiving
outcomes, and is not necessarily associated with
poorer care for the person with dementia.
These authors further suggest that the quality of the
previous relationship may have a direct influence on
the way in which the family member now cares for the
person. This is consistent with the work undertaken
by Keady and Nolan (2003) who identify that the
experience of dementia for the family caregiver and
the person with dementia may result in different
relational strategies, including working together,
working separately, working alone or working apart.
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