This study was an investigation of the phenomenon of dementia caregiving burden and breakdown in community caregiving situations. 109 carer subjects participated in the study, with 91 current carers - 17 via face-to-face interview and 74 via the internet, and 18 past carers - two via face-to-face interview and 16 via the internet, contributing their experiences of dementia caregiving. Two new carers' assessment tools were devised to meet more fully the requirements of the 'Carers (Recognition and Services) Act 1995' (DoH, 1995), namely the 'Dementia Caregiving Problems Questionnaire (DCPQ)' and 'Dementia Caregiving Burden Questionnaire (DCBQ)'. These new assessments were tested and demonstrated to be reliable, with Cronbach Alpha scores of 0.7029 and 0.8430 respectively, and are recommended for implementation in clinical practice. The key predictive risk factors for high caregiving burden in this study were perceived stress; omission of caregiving satisfactions; carer depression; perceived impact on quality of life; perceived helpfulness of community care services; behaviour problems - especially shouting, swearing and screaming, irritability and night disturbance; poor quality carer/dependant relationship; mood problems; perceived helpfulness of informal support; perceived impact of caregiving on dependant emotional well-being and, to a lesser extent, hours spent in caregiving. The key predictive risk factors for expected relinquishment of home caregiving were DCBQ score; perceived impact on quality of life; perceived stress; carer depression and, to a lesser extent, geographical distance in caregiving; perceived helpfulness of community care services and omission of positive feelings in the carer. Based on the above risk factors, a new 'Dementia Caregiving Breakdown Risk Assessment Tool (DCBRAT)' is proposed for use by community care managers to identify 'at risk' caregiving situations so that service interventions can be targetted more towards carers who are highly burdened in their role, who are at risk of developing psychological health problems or who may be nearing breakdown in their caregiving situation. Thus the effectiveness of service interventions may be maximised and optimal health gain for carers achieved, resulting in improved outcomes for people with dementia. The DCBRAT and the similarly proposed 'Conceptual Model of Dementia Caregiving, Burden and Breakdown' will need to be further tested in post-doctoral research.

The purpose of this study was to understand the decision making process of caregivers placing their elderly family members in a nursing home facility. Experiential Learning Theory (ELT) was used, as well as the Critical Incident Technique (CIT). ELT was utilized in an effort to understand the learning that took place during the caregiving experiences, and CIT was used to better understand the critical incidents that led the caregivers to seek nursing home placement. A sample of twelve former informal dementia caregivers between the ages of fifty-seven and eighty-seven was drawn from the metropolitan Richmond, Virginia area. In-depth interviews were audiotaped and provided the primary source of data for this study. An interview protocol consisting of eleven open-ended questions derived from current dementia caregiving literature guided the conversation between the researcher and the caregivers in the sample. A constant comparison method was used in this study. The findings revealed that there are a variety of reasons why informal dementia caregivers seek nursing home placement for their family members. Themes related to the decision making process to seek nursing home placement include (1) dementia related behaviors, (2) safety concerns, (3) emotional and psychological burden, and (4) unexpected medical intervention. Indicators of each theme found in this study suggest that providing informal care for an individual with dementia can be very overwhelming and challenging. Although there were some positive aspects associated with this form of caregiving, such as feelings of pride and self-worth, the overall consensus from this study was that dementia caregiving is a very difficult experience in which the primary caregiver had to ultimately seek formal placement in a nursing home for their family member for a variety of reasons.

Caring for an elder with dementia at home is considered a challenging and complex process. The purpose of this study was to describe the impact of family caregiving upon caregivers of elders with dementia on caregiver's health in the context of Chinese family caregiving. The investigation also describes the roles of caregiving appraisal, coping, familism, and perceived social support on the relationship between caregving stressors and caregiver outcomes.A cross-sectional correlational design was used to examine relationships among the variables. Ninety-six family caregivers of elders with dementia in China were recruited. Self-reported questionnaires were utilized to measure the variables.Results from bivariate correlational analysis found that ADL impairments had no any significant relationship with other variables and was not used in model testing.. Path analysis indicated that the proposed Dementia Caregiving Model did not fit the data well. Model modifications were performed based on AMOS 5.0 output and the theoretical rationale for the potential modifications. The modified final model fit the data perfectly. It explained 21.1% and 39.7% of the variance in caregiver physical health and psychological health respectively. In the final models, behavioral problems of care-recipients and perceived social support of caregivers had direct and indirect effects on caregiver physical health and psychological health. Familism and caregiving satisfaction only had indirect effects on caregiver psychological health and no effects on caregiver physical health. Conversely, caregiving subjective burden and coping had direct effects on caregiver health; burden had direct effects on both physical and psychological health of caregivers, whereas coping had a direct effect on caregiver psychological health.The findings enrich knowledge of dementia family caregiving in the context of China and Chinese culture and add the important variables of caregiver appraisal of caregiving satisfaction and familism to existing theories and models of stress and coping on family caregiving cross culturally. This study not only contributes to Chinese nursing research by introducing a conceptual model for family caregiving of elders with dementia, but also can be a basis for formulating interventions to help family caregivers of elders with dementia cope with their caregiving situations.

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