Alzheimer's Disease Caregiver Burden

173 Pages·2016·1.17 MB·English

University of Tennessee, Knoxville
Trace: Tennessee Research and Creative
Exchange
Doctoral Dissertations Graduate School
12-2010
Alzheimer's Disease Caregiver Burden: Does
Resilience Matter?
Cathy B Scott
University of Tennessee - Knoxville, [email protected]
Recommended Citation
Scott, Cathy B, "Alzheimer's Disease Caregiver Burden: Does Resilience Matter?. " PhD diss., University of Tennessee, 2010.
https://trace.tennessee.edu/utk_graddiss/912
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To the Graduate Council:
I am submitting herewith a dissertation written by Cathy B Scott entitled "Alzheimer's Disease Caregiver
Burden: Does Resilience Matter?." I have examined the final electronic copy of this dissertation for form
and content and recommend that it be accepted in partial fulfillment of the requirements for the degree
of Doctor of Philosophy, with a major in Social Work.
David R. Dupper, Major Professor
We have read this dissertation and recommend its acceptance:
Bill Nugent, Becky Fields, Sherry Cummings
Accepted for the Council:
Carolyn R. Hodges
Vice Provost and Dean of the Graduate School
(Original signatures are on file with official student records.)
To the Graduate Council:

I am submitting herewith a dissertation written by Cathy Brawley Scott entitled “Alzheimer’s
disease caregiver burden: Does resilience matter?” I have examined the final electronic copy of
this dissertation for form and content and recommend that it be accepted in partial fulfillment of
the requirements for the degree of Doctor of Philosophy, with a major in Social Work.

David R. Dupper, Major Professor

We have read this dissertation
and recommend its acceptance:

Bill Nugent

Becky Fields

Sherry Cummings

Accepted for the Council:

Carolyn R. Hodges
Vice Provost and Dean of the Graduate School

(Original signatures are on file with official student records.)
Alzheimer’s Disease Caregiver Burden: Does Resilience Matter?

A Dissertation
Presented for the
Doctor of Philosophy
Degree
The University of Tennessee, Knoxville

Cathy B. Scott
December 2010
DEDICATION
This dissertation is dedicated to my dear mother, the late Mary Brawley, for her
enduring love and support in my life. She always offered comforting words and
encouragement. Because of the legacy of determination she instilled in me, I was able to
pursue and accomplish my dream. This day, I know her spirit is with me.
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ACKNOWLEDGEMENTS
First I would like to thank my Lord and Savior Jesus Christ. Without His strength, this
journey would not have been possible. I would also like to thank my loving and supportive
husband, Rodney Scott, for being so understanding while I had to spend so much time away from
our family and for your prayers while I traveled to and from school. Your support meant
everything to me. To my beautiful daughters, Sydnee and McKenzie, thank you for being such
sweet and obedient girls. I will especially cherish the many evenings the three of us sat together
and did our homework. Remember to pursue your dreams steadfastly.
I would like to acknowledge each of my committee members for their unique
contribution to me during the dissertation process. To Dr. David Dupper, thank you for the
guidance and support you offered throughout this daunting experience and for your reassurance
when I was feeling overwhelmed; To Dr. Sherry Cummings, thank you for the critical feedback
you offered in my writing and for being an inspiration for my work in social work and
gerontology; To you, Dr. Becky Fields, thank you for being a role model for me and challenging
me to strive for excellence; Finally, Dr. Bill Nugent, thank you for being patient with me in my
quest to grasp the fundamentals of data analysis.
I would also like to thank the staff at Alexian Brothers PACE program for their support
and encouragement. So often, many of you stopped me, asked how the research project was
coming and cheered me on. I offer much gratitude to you for your kindness. Thank you to Amy
French and the Southeast Alzheimer’s Association for their commitment to support my research.
Adrienne Dessel, my cohort member, colleague and friend. Thank you so much for the
unwavering support you have offered me. You are truly an inspiration.
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Abstract

Caring for an individual with Alzheimer’s disease is especially challenging and impacts
every aspect of the lives of the informal caregivers. Informal caregiving is defined as unpaid care
provided by family or friends to people with a chronic illness or disability (Young & Newman,
2002). Caregiver burden involves the physical, psychological, social and emotional problems
experienced by a caregiver of an impaired loved one (Gwyther & George, 2006). Alzheimer’s
disease caregivers report more depression than their caregiving and non-caregiving peers,
experience increased physical decline, and often experience financial challenges. Evidence
suggests Alzheimer’s disease caregiver burden is a result of both care recipient and caregiver
factors. Pearlin et al’s Stress Process model (1990) is widely used to examine triggers in
caregiver burden. The model consists of antecedents, stressors, and outcomes. Few studies have
examined moderators in the burden process in Alzheimer’s disease caregiving. Whether
resilience accounts for variance in outcomes associated with caregiver burden is not addressed in
the literature. Data from a convenience sample of Alzheimer’s disease caregivers (N=111) were
examined for the purpose of exploring the moderating effect of resilience on the relationship
between stressors and caregiver burden predictors. RESULTS: Resilience did not moderate the
relationship between the caregiver stressors and caregiver burden. However, results indicated a
relationship between resilience and caregiver burden. Specifically, as resilience increases,
caregiver burden decreased. This finding highlights the importance of Alzheimer’s caregivers
and implementing support and interventions that will increase their resilience.
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TABLE OF CONTENTS
Chapter 1- Introduction 1
Statement of the Problem 2
Study Objectives
Chapter 2- Literature Review 7
Alzheimer’s Disease Caregivers 7
Theoretical perspectives 9
Caregiver Burden in AD caregivers 11
Predictors of caregiver burden 24
Moderators in caregiver burden 36
Resilience 41
Resilience and Alzheimer’s disease caregivers 58
What We Know & Remaining Questions 66
Chapter 3-Research Proposal 69
Conceptualizations 73
Methodology and Study Design 77
Research Questions 75
Hypotheses 75
Chapter 4-Data Analysis and Results 86
Limitations 97
Chapter 5- Discussion and Implications 100
References 106
APPENDIX 122
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LIST OF FIGURES

Figure 1: The Stress Process Model 11
Figure 2: The Resilience-Moderated Burden Model 70
Figure 3: The Resilience Scale Distribution of Scores 88
Figure D-1c: Alzheimer’s Knowledge Distribution of Scores 140
Figure D-2c: Activities of Daily Living Distribution of Scores 142
Figure D-3c: Instrumental ADL Distribution of Scores 144
Figure D-4c: Behavior Frequency Distribution of Scores 146
Figure D-5c: Reaction to Behavior Frequency Distribution of Scores 148
Figure D-6c: Caregiver Burden Distribution of Scores 150
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LIST OF TABLES
Table 1: Conceptualization Table 74
Table 2: Descriptive Statistics of Alzheimer’s Disease Caregivers 89
Table 3: Summary Statistics of the Study Variables 90
Table 4: Bivariate Correlations 93
Table 5: Model Summary Table 94
Table 6: Results of Multiple Regression 97
Table D-1a: Alzheimer’s Knowledge Case Summary 139
Table D-1b: Alzheimer’s Knowledge Descriptive Statistics 139
Table D-2a: Activities of Daily Living Case Summary 141
Table D-2b: Activities of Daily Living Descriptive Statistics 141
Table D-3a: Instrumental Activities of Daily Living Case Summary 143
Table D-3b: Instrumental Activities of Daily Living Descriptive Statistics 143
Table D-4a: Behavior Frequency Case Summary 145
Table D-4b: Behavior Frequency Descriptive Statistics 145
Table D-5a: Reaction to Behavior Frequency Case Summary 147
Table D-5b: Reaction to Behavior Frequency Descriptive Statistics 147
Table D-6a: Caregiver Burden Case Summary 149
Table D-6b: Caregiver Burden Descriptive Statistics 149
Table D-7 Alzheimer’s Knowledge Missing Values Summary 151
Table D-8 Activities of Daily Living Missing Values Summary 151
Table D-9 Instrumental Activities of Daily Living Missing Values 152
Table D-10 Behavior Frequency Missing Values Summary 153
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