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Alzheimer's Disease Caregiver Burden PDF

173 Pages·2016·1.17 MB·English
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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 This Dissertation is brought to you for free and open access by the Graduate School at Trace: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of Trace: Tennessee Research and Creative Exchange. For more information, please [email protected]. 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. ii 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. iii 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. iv 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 v 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 vi 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 vii

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