O3‐07–02: Baseline differences and trajectories of change for patient‐caregiver dyads in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study differentiated by end‐of‐study patient outcome
Year: 2008
Type: article
Abstract: Several studies report baseline predictors of institutional placement and death of AD patients, but few report trajectories of change among patients and caregivers that precede these endpoints. Caregiver/patient dyads (N=1222) were assessed four times at six month intervals. At baseline, all caregivers were living with and providing care to a relative with dementia at home. By end of 18-months, patients became deceased (Deceased, N = 187), were placed in a long-term care facility (Placed, N = 180), or continued to receive care in the home from their relative (Continued, N = 855). We compared baseline differences and direction and magnitude of change in each of the three groups. At baseline, deceased patients had more Activities of Daily Living dysfunction (ADL, p<.001) than either the Continuous or Placed groups. Continuous caregivers were caring for patients with higher functioning in Instrumental Activities of Daily Living (IADL) (p<.001) and Mini Mental Status Scores (MMSE) (p<.01) than the other two groups. Caregivers of Placed patients used more homecare services than the other two groups (p<.05). To assess the direction and magnitude of change over time, we used MANOVA to test for group (Continuous, Deceased, and Placed) by time (baseline, six month follow-up) interactions using available data collected prior to death or placement. Statistically significant interactions were found for patient MMSE scores (F2,591=4.10, p=.02) and patient health service use (F2,893=6.42, p=.002). Patients in either the Deceased or Placed groups had greater cognitive declines than did patients in the Continued group. Deceased patients had more health service use while the other two groups showed no change. We also found a significant interaction for the extent to which caregivers were bothered by patient memory problems (F2,890=3.17, p=.04). Caregivers in either the Deceased or Continuous groups reported declines in bother by patient memory problems while caregivers in the Placed group reported increases. The combination of baseline status and direction of change uniquely characterize each of the three groups studied. Monitoring indicators of patient/caregiver status and their changes may improve service provision and planning for the future.
Source: Alzheimer s & Dementia
Institutions: University of Pittsburgh, University of Miami, Wyeth
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2079865319