Long-term care placement of dementia patients and caregiver health and well-being

Richard Schulz, Steven H. Belle, Sara J Czaja, Kathleen A. McGinnis, Alan Stevens, Song Zhang

Research output: Contribution to journalArticle

230 Citations (Scopus)

Abstract

Context: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. Objective: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. Design, Setting, and Participants: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. Main Outcome Measures: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. Results: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P=.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P=.21). These effects were most pronounced among caregivers who were married to the patient (P=.02 for depression), visited more frequently (P=.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P=.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P=.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P=.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative. Conclusions: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.

Original languageEnglish
Pages (from-to)961-967
Number of pages7
JournalJournal of the American Medical Association
Volume292
Issue number8
DOIs
StatePublished - Aug 25 2004

Fingerprint

Long-Term Care
Caregivers
Dementia
Depression
Health
Anxiety
Epidemiologic Studies
Equipment and Supplies
Anti-Anxiety Agents
Spouses
Antidepressive Agents
Prescriptions
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schulz, R., Belle, S. H., Czaja, S. J., McGinnis, K. A., Stevens, A., & Zhang, S. (2004). Long-term care placement of dementia patients and caregiver health and well-being. Journal of the American Medical Association, 292(8), 961-967. https://doi.org/10.1001/jama.292.8.961

Long-term care placement of dementia patients and caregiver health and well-being. / Schulz, Richard; Belle, Steven H.; Czaja, Sara J; McGinnis, Kathleen A.; Stevens, Alan; Zhang, Song.

In: Journal of the American Medical Association, Vol. 292, No. 8, 25.08.2004, p. 961-967.

Research output: Contribution to journalArticle

Schulz, R, Belle, SH, Czaja, SJ, McGinnis, KA, Stevens, A & Zhang, S 2004, 'Long-term care placement of dementia patients and caregiver health and well-being', Journal of the American Medical Association, vol. 292, no. 8, pp. 961-967. https://doi.org/10.1001/jama.292.8.961
Schulz, Richard ; Belle, Steven H. ; Czaja, Sara J ; McGinnis, Kathleen A. ; Stevens, Alan ; Zhang, Song. / Long-term care placement of dementia patients and caregiver health and well-being. In: Journal of the American Medical Association. 2004 ; Vol. 292, No. 8. pp. 961-967.
@article{1769bfa7ef5a409f93bf5d33b7e0ca31,
title = "Long-term care placement of dementia patients and caregiver health and well-being",
abstract = "Context: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. Objective: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. Design, Setting, and Participants: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. Main Outcome Measures: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. Results: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P=.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P=.21). These effects were most pronounced among caregivers who were married to the patient (P=.02 for depression), visited more frequently (P=.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P=.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1{\%}) to after (17.9{\%}) placement (P=.16). The use of anxiolytics before to after placement increased from 14.6{\%} to 19{\%} (P=.02), and nearly half of caregivers (48.3{\%}) were at risk for clinical depression following placement of their relative. Conclusions: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.",
author = "Richard Schulz and Belle, {Steven H.} and Czaja, {Sara J} and McGinnis, {Kathleen A.} and Alan Stevens and Song Zhang",
year = "2004",
month = "8",
day = "25",
doi = "10.1001/jama.292.8.961",
language = "English",
volume = "292",
pages = "961--967",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - Long-term care placement of dementia patients and caregiver health and well-being

AU - Schulz, Richard

AU - Belle, Steven H.

AU - Czaja, Sara J

AU - McGinnis, Kathleen A.

AU - Stevens, Alan

AU - Zhang, Song

PY - 2004/8/25

Y1 - 2004/8/25

N2 - Context: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. Objective: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. Design, Setting, and Participants: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. Main Outcome Measures: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. Results: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P=.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P=.21). These effects were most pronounced among caregivers who were married to the patient (P=.02 for depression), visited more frequently (P=.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P=.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P=.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P=.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative. Conclusions: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.

AB - Context: Placing a relative with dementia into a long-term care facility is common among caregivers. Placement transition and factors that affect caregiver health and well-being after placement of the patient are not well described. Objective: To assess the impact of placing a relative with dementia in a long-term care facility on caregivers' health and well-being. Design, Setting, and Participants: Prospective study from 1996 to 2000 of the placement transition in a sample of 1222 caregiver-patient dyads recruited from 6 US sites. A total of 180 patients were placed in a long-term care facility during the 18-month follow-up period. Data collected before and after placement were analyzed to identify factors associated with placement, the nature of contact between caregivers and their institutionalized relatives after placement, and the relation of both of these factors to health outcomes among dementia caregivers. Main Outcome Measures: Caregiver depression (symptoms on the Center for Epidemiological Studies-Depression [CES-D] scale; range, 0-60) and anxiety (State Trait Inventory; range, 10-40) and use of prescription medications for depression and anxiety. Results: Caregivers who institutionalized their relative reported depressive symptoms and anxiety to be as high as they were while in-home caregivers. Overall CES-D scores for depression did not change from before to after placement (median [IQR], 15.0 [8-24.5] and 15.0 [7.7-28]; P=.64). Overall anxiety scores on the State Trait Inventory also did not change significantly (median [IQR], 22.0 [19-27] before vs 21.1 [18-27] after; P=.21). These effects were most pronounced among caregivers who were married to the patient (P=.02 for depression), visited more frequently (P=.01 for depression and P<.001 for anxiety), and were less satisfied with the help they received from others (P=.003 for depression and P<.001 for anxiety). The use of antidepressants did not change significantly before (21.1%) to after (17.9%) placement (P=.16). The use of anxiolytics before to after placement increased from 14.6% to 19% (P=.02), and nearly half of caregivers (48.3%) were at risk for clinical depression following placement of their relative. Conclusions: The transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. Clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals.

UR - http://www.scopus.com/inward/record.url?scp=4143137644&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4143137644&partnerID=8YFLogxK

U2 - 10.1001/jama.292.8.961

DO - 10.1001/jama.292.8.961

M3 - Article

C2 - 15328328

AN - SCOPUS:4143137644

VL - 292

SP - 961

EP - 967

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 8

ER -