The behavioral manifestations of dementia can pose significant management difficulties for family members who provide daily care for a moderately impaired elder. Behavioral difficulties are particularly challenging for spouse caregivers, who are highly committed to caregiving, reside with the care recipient, and tend to be the only resource for care. Although the emotional and economic costs of caregiving have been documented, the actual processes by which care is provided by spouses and the ways in which behaviors are managed have not been systematically examined. Also, the relationship between cognitive appraisal and gender and race have not been examined, nor the relationship between specific caregiving actions and well-being. The purpose of this study is to develop and describe a typology of thinking and action processes by which spouses manage the daily care and difficult situations that arise in caring for their family member. These thinking and action processes are referred to as caregiving styles by the investigator. Thinking processes are comprised of the caregiver's beliefs as to what is happening to their family member, the meaning of these changes, and the expoused approaches for solving care related problems. Action processes represent the actual management strategies used by the spouse caregiven on a daily basis. Support is sought through a FIRST Investigator Award to conduct a five year study of the diversity in thinking and action processes of spouse caregivers (N=100).
Three specific aims of the study are to: 1. Describe the thinking and action processes of spouses who provide care in the home for their spouse with moderate dementia; 2. Develop a typology of caregiving style by describing the ways in which thinking and actions are combined; and, 3. Compare caregiving style by gender and race. A secondary aim of this study is to examine the associations between caregiving styles and well-being (depression, burden, and uplifts). The research design for the proposed study emphasizes data collection through in-depth interviews and observations in 3 home visits, designed to build on one another, beginning with an examination of thinking processes related to care in Visit One. In Visit Two, observations of the caregiver while working with the impaired spouse during a meal preparation and eating activity will form the basis for open-ended questions about the caregiver's perceptions on his/her actions. In Visit Three, the caregiver will choose a care activity which typifies his/her approach to care for interviewer observation. Through interview, the caregiver will compare thinking and action, and reflect on the origins and challenges of care approaches. As a result, the investigator will gain additional insight as to how thinking and action are combined. Thematic analysis is used to examine the diversity in thinking and action and to develop and describe caregiving styles, and qualitative display matrices are used to compare styles associated with several factors, such as well-being. This study builds upon and expands preliminary work by the PI and ongoing funded research efforts in dementia management in collaboration with the Co-Investigator. It is anticipated that the outcomes of this study, better understanding of the process of caring by spousal caregivers, has significance for the development of culturally relevant, effective caregiver services.
| Corcoran, Mary A (2011) Caregiving styles: a cognitive and behavioral typology associated with dementia family caregiving. Gerontologist 51:463-72 |
