Abstract
Problem: Over 5 million Americans are living with Alzheimer’s, and nearly 16 million baby boomers are likely to develop the disease by the year 2050. They will need someone to care for them. The people caring for them may experience stresses that affect their health and will affect how they care for persons with dementia.
Background: The existence of caregiver stress and its negative health effects have been well documented. However, little is known about how home visits influence caregivers stress levels.
Significance: Approximately 70% of people with dementia or cognitive impairment are living at home. Caregivers are at a high risk for stress and other complex and diverse health related problems. It is estimated that the cost of caring for persons with Alzheimer’s and other dementias in 2013 was $203 billion and will increase to $1.2 trillion by mid-century. Therefore, evaluating caregiver stress and medical home visits to persons with dementia is important before the consequences of caregiver stress lead to mounting medical expenditures. These increased expenditures will affect families, communities and the nation.
Methods: A cross-sectional convenience sample of all gender between the ages of 19 – 89 years old will be recruited from the homes visited for monthly medical evaluations by the nurse practitioner. Frequency statistics and measures of central tendency (means, medians) will be employed to describe the sample. Relationships between the variables will be explored using bivariate measures of association (Pearson’s r, Spearman’s rho as well as four-fold table analysis employing Odds Ratios and phi coefficients). Linear multiple regression modeling (F tests; fixed model, R² deviation from zero) will be used to assess the association of predictor variables (non-continuous predictors will be coded as dichotomous “dummy” variables with values of 1 and 0) with the outcome variable of stress. With a sample size of 100 and a maximum of nine predictors, a linear multiple regression analysis will be sensitive to overall medium to large effect size of f2=0.172 with a power of .8 with an alpha of .05. Individual bivariate regressions will be sensitive to effect sizes of r=0.243. Confidence Intervals (95%) for the population values of continuous variables will be within + 0.2SD of the sample estimates and will be within + 4.9% of the estimates obtained from categorical variable estimates. The participants will be identified by running a query in the New Horizons Family Clinic electronic health record to identify patients with any type of dementia. Two hundred charts using a random number generator will be randomly selected from that pool. The surveys will be mailed to the participants in a self-addressed-stamped envelope (SASE). The informed consent will be mailed in a separate SASE. Normally, only 50% people survey will respond to a survey. Therefore, 200 letters will be mailed. The person must be a caregiver for more than 6 months. The caregiver must write and understand English. The participant cannot have a mental illness. The Kingston Caregiver Stress Scale will be utilized to evaluate caregiving issues, family issues and financial issues of the caregiver. The search engines PubMed and CINHAL will be used to review literature, published between 2008- 2014.
Findings: These findings will examine stress in people caring for others with dementia. The results may help identify caregivers’ stress and allow the researcher to find ways decrease the caregiver stress. It may also identify if there is a positive relationship between caregivers stress and receipt of home visits to patients with dementia.
Key words: caregiving, dementia, house call, home visit, patients with Alzheimers
Modified Lazarus and Folkman Transactional Model of Stress and Coping
Conceptual Framework of the stress and outcome process
This is a scholarly nursing research project.
I am looking for caregiver statistic in the US, age, gender and education. Define C/G. complications of being a caregiver. The financial burden.
After these are defined, please indicate “ this evidence shows that intervention to decrease C/G is essential to …..
Reiterate the significance of home visits programs
Need Review of Literature to support this
The purpose of this study is to evaluate caregiver perceived stress
The findings will provide a basis to guide for further research and pilot programs that can ultimately alter the provision of effective and efficient intervention to decrease caregiver stress in caring for persons with dementia.
The objective of the investigator is to evaluate caregiver stress and examine if there is a positive relationship between caregiver stress and the delivery of home visits for persons with dementia. It is hoped that the outcome of…. Will pave the way for further exploration into ways to develop alternate mechanism for …..
Theoretical framework:
The NP making home visits provides a point of contact for caregivers and the outside health world
Study Design
Data Collection
Inclusion criteria
Exclusion criteria
Data Analysis
Demographics statistics will be inserted later once that information is collected and analyzed
Discussion: will be based on analysis. Caregiving in itself is stressful and requires an interdisciplinary team approach between caregiver, nurse practitioner, pharmacy and the community. The concentrated goal is that the outcomes and findings from the survey can pave the way for further research. One aspect would be to develop a more frequent monitoring such as telemonitoring to inspire and encourage and answer questions.
Limitations. The research has several limitations. It was primarily limited by its sample size. The sample size could have been expanded by including online surveys. It was limited also by scarcity by finding. Additionally, an earlier start in data collection would have increased the time needed for a pre-test and post-test data collection.
Future Research: A greater depth of information may have been obtained by doing online surveys, contacting agencies that are involved in caregiving with persons with dementia. Having open-ended questions would have allowed for theme search.
Implications: Caregivers indicated that they sometimes forego their own health conditions to care for persons with dementia. While they were optimistic about been less tressed about taking their loved ones from familiar setting caregiver own health conditions were unaddressed. This results in possibility of federal changes to amend or modify homebound status to include caregivers. Although respite is an alternative, persons with dementia don’t adjust well in new environment ???? SOURCE.
Caregiver Stress Survey
Please circle one or more choices about YOU
Ethnicity: Black White Other
Hispanic Non-Hispanic
Gender: Male Female
Marital status Partnered Married Single Divorced
Please answer these questions about YOU by filling in the blank.
Age: ___________
Highest grade completed ________________________
Relationship to person with dementia. I am the ________________________
For how many years and months have you provided care? _____ years _____months
Please answer these questions about the person you are taking care of.
Ethnicity: Black White Other
Hispanic Non-Hispanic
Gender: Male Female
Age: __________________
Diagnosed with dementia for how many: ____ years ____ months (____ not sure)
Thank you for your help so far. The rest of the questions will help us to know a little bit more about your unique situation.
Please circle only one answer to each questions as yes or no. Not Both
| I live with this person. | Yes | No | N/A |
| I am the only one providing care. | Yes | No | N/A |
| I provide care to others. | Yes | No | N/A |
| In an emergency, I have someone else to help me | Yes | No | N/A |
| The caregiving experience is affecting my job. | Yes | No | N/A |
| I have one or more chronic illness (high blood pressure, diabetes, etc.). | Yes | No | N/A |
| I am able to go to the doctor with the person I care for. | Yes | No | N/A |
| I am able to go to the doctor for myself. | Yes | No | N/A |
| My own health has affected my ability to provide care. | Yes | No | N/A |
| I feel satisfied with the care I give. | Yes | No | N/A |
| I have a medical person who comes in the home to see the person I am providing care for | Yes | No | N/A |
References
Alzheimer’s Disease Facts and Figures (2013). Retrieved on 8th February, 2014 from www.alz.org/facts
Bialon, L. N., & Coke, S. (2012). A study on caregiver burden: Stressors, challenges, and possible solutions. American Journal of Hospice & Palliative Medicine, 29(3), 210-218. doi:10.1177/1049909111416494
Caregiving in the U.S. (2011). National Alliance for Caregiving. Administration on Aging.
homebound elders: Does caregiver burden play a role? Journal of Aging Health, 9(25), 1036-1049
Folkman, S., & Lazarus, R. S. (1988). The relationship between coping and emotion: Implications for theory and research. Social Science & Medicine, 26 (3), 309-317. DOI: 10.1016/0277-9536(88)90395-4
Gitlin, L. N., Belle, S. H., Burgio, L. D., Czaja, S. J., Mahoney, D., Gallagher-Thompson, D., … & Ory, M. G. (2003). Effect of multicomponent interventions on caregiver burden and depression: the REACH multisite initiative at 6-month follow-up. Psychology and Aging, 18(3), 361. doi: 10.1037/0882-7974.18.3.361
Godwin, K. M., Mills, W. L., Anderson, J. A., & Kunik, M. E. (2013). Technology-driven interventions for caregivers of persons with dementia: a systematic review. American Journal of Alzheimer’s Disease and Other Dementias, 28(3), 216-222. doi:10.1177/1533317513481091; 10.1177/1533317513481091
Grant, J. S. (2008). Problem-solving training for family caregivers of persons with traumatic brain injuries: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89(5), 931-941. doi: 10.1037/a0028229
Marwit SJ, Meuser TM. (2002) Development and initial validation of an inventory to assess grief in caregivers of persons with Alzheimer’s disease. Gerontologist. 42(6):751-65
McDaniel, K., R., & Allen, D. G. (2012). Working and care-giving: The impact on caregiver stress, family-work conflict, and burnout. Journal of Life Care Planning, 10(4), 21-32.
Reckrey, J.M., DeCherrie, L.V., Kelley, A.S., & Ornstein, K. (2013). Health care utilization among homebound elders: Does caregiver burden play a role? Journal of Aging Health, 9(25): 1036-1049.
Rivera, P. A., Elliott, T. R., Berry, J. W., & Grant, J. S. (2008). Problem-solving training for family caregivers of persons with traumatic brain injuries: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89(5), 931-941. doi: 10.1016/j.apmr.2007.12.032
Thies, W., & Bleiler, L. (2011). Alzheimer’s disease facts and figures, Alzheimer’s and dementia. Alzheimer’s Association, 7(2), 208-244.
Tibaldi V, Aimonino N, Ponzetto M, Stasi MF, Amati D, Raspo S, Roglia D, Molaschi M, Fabris F. (2004) A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver’s stress. Archives of Gerontology and Geriatrics. Supplement.(9):431-6. DOI:10.1016/j.archger.2004.04.055
Vedhara, K., Shanks, N., Anderson, S., & Lightman, S. (2000). The role of stressors and psychosocial variables in the stress process: a study of chronic caregiver stress. Psychosomatic Medicine, 62(3), 374-385.
Unwin, B. K., & Tatum, P. E. (2011). House calls. American Family Physician, 83(8), 925-938.
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