Celia Nogales-González

Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers

Introduction: Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers. Method: The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patients frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD. Results: We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers’ distress. Conclusions: The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.

Behavioral correlates of anxiety in well-functioning older adults

BACKGROUND Research on the behavioral correlates of anxiety in older adults is sparse. The aim of this study was to explore the association of anxiety with behavioral patterns defined by health, activity, emotional and social variables. METHODS A convenience sample of 395 older adults completed measures of health, activity, emotions, social variables and experiential avoidance. Cross-sectional data were analysed using cluster analysis. RESULTS Five clusters were identified: active healthy, healthy, active vulnerable, lonely inactive and frail lonely. Participants in the active healthy and healthy clusters showed the highest scores on health variables (vitality and physical function), and adaptive scores on the rest of variables. They also reported the lowest scores on anxiety and included the lowest number of cases with clinically significant anxiety levels. Active vulnerable showed high scores on social support, leisure activities and capitalization on them but low scores in vitality and physical functioning. Participants in the lonely inactive cluster reported the highest mean score in experiential avoidance and high scores on boredom and loneliness, and low scores on social support, leisure activities capitalizing on pleasant activities and health variables. Frail lonely represent a particularly vulnerable profile of participants, similar to that of lonely inactive, but with significantly lower scores on health variables and higher scores on boredom and hours watching TV. CONCLUSIONS Anxiety in older adults is not only linked to poor health, but also to dysfunctional social behavior, loneliness, boredom and experiential avoidance. Maladaptive profiles of older adults with regard to these variables have been identified.

ASSESSMENT OF PREFERENCE FOR EDIBLE AND LEISURE ITEMS IN INDIVIDUALS WITH DEMENTIA

We conducted 2 studies on reinforcer preference in patients with dementia. Results of preference assessments yielded differential selections by 14 participants. Unlike prior studies with individuals with intellectual disabilities, all participants showed a noticeable preference for leisure items over edible items. Results of a subsequent analysis with 3 participants showed reinforcement effects when highly preferred items were delivered as consequences.

Behavioral Intervention for Reducing Resistance in Care Recipients to Attending Adult Day Care Centers: A Pilot Study

The aim of the present study was to analyze the efficacy of an individualized intervention that trains caregivers of family members with dementia in behavioral skills to assess and modify their relative’s resistance to attending an adult day care center (ADC). Three caregivers were trained in assessment techniques for registering the behaviors related to resistance to attending the ADC, behavioral techniques for modifying antecedents and consequences of the behaviors, and implementation of those techniques. The frequency of behaviors was recorded every day. Caregivers’ depressive symptomatology and anxiety, and occurrence of care recipients’ behavioral problems related to attending the ADC, were assessed. After the intervention, frequency of behavioral problems decreased for all people with dementia, anxiety decreased for two caregivers, and depression decreased clinically for two caregivers. Behavior modification appears to be effective for helping caregivers to manage disruptive behaviors by care recipients associated with attending an ADC.

Rumiación y fusión cognitiva en el cuidado familiar de personas con demencia

INTRODUCTION Rumination has been described as a dysfunctional coping strategy related to emotional distress. Recently, it has been highlighted from the Acceptance and Commitment Therapy therapeutic approach, the negative role that cognitive fusion (the extent to which we are psychologically tangled with and dominated by the form or content of our thoughts) has on the explanation of distress. The aim of this study is to simultaneously analyze the role of rumination and cognitive fusion in the caregiving stress process. MATERIAL AND METHODS The sample of 176 dementia caregivers was divided in four groups, taking into account their levels of rumination and cognitive fusion: HRHF=high rumination+high cognitive fusion; HRLF=high rumination+low cognitive fusion; LRHF= low rumination+high cognitive fusion; and LRLC=low rumination and low cognitive fusion. Caregiver stress factors, frequency of pleasant events, experiential avoidance, coherence and satisfaction with personal values, depression, anxiety and satisfaction with life, were measured. RESULTS The HRHF group showed higher levels of depression, anxiety, experiential avoidance and lower levels of satisfaction with life, frequency of pleasant events, coherence and satisfaction with personal values, than the other three groups. CONCLUSIONS Considering simultaneously rumination and cognitive fusion may contribute to a better understanding of caregiver coping and distress.