Joan Vilalta-Franch

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design

BACKGROUND Research into burden among spouse and adult-child caregivers of patients with Alzheimers disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences. OBJECTIVES The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers. DESIGN Cross-sectional analytic study. SETTINGS All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain). PARTICIPANTS Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers. METHODS The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers. RESULTS The results show greater burden among adult-child caregivers (p<.05), who experience more feelings of guilt (p<.001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p<.001). Living with the patient has a notable influence on burden among adult children (p<.001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p<.05) and progressively worse mental health (p<.01). However, the correlations between burden and mental health were strongest in daughters (p<.001). CONCLUSION The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.

Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers

To compare care recipient and caregiver perceptions of quality of life in patients (QoL‐p) with Alzheimers disease (AD). To identify associated factors, and the concordances‐discrepancies.

Prevalence and risk factors of suspected elder abuse subtypes in people aged 75 and older.

OBJECTIVES: To assess the prevalence of suspected elder abuse subtypes and to identify related factors.

Incidence of dementia in a rural community in Spain: The Girona cohort study

Background: Information on dementia incidence in Spanish populations is still scarce, and there is a dearth of prospective studies. Objective: To estimate the incidence rates of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) in a population cohort aged 75 and over in a rural area in Spain. Methods: A prospective population cohort study over a 5-year period in 8 rural villages in the province of Girona. The baseline study in 1990 identified 200 prevalent cases of dementia. The dementia-free cohort included 1,260 persons aged 75 and over. This was the sample used for the incidence study. We rescreened and selectively reexamined this group in 1995 using a two-phase procedure consisting of a screening interview at home using the MMSE. Diagnoses of dementia, AD and VaD were established using the Cambridge Examination for Mental Disorders of the Elderly for surviving participants. For deceased participants, we used the Retrospective Collateral Dementia Interview to establish a diagnosis of dementia and AD according to DSM-III-R diagnostic criteria. Results: Information was obtained for 91% of the subjects at risk; 122 incident cases of dementia were identified. Incidence rates per 1,000 person-years at risk were 23.2 (95% CI = 19.1–27.3) for dementia, 10.8 (95% CI = 7.8–13.7) for AD and 9.5 (95% CI = 6.7–12.1) for VaD. All dementia subtypes showed an age-dependent pattern. Females had a relative risk of 1.8 (95% CI = 1.0–3.4) to develop AD. The inclusion of deceased cases with manifestations of dementia increased the rate of dementia incidence in 7.1 cases/1,000 person-years at risk. Conclusion: Incidence rates were similar to those reported by other cohort studies. All dementia subtypes increased with age, but incidence rates did not increase exponentially in the oldest old. Females were at increased risk for AD. The inclusion of information about dementia symptoms from relatives of deceased participants was useful in order to avoid underestimation of the dementia incidence rates. Underestimation of the incidence rates was more important in those aged 75–84 years.

Quality of Life of Patients with Alzheimer’s Disease: Differential Perceptions between Spouse and Adult Child Caregivers

Background/Aims: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer’s disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. Method: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. Results: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. Conclusions: Spouse caregivers have a more positive perception of the patient’s quality of life than adult child caregivers.

Burden associated with the presence of anosognosia in Alzheimer's disease

Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimers disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden.

Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort

OBJECTIVES to determine the prevalence of three independent, disability-free and operationally defined frailty phenotypes and the associated risk of mortality in a community-dwelling older people cohort over 74 years of age. METHODS observational, prospective and population-based design. Bio-psycho-social variables were assessed using a range of standardised instruments. The physical frailty phenotype (PFP), mental frailty phenotype (MFP) and social frailty phenotype (SFP) were operationally defined using a deficit accumulation model that excluded disability. Logistic regression analyses explored associations of the frailty phenotypes with sex, age and marital status, and a Cox proportional hazard regression analysis was performed to evaluate the association between frailty phenotypes and mortality. RESULTS of the eligible individuals, 82% (n = 875) participated. The prevalence of any frailty phenotype in an individual was 38.8%; 17.3% exhibited the PFP, 20.2% exhibited the MFP, and 8.9% exhibited the SPF. Older and female were more likely to exhibit the PFP, and widowhood was associated with the SFP. The hazard ratios of mortality were 3.09 (95% CI = 1.54-6.17) for the PFP and 2.69 (95% CI = 1.01-7.25) for the SFP. CONCLUSION three different disability-free frailty phenotypes were differentially related to the socio-demographical characteristics of sex, age and marital status and independently predicted risk of mortality.

Environmental Determinants of Quality of Life in Nursing Home Residents with Severe Dementia

To determine the relationship between quality of life (QOL) and environmental factors of temperature, noise, and lighting in nursing home residents with severe dementia.

Análisis de los costes de la enfermedad de Alzheimer en función del deterioro cognitivo y funcional

Fundamento y objetivo El objetivo del estudio fue determinar la relacion entre diversos costesde la atencion medica y sociosanitaria en pacientes con enfermedad de Alzheimer (EA) y lascaracteristicas clinicas y sociodemograficas de los pacientes y sus cuidadores. Pacientes y metodo Se realizo un estudio prospectivo observacional en una muestra de pacientesdiagnosticados de EA que recibian atencion ambulatoria. Se recogio informacion sobre el uso derecursos sanitarios y no sanitarios, y se realizo una estimacion de los costes desde una perspectivasocial. Para los costes indirectos se utilizo una aproximacion al coste de sustitucion. Se aplicoa los pacientes el Mini-Mental State Examination (MMSE) y a sus cuidadores la Escala de EvaluacionRapida de la Incapacidad (RDRS-2), el Inventario Neuropsiquiatrico (NPI), la Escala deSobrecarga del Cuidador (BI) y la Escala de Utilizacion de Recursos en Demencia (RUD). Se realizouna estratificacion de los pacientes a partir de su puntuacion en el MMSE. Resultados La muestra estuvo formada por 417 pacientes, con una edad media (DE) de 75,2(6,6) anos, de los cuales el 71% eran mujeres. La gravedad de la EA, a partir de la puntuaciondel MMSE, fue del 26% para MMSE superior a 19, del 66% para MMSE entre 19 y 11, y del8% para MMSE inferior a 11. El 69% de los cuidadores eran mujeres, con una edad media de57,1 (15,8) anos. El coste mensual estimado para los pacientes con MMSE superior a 19 fuede 419,3 € para los pacientes con MMSE entre 19 y 11, de 641,9 €, y para los pacientescon MMSE inferior a 11, de 1.150,6 €. Conclusiones El coste de la EA aumenta de forma significativa con el grado de deterioro cognitivoy funcional y el nivel de carga del cuidador. El sexo y el estado civil del paciente tambienestan asociados al coste de la enfermedad. Background and objective This study aims to identify the relationship between costs of medicaland social attention in patients with dementia of Alzheimer disease (AD) type and clinical andsociodemographic data of patients and their caregivers. Patients and method It was an analytic observational study in a cohort of patients diagnosedwith Alzheimers disease who received ambulatory attention. Information about the use of health-related resources was collected and costs were estimated from a societal perspective. Indirectcosts were calculated using a replacement cost approach. Patients and caregivers wereexamined with the Mini-Mental State Examination (MMSE), the Rapid Disability Rating Scale(RDRS-2), the Neurospychiatric Inventory (NPI), the Burden Interview (BI) and the ResourceUtilization in Dementia (RUD). Patients were grouped taking into account the score obtainedin the MMSE. Results A cohort of 417 patients, mean age (SD) 75.2 (6.6) years, 71% females, was studied.Disease severity levels were distributed as follows: MMSE, 26% for MMSE > 19, 66% forMMSE = 19-11, and 8% for MMSE 19, 641.9 € for MMSE = 19-11, and 1150.6 € for MMSE Conclusions The societal cost of AD increases dramatically with increasing disease severity.Caregiver burden and sex as well as the marital status of patients are associated wth the cost ofthe disease.

Depression subtypes and 5‐year risk of dementia and Alzheimer disease in patients aged 70 years

The objective of this study was to estimate several subtypes of depressive disorders as risk factors for dementia and Alzheimer disease (AD) specifically.