Quality of in-home care, long-term care placement, and the survival of persons with dementia

• Published in: Aging & mental health 2015-12, Vol.19 (12), p.1093-1102
• Main Authors: McClendon, McKee J., Smyth, Kathleen A.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Caregivers - psychology; Caregivers - standards; Caring; coping; Dementia; Dementia - mortality; Dementia - nursing; dementia caregiving; Female; Home Nursing - standards; Humans; Long-Term Care; Male; Mental health; Nursing Homes; Proportional Hazards Models; Quality Assurance, Health Care; quality of caregiving; Quality of Life; Stress, Psychological; Survival; Survival Analysis; Survival strategy; Time Factors
• ISSN: 1360-7863; 1364-6915
• DOI: 10.1080/13607863.2014.1003284

Purpose of the study: Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival. Design and methods: We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival. Results: Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival. Implications: It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.