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Abstract
Purpose
This study was a systematic review and metaanalysis designed to investigate the variables related to burden of caregivers of people with dementia living at home.
Methods
In total, 24 studies were identified through a systematic review and 11 studies met the inclusion criteria for the metaanalysis. EMBASE, MEDLINE(Ovid-MEDLINE, Pubmed) and several Korean databases were searched until April 2018. ‘ R 3.5.1’ version was used to analyze the correlated effect sizes.
Results
According to the results, variables related to caregivers’ burden were categorized into factors related to patients and factors related to family caregivers. The effect sizes of correlations between factors associated with patients and caregivers’ burden were as follows: problematic behavior & cognition(memory) (.42), problematic behavior (.37), cognition(memory) (.35), stage of dementia (.31), and ability to perform daily life functions(-.27). Factors associated with family caregivers correlated with caregiver burden as follows: health status (-.40), relation (.33), education(.25), time of caring (.24), income(-.21), age(.20), job(-.17), duration of caring(.15), and religion (.14).
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Appendix 1. Studies Included in Systematic Review and Meta-analysis.
A1. Brodaty H, Woodward M, Boundy K, Ames D, Balshaw R. PRIME Study Group. Prevalence and predictors of burden in caregivers of people with dementia. The American Journal of Geriatric Psychiatry. 2014; 22(8):756–65. https://doi.org/10.1016/j.jagp.2013.05.004.
A2. Campbell P, Wright J, Oyebode J, Job D, Crome P, Bentham P, et al. Determinants of burden in those who care for some-one with dementia. International Journal of Geriatric Psychiatry. 2008; 23(10):1078–85. https://doi.org/10.1002/gps.2071.
A3. Cheng S-T, Lam LCW, Kwok T. Neuropsychiatric symptom clusters of Alzheimer disease in Hong Kong Chinese: correlates with caregiver burden and depression. The American Journal of Geriatric Psychiatry. 2013; 21(10):1029–37. https://doi.org/10.1016/j.jagp.2013.01.041.
A4. Choi YO. A study on the care burden and service demand of the poverty families caring for the demented elderly. Journal of Korean Geriatric Psychiatry. 2005; 9(2):122–31.
A5. Cho E, Cho E, Kim S. Effects of family relationship on burden of family caregivers of older adult with dementia. Journal of the Korean Gerontological Society. 2010; 30(2):421–37.
A6. Han EJ, Na YK, Lee JS, Kwon J. Factors to influence the family caregivers' burden with the community-dwelling elderly under longterm care insurance system: comparison among sub-dimensions. Korea Social Policy Review. 2015; 22(2):61–96. https://doi.org/10.17000/kspr.22.2.201506.61.
A7. Han JW, Jeong H, Park JY, Kim TH, Lee DY, Lee DW, et al. Effects of social supports on burden in caregivers of people with dementia. International Psychogeriatrics. 2014; 26(10):1639–48. https://doi.org/10.1017/S1041610214001331.
A8. Kong E-H, Cho E, Song M. The burden and caregiving satisfaction of primary family caregivers of older adults with dementia: cultural and non-cultural predictors. Journal of the Korean Gerontological Society. 2009; 29(2):701–16.
A9. Lee E-H. Impact of family function in the burden of caregiving elderly dementia patients. Korean Journal of Gerontological Social Welfare. 2003; 19:173–97.
A10. Lee H-J. Influencing factors and caregiving burden among primary caregiver for demented elderly. Korean Journal of Care Work. 2006a; 2(1):33–60.
A11. Lee H-J. The effect of caregiver's burden for the dementia elderly by the use of daycare center. Journal of the Korean Gerontological Society. 2006b; 26(2):329–46.
A12. Lee Y, Kim H, Cho I. Factors influencing care burdens of caregivers of elders with dementia who request dementia domi-ciliary welfare services. Journal of Korean Academy of Fundamentals of Nursing. 2008; 15(3):274–83.
A13. Liu S, Li C, Shi Z, Wang X, Zhou Y, Liu S, et al. Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. Journal of Clinical Nursing. 2017; 26(9-10):1291–300. https://doi.org/10.1111/jocn.13601.
A14. Ma PS. A study on the people in charge of the demented- es-pecially people in the day care center or short stay service. [master's thesis]. Seoul: Ewha Womans University;1998. p. 1–93.
A15. Miller LA, Mioshi E, Savage S, Lah S, Hodges JR, Piguet O. Identifying cognitive and demographic variables that con-tribute to carer burden in dementia. Dementia and Geriatric Cognitive Disorders. 2013; 36(1-2):43–9. https://doi.org/10.1159/000347146.
A16. Mioshi E, Foxe D, Leslie F, Savage S, Hsieh S, Miller L, et al. The impact of dementia severity on caregiver burden in fron-totemporal dementia and Alzheimer disease. Alzheimer Disease & Associated Disorders. 2013; 27(1):68–73. https://doi.org/10.1097/WAD.0b013e318247a0bc. A17. Onishi, J, Suzuki Y, Umegaki H, Nakamura A, Endo H, Igu-chi A. Influence of behavioral and psychological symptoms of dementia (BPSD) and environment of care on caregivers' burden. Archives of Gerontology and Geriatrics. 2005; 41(2):159–68. https://doi.org/10.1016/j.archger.2005.01.004.
A18. Rosdinom R, Zarina MZN, Zanariah MS, Marhani M, Suzaily W. Behavioural and psychological symptoms of dementia, cognitive impairment and caregiver burden in patients with dementia. Preventive Medicine. 2013; 57:S67–9. https://doi.org/10.1016/j.ypmed.2012.12.025.
A19. Shin H, Youn J, Kim JS, Lee J-Y, Cho JW. Caregiver burden in Parkinson disease with dementia compared to Alzheimer disease in Korea. Journal of Geriatric Psychiatry and Neurology. 2012; 25(4):222–6. https://doi.org/10.1177/0891988712464819.
A20. Son YJ, Kang KS, Kim SJ. The home care need and the burden of a primary family care giver with senile dementia patients. Journal of Korean Academy of Community Health Nursing. 2000; 11(2):423–40.
A21. Song M-Y, Choe G-G. The decision factor on primary caregiver's burden for senile dementia elderly. Korean Journal of Gerontological Social Welfare. 2007; 37:131–60.
A22. Yoo IY, Kim M. Influencing factors on care burden in the caregivers of demented elderly. Journal of Korean Gerontological Nursing. 2006; 8(1):45–57.
A23. You KS. A study on the care burden of family caregivers for senile dementia. Journal of Korean Public Health Nursing. 2001; 15(1):125–47.
A24. Wang J, Xiao LD, He G-P, Ullah S, De Bellis A. Factors con-tributing to caregiver burden in dementia in a country without formal caregiver support. Aging & Mental health. 2014; 18(8):986–96. https://doi.org/10.1080/13607863.2014.899976.
Table 1.
Characteristics of Studies included in Systemic Review; for Patients
| Author (year) | Publication | Sample size | BM | MA | Factors | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| General | Disease related | Others | |||||||||||||
| Age | Gender | Spouse | E | SOD | PB | C or M | PB & C (M) | PFDL | DOD | ||||||
| Boundy et al. 2014 [A1] | Journal | 732 | ZBI | o | o | o† | o | o† | o | o† | o | o† | Antidepressant, chEI, antipsychotic, type of dementia† | ||
| Campbell et al.2008 [A2] | Journal | 74 | ZBI | o | o | o | |||||||||
| Cheng et al.2013 [A3] | Journal | 142 | ZBI | o | o† | o†(M) | o | Depression† | |||||||
| Choi, 2005 [A4] | Journal | 229 | CCI | o | o† | o† | Number of children | ||||||||
| Cho et al. 2010 [A5] | Journal | 131 | Kwon | o | o | o† | o | Frequency of symptom (PB & M) | |||||||
| Han et al. 2015 [A6] | Journal | 1,827 | Kwon | o† | o† | o | o† | o | o | Other disease, qualification of national health insurance service†, residential area†, longterm care service class, needs of nursing treatment, service discomfort, wish other longterm care service, wish additional service | |||||
| Han et al.2014 [A7] | Journal | 1,462 | ZBI | o† | o | ||||||||||
| Kong et al. 2009 [A8] | Journal | 112 | K-ZBI | o | o† | o (M) | o† | ||||||||
| Lee, 2003 [A9] | Journal | 70 | CBI | o | o | The existence of children | |||||||||
| Lee, 2006a [A10] | Journal | 196 | CBI & Kwon | o | o | o | o† | ||||||||
| Lee, 2006b [A11] | Journal | 364 | CBI & Kwon | o | o | o | o† | o† | |||||||
| Lee et al. 2008 [A12] | Journal | 92 | Kwon | o | o† | o† | o | o† | Religion†, number of other disease, disease existence, number of children | ||||||
| Liu et al. 2017 [A13] | Journal | 309 | ZBI | o | o | o | o | o† | o | ||||||
| Ma, 1998 [A14] | Thesis | 91 | CBI | o | o† | o† | o | ||||||||
| Miller et al. 2013 [A15] | Journal | 96 | ZBI | o† | o† | Type of dementia (diagnosis)† | |||||||||
| Mioshi et al.2013 [A16] | Journal | 76 | short-ZBI | o† | o | ||||||||||
| Onishi et al.2005 [A17] | Journal | 116 | ZBI | o† | o† | Frequency of symptom (BPSD), urinary incontinence† | |||||||||
| Rosdinom et al.2013 [A18] | Journal | 65 | ZBI | o | o | o | o | o | o† | o | Race, marital status | ||||
| Shin et al.2012 [A19] | Journal | 151 | ZBI | AD: o† PDD: o | † o | AD: o† PDD: o | |||||||||
| Son et al.2000 [A20] | Journal | 53 | Kwon | o | o | o†(C) | o | o | |||||||
| Song et al.2007 [A21] | Journal | 128 | Kwon | o†(C) | |||||||||||
| Yoo et al. 2006 [A22] | Journal | 139 | Kwon | o | o† | o† | o† | o† | Character change† | ||||||
| Yoo, 2001 [A23] | Journal | 137 | CCI | o | o | o | o† | o†(C) | o† | Treatment or not | |||||
| Wang et al.2014 [A24] | Journal | 152 | CBI | o | o† | o† | |||||||||
| Total | 11 | 9 | 6 | 4 | 7 | 7 | 11 | 10 | 5 | 17 | 9 | ||||
AD=Alzheimer's disease; BM=burden measurement; BPSD=behavioral and psychological symptoms of dementia; C=cognition; CBI=caregiver burden inventory; CCI=cost of care index; ChEI=cholinesterase inhibitor; DAS=dementia attitude scale; DOD=duration of dementia; dys-B-COPE=dysfunctional-brief COPE, E=education; M=memory; MA=metaanalysis; PB=problematic behavior; PDD=Parkinson disease with dementia; PFDL=perform function of daily life; SOD=stage of dementia; ZBI=zarit burden interview;
Table 2.
Characteristics of Studies included in Systemic Review; for Family Caregivers
| Author (year) | MA | A Age | Factors | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| General | Caring related Health related | Others | ||||||||||||||
| Gender | R | E | Job | SES | Income | RWP | DOC | TOC | Family help | y Living with PWD | Health status | D | ||||
| Boundy et al. 2014 [A1] | o† | o | ||||||||||||||
| Campbell et al.2008 [A2] | o | o | o† | Relationship quality, caregiver overload, family disagreement, role capitivity, conodence, neuroticism | ||||||||||||
| Cheng et al.2013 [A3] | o | o | o | |||||||||||||
| Choi, 2005 [A4] | o | o† | o† | |||||||||||||
| Cho et al. 2010 [A5] | o | o† | o | o† | o | o† | o | o† | o† | Mutual relation†, cohesiveness†, expression†, conflict†, hours of rotation family†, number of rotation family† | ||||||
| Han et al. 2015 [A6] | o† | o | o | o† | o† | o† | o† | o† | o† | o† | Marital status, economic activity†, inconvenience of service use, counseling, residential area, home-based benefits, service type, non-long term care service resources, desire of other longterm care service† | |||||
| Han et al. 2014 [A7] | o† | DAS†, dys-B†, number of visits† | ||||||||||||||
| Kong et al. 2009 [A8] | o | o | o | o† | Familyism, intimacy, motivation of caring, satisfaction of caring | |||||||||||
| Lee, 2003 [A9] | o | o† | o | o | o | o† | o† | |||||||||
| Lee, 2006a [A10] | o | o | o | o† | o | |||||||||||
| Lee, 2006b [A11] | o | o | o | o† | o | |||||||||||
| Lee et al. 2008 [A12] | o | o | o | o† | o | o† | o† | o† | Spouse, amount of resting†, cost of caring, will of caring†, fatigue†, helper | |||||||
| Liu et al. 2017 [A13] | o | o | o | o | o | o | o | o† | o | Emotional state, sleep quality, adequate sleep, level of life satisfaction, PHQ-9†, GAD-7†, PSQI, working time, number of family | ||||||
| Ma, 1998 [A14] | o | o† | o† | o† | Objective health status† | |||||||||||
| Miller et al. 2013 [A15] | o† | |||||||||||||||
| Mioshi et al.2013 [A16] | o† | o† | ||||||||||||||
| Onishi et al.2005 [A17] | o | o | o | o | o | o | o† | Premorbid interpersonal relationship with a care recipient, frequency of physical pain, the presence of an intimate counselor†, the presence of an alternative caregiver, desire, satisfaction | ||||||||
| Rosdinom et al.2013 [A18] | o | o | o | o† | o | o | o | o | Marital status, race, caregiving | |||||||
| Shin et al.2012 [A19] | AD: o† PDD: o | AD: caregivers' health related quality of life (EQ-5D)† PDD: caregivers' health related quality of life (EQ-5D) | ||||||||||||||
| Son et al.2000 [A20] | o | o† | o† | |||||||||||||
| Song et al.2007 [A21] | o† | o† | o | o | o† | |||||||||||
| Yoo et al. 2006 [A22] | o | o | o | o | o† | o† | o | o† | o† | |||||||
| Yoo, 2001 [A23] | o | o | o | o | o | o | o | Reason of caring†, facility use†, contents of helping, type of helpers | ||||||||
| Wang et al.2014 [A24] | o | o | o† | o | o | o | o | Financial burden, paid caregiver | ||||||||
| Total | 11 | 13 | 13 | 4 | 8 | 6 | 6 | 11 | 13 | 7 | 10 | 2 | 5 | 9 | 4 | |
AD=Alzheimer's disease; D=depression; DAS=dementia attitude scale; DOC=duration of caring; E=education; EQ-5D=visual analog scale of EuroQol; GAD-7=the generalized anxiety disorder scale; MA=metaanalysis; PHQ-9=the patient health questionnaire; PDD=Parkinson disease with dementia; PSQI=the Pittsburgh Sleep Quality Index; PWD=patien.t with dementia; R=religion; RWP=relation with patients; SES=subjective economic status; TOC=time of caring;
Table 3.
Effect Size of Defensive Sub-variables related to Burden
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