Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia

Miran Bang; Oksoo Kim

doi:10.7469/kjan.2016.28.1.71

Journal List > Korean J Adult Nurs > v.28(1) > 1076439

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Bang and Kim: Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia

Original Article

Korean J Adult Nurs 2016;28(1):71-82.

Published online: February 2016

DOI: https://doi.org/10.7469/kjan.2016.28.1.71

Effect of the Family Resilience Reinforcement Program for Family Caregivers of the Elderly with Dementia

Miran Bang^1,, Oksoo Kim²

^¹School of Nursing, Kyungdong University, Wonju

^²College of Nursing, Ewha Womans University, Seoul, Korea

Corresponding author: Bang, Miran Department of Nursing, Kyungdong University, 815 Gyeonhwon-ro, Munmak, Wonju 220-804, Korea. Tel: +82-33-738-1407, Fax: +82-33-738-1449, E-mail: bmr@kduniv.ac.kr

Received 3 November 201525 January 2016 Accepted 31 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to investigate the effect of Family Resilience Reinforcement Program (FRRP) for family caregivers of the elderly with dementia on the family resilience, caregiver burden, family adaptation, perceived health status and depression.

Methods

FRRP was implemented for 60 minutes each time, once a week, for 8 weeks. According to 3 factors of Walsh's Family resilience theory, FRRP was organized and specified as redefining ‘belief system’ in 1 to 2 sessions, figuring out one's own ‘organizational pattern’ in 3 to 5 sessions, enhancing ‘communication process’ in 6 to 8 sessions. A total of 46 family caregivers were assigned into either the experimental group with FRRP or the control group. Data were collected from February 18 to April 12, 2013 at the dementia support centers, and the data of 36 participants were finally analyzed.

Results

The experimental group reported statistically significant differences in family resilience (p=.002), caregiver burden (p=.012), family adaptation (p<.001), and perceived health status (p=.002) compared to those in the control group. No significant difference was found between the two groups in depression.

Conclusion

In the light of these results, FRRP is considered to decrease caregiver burden and to influence family resilience, family adaptation and perceived health status positively. The developed FRRP is considered to be an efficient nursing intervention for strengthening family resilience of the given population. It warrants future research expanding the range of target population to those caregivers of the patients with other chronic conditions.

Keywords: Dementia, Resilience, Family, Caregivers

REFERENCES

1.Ministry of Health & Welfare. 2012 Nationwide study on the prevalence of dementia in Korean elders [Internet]. Seoul: author;2013. [cited 2015 July 29]. Available from:. http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=286138&page=1.

2.Papastavrou E., Kalokerinou A., Papacostas SS., Tsangari H., Sourtzi P. Caring for a relative with dementia: family caregiver burden. Journal of Advanced Nursing. 2007. 58(5):446–57. http://dx.doi.org/10.1111/j.1365-2648.2007.04250.x.

3.Suh KH., Chun KI. The moderate effect of social support on family caregivers' burdens and health and quality of life with demented patients. Korean Journal of Culture and Social Issues. 2009. 15(3):339–57.

4.Park MH., Park MH., Kim HH. Effects of a multimodal psychoeducational program on burden, depression, and problem coping behaviors in family caregivers of patients with dementia. Journal of Korean Gerontological Nursing. 2015. 17(1):10–9. http://dx.doi.org/10.17079/jkgn.2015.17.1.10.

5.Song EJ., Jo HK. Effects of "Happy Plus Program" for family caregivers of patients with dementia on sleep, depression, burden, and quality of life of caregivers. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2014. 23(2):49–59. http://dx.doi.org/10.12934/jkpmhn.2014.23.2.49.

6.Walsh F. Strengthening family resilience. New York: Guilford Press;1998. p. 1–338.

7.Yoo YS. The study on factors affecting adaption of the family with the elderly dementia. Journal of Welfare for the Aged. 2007. 38:31–50.

8.Kim SD., Kim YH. The effect of family resilience on the life satisfaction of the family caregivers of the elderly with the dementia. Journal of Welfare for the Aged. 2009. 45:7–31.

9.Jang HY., Yi MS. Effects of burden and family resilience on the family adaptation of family caregivers of elderly with dementia. Korean Journal of Adult Nursing. 2013. 25(6):725–35. http://dx.doi.org/10.7475/kjan.2012.24.6.725.

10.Lee YK., Jung MH. The effect of family resilience on depression and suicide ideation of the elderly. Journal of Welfare for the Aged. 2013. 61:111–34.

11.Lee HJ., Lee JW., Lee JY. Family caregiver's burden for the elderly with dementia: moderating effects of social support. Journal of Institute for Social Sciences. 2015. 26(1):345–67. http://dx.doi.org/10.16881/jss.2015.01.26.1.345.

12.Oh H., Sok SH. Health condition, burden of caring, and the quality of life among family members of the elderly with senile dementia. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2009. 18(2):157–66.

13.Yang MH., Yoon GJ. A study on the development and effectiveness verification of a program designed to strengthen family resilience of inpatients with cancer and their families. Journal of the Korean Home Economics Association. 2012. 50(1):121–39. http://dx.doi.org/10.6115/khea.2012.50.1.121.

14.Min HS. The development and application of family resiliency improvement program for improving family adaptation of person with brain injury [dissertation]. Pusan: Kyungsung University;2007. p. 1–206.

Lim HS., Han KS. Effects of the family resilience enhancement program for families of patients with chronic schizophrenia. Journal of Korean Academy of Nursing. 2013. 43(1):133–42. http://dx.doi.org/10.4040/jkan.2013.43.1.133.

16.Seok HK., Choi JS. Family resilience enhancement for families with elders affected by dementia. Journal of Korean family therapy. 2015. 23(3):499–523.

17.Huey WT., Hashim S. A resilience training module for care-givers of dementia patients. SHS Web of Conferences. 2015. 18(05001):1–8. http://dx.doi.org/10.1051/shsconf/20151805001.

18.Faul F., Erdfelder E., Buchner A., Lang AG. Statistical power analyses using GPower 3.1: tests for correlation and regression analyses. Behavior Research Methods. 2009. 41(4):1149–60. http://dx.doi.org/10.3758/BRM.41.4.1149.

19.Sixbey MT. Development of the family resilience assessment scale to identify family resilience constructs [doctoral dissertation]. Florida: University of Florida;2005. p. 1–171.

20.Kim EJ. The influence of family stress on the personal and social performance in schizophrenia: The moderating effect of family resilience [master's thesis]. Seoul: Yonsei University;2007. p. 1–133.

21.Song SI. A study on adaptation of the family with mental disorder: focused on the moderating effect of family resilience. Journal of Social Welfare Development. 2010. 16(2):133–55.

22.Kwon JD. Measuring the caregiver burden of caring for the demented elderly. Yonsei Social Welfare Review. 1996. 3:140–68.

23.Antonovsky A., Sourani T. Family sense of coherence and family adaptation. Journal of Marriage and Family. 1988. 50(1):79–92. http://dx.doi.org/10.2307/352429.

24.Song JK. Strength and adaptation in families with epileptic children. Journal of Korean Family Therapy. 2009. 17(1):145–65.

25.Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977. 1(3):385–401. http://dx.doi.org/10.1177/014662167700100306.

26.Chon KK., Lee MK. Preliminary development of Korean version of CES-D. The Korean Journal of Clinical Psychology. 1992. 11(1):65–76.

27.Kim JY., Choi JW. A study on the influences of the filial responsibility attitude and care burden of the family with the elderly with dementia upon the changes of family relation. Korean Thought and Culture. 2011. 60:495–525.

28.Ahn YS., Jun HJ. The effects of alcoholic family's family resilience on family adaptation. Journal of Family Relations. 2010. 15(3):155–74.

29.Cheon SH. The relationship among perceived entrapment, depression and subjective well-being of women as family care-givers caring for dementia elderly. Korean Journal of Women Health Nursing. 2011. 17(3):285–93. http://dx.doi.org/10.4069/kjwhn.2011.17.3.285.

30.Suh KH., Chun KI. The moderate effect of social support on family caregivers' burdens and health and quality of life with demented patients. Korean Journal of Psychological and Social Issues. 2009. 15(3):339–57.

Figure 1.

Flow diagram of family resilience reinforcement program.

Table 1.

Contents of the Family Resilience Reinforcement Program

Unit	Session	Topic	Contents (min)
Orientation		The program orientation	Show the purpose, contents, and agenda of the program
			Understand the rules of the program
			Explain the manuals and sign the agreement form
			Introduce the participants and make the nicknames
			Pretest
Belief system	1	Dementia and family	Lesson (20 min): Dementia and family
			Group activity (40 min):
			Express one's perception about dementia patients
			Introduce family members
			Recognize the roles of the individual family members
	2	Find strengths in the difficult times	Lesson (20 min): what is family resilience?
			Group activity (40 min):
			Find the strengths in the family
			Discuss successful and unsuccessful cases in overcoming difficulties
Organizational pattern	3	Being a happy partner	Lesson (20 min): How to attend on dementia patients
			Group activity (40 min): laughter therapy
			Stress management of dementia patient's family: Laughter therapy
	4	Enhance family cohesion	Lesson (20 min): Family rules
			Group activity (40 min):
			Identify family rules
			Make functional family rules
			Enhance family interaction through the analysis of a genogram
	5	Utilizing the family resources	Lesson (20 min): Utilize dementia-related resources available in the community
			Group activity (40 min):
			Find the resources available in the family
			Find the resources available in society
			Establish a support group
Communication process	6	Observe family communication	Lesson (20 min): what is communication?
			Group activity (40 min):
			Identify the communication types of the family members
			Identify the improvements in communication
	7	Improve communication skills	Lesson (20 min): Effective communication
			Group activity (40 min):
			A clear and open communication method
			Reflective listening
			Practice effective communication methods
	8	Problem solving through cooperation	Lesson (20 min): An effective problem solving method
			Group activity (40 min):
			Apply a 6 step problem solving method
Wrap up		The end of the program	The program evaluation
			Award a certificate
			Write a letter to the dementia patient
			Posttest

Table 2.

Demographic Characteristics of the Participants (N=36)

Variables	Characteristics	Categories	Exp. (n=18)	Cont. (n=18)	x² or t or U	p
Variables	Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t or U	p
Family caregivers	Age (year)		62.8±13.29	61.7±12.19	0.25	.805
	Age (year)
	Gender	Male	0 (0.0)	3 (16.7)		.229
	Gender	Female	18 (100.0)	15 (83.3)
	Religion	Yes	14 (77.8)	17 (94.4)		.338
	Religion	No	4 (22.2)	1 (5.6)
	Family relation to patient	Spouse	10 (55.6)	11 (61.1)	2.70^†	.791
		Daughter	2 (11.1)	3 (16.7)
		Son	0 (0.0)	1 (5.6)
		Daughter-in-law	5 (27.8)	3 (16.7)
		Grandchildren	1 (5.6)	0 (0.0)
	Income (10,000 won)	≤100	6 (33.3)	7 (38.9)	3.63^†	.508
		101~200	7 (38.9)	3 (16.7)
		201~300	2 (11.1)	4 (22.2)
		301~400	1 (5.6)	3 (16.7)
		≥401	2 (11.1)	1 (5.6)
	Care costs (10,000 won)	≤10	5 (27.8)	2 (11.1)	6.85^†	.187
		11~30	6 (33.3)	5 (27.8)
		31~50	7 (38.9)	5 (27.8)
		51~70	0 (0.0)	3 (16.7)
		71~90	0 (0.0)	2 (11.1)
		≥91	0 (0.0)	1 (5.6)
	Period of caregiving (month)		50.4±50.08	56.7±31.55	-0.45	.658
	Caregiving time (hour/day)		17.3±6.90	18.1±8.61	-0.28	.783
Elderly with dementia	Age (year)		81.3±7.68	75.1±8.49	2.29	.029
	Period of dementia diagnosis (month)		40.8±44.97	54.3±30.19	-1.06	.298
	Living with spouse	Yes	10 (55.6)	14 (77.8)	2.00	.289
		No	8 (44.4)	4 (22.2)
	Taking medicine	Yes	17 (94.4)	18 (100.0)		.999
		No	1 (5.6)	0 (0.0)
Family resilience			182.56±21.30	183.78±17.07	155.00^‡	.833
Caregiver burden			88.00±25.34	88.17±16.80	-0.02	.982
Family adaptation			26.33±5.01	27.06±3.44	129.50^‡	.308
Perceived health status			2.17±1.04	2.44±0.62	123.00^‡	.226
Depression			17.94±9.86	17.89±9.66	0.02	.986

Exp.=experimental group (n=18); Cont.=control group (n=18);

^† Fisher's exact test;

^‡ Mann-Whitney U-test.

Table 3.

Differences in Family resilience, Caregiver burden, Family Adaptation, Perceived Health Status, and Depression after the Intervention Between the Two Groups (N=36)

Variables	Groups	Pretest	Posttest	t or Z (p)	Difference	t or U (p)
Variables	Groups	M±SD	M±SD	t or Z (p)	M±SD	t or U (p)
Family resilience	Exp.	182.56±21.30	191.50±20.68	-2.55 (.004)^†	8.94±16.64	70.50 (.002)^‡
Family resilience	Cont.	183.78±17.07	179.11±14.89	-1.66 (.051)^†	-4.67±13.53
Belief system	Exp.	54.72±6.42	57.33±6.27	-1.62 (.062)	2.61±6.84	2.09 (.022)
Belief system	Cont.	53.61±5.75	52.11±5.51	1.34 (.100)	-1.50±4.77
Organizational pattern	Exp.	73.11±9.00	76.17±8.99	-2.41 (.014)	3.06±5.37	2.95 (.003)
Organizational pattern	Cont.	73.28±7.41	70.94±6.35	1.77 (.048)	-2.33±5.59
Communication process	Exp.	54.72±7.58	58.00±6.76	-2.10 (.017)	3.28±6.67	101.00 (.027)
Communication process	Cont.	56.89±5.63	56.06±4.99	-0.91 (.191)	-0.83±4.54
Caregiver burden	Exp.	88.00±25.34	82.50±22.77	2.38 (.015)	-5.50±9.80	-2.37 (.012)
Caregiver burden	Cont.	88.17±16.80	92.89±24.50	-1.30 (.106)	4.72±15.47
Social activity restriction	Exp.	18.94±6.39	18.39±5.56	0.44 (.332)	-0.56±5.32	150.50 (.361)
Social activity restriction	Cont.	20.50±5.27	20.11±5.11	0.31 (.380)	-0.39±5.32
Negative change of elderly-caregiver relationship	Exp.	25.06±7.50	22.28±6.09	2.98 (.004)	-2.78±3.95	93.00 (.014)
Negative change of elderly-caregiver relationship	Cont.	22.33±4.83	23.17±6.02	-0.80 (.218)	0.83±4.44
Negative change of family relationship	Exp.	14.00±4.26	14.17±3.96	-0.24 (.407)	0.17±2.96	160.00 (.478)
Negative change of family relationship	Cont.	14.22±3.57	15.28±6.30	-0.90 (.192)	1.06±5.00
Psychological burden	Exp.	11.67±5.03	9.78±5.15	-3.04 (.001)	-1.89±2.08	-3.31 (.002)
Psychological burden	Cont.	10.72±3.97	12.83±5.31	-1.67 (.050)	2.11±4.69
Financial and job-related burden	Exp.	8.50±3.81	8.56±3.88	-0.12 (.451)	0.06±1.89	116.50 (.068)
Financial and job-related burden	Cont.	9.50±2.85	10.44±3.43	-1.96 (.033)	0.94±2.04
Health-related burden	Exp.	9.83±3.26	9.33±2.89	-1.30 (.118)	-0.50±1.47	-0.76 (.226)
Health-related burden	Cont.	10.89±3.01	11.06±3.23	-0.11 (.467)	0.17±3.42
Family adaptation	Exp.	26.33±5.01	29.72±5.04	-2.93 (.001)^†	3.39±4.06	40.00 (＜.001)^‡
Family adaptation	Cont.	27.06±3.44	24.83±3.30	-2.40 (.007)^†	-2.22±3.34
Perceived health status	Exp.	2.17±1.04	3.06±0.94	-2.89 (.002)^†	0.89±0.90	78.00 (.002)^‡
Perceived health status	Cont.	2.44±0.62	2.44±0.62	0.00 (.999)^†	0.00±0.59
Depression	Exp.	17.94±9.86	15.83±11.24	1.26 (.113)	-2.11±7.12	-0.79 (.218)
Depression	Cont.	17.89±9.66	18.00±6.97	-0.05 (.481)	0.11±9.59

Exp.=experimental group (n=18); Cont.=control group (n=18);

^† Wilcoxon Signed Rank test;

^‡ Mann-Whitney U-test.

TOOLS

Similar articles