Determining factors of the psychological health of primary caregivers caring for people with dementia: A comparison between Taiwan and the United States
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Dementia is one of the most burdensome and expensive chronic diseases (Alzheimer's Association, 2003). The number of people with dementia is expected to double every 20 years worldwide (Ferri, et al., 2005). More than 70 % of all persons with dementia are cared for by their family members at home both in the U.S. and in Taiwan (Alzheimer's Association, 2007; Department of Statistics, 1997). The magnitude of caregiver burden is a predictor in determining if the care recipient will be kept at home, or if the care recipient will be institutionalized (Ho, Friedland, Rappolt, & Noh, 2003; Pinquart & Sorensen, 2006). The purpose of this study was to identify similarities and differences in the psychological health of adults caring for people with dementia in two aging societies: Taiwan and the U.S. The conceptual model leading to this study was adapted from a model of Alzheimer's caregiver stress (Pearlin, Mullan, Semple, & Skaff, 1990). Sixty-nine Taiwanese primary caregivers of adults with dementia and 50 American caregivers were enrolled. An interview form including the Center for Epidemiological Studies Depression Scale (CES-D), the UCLA Loneliness Scale (Version 3), the Picot Caregiver Reward Scale (PCRS), the Zarit Burden Interview (ZBI), and a questionnaire relating to background information, levels of involvement, and perceptions of services was distributed to all participants in this study. The participants in Taiwan were given Chinese versions of the questionnaires with an additional scale: the Social Obligation Scale. This data from the two countries were analyzed using independent t -tests, Pearson correlations, and discriminant analysis. No statistically significant difference was found between the two groups on burden, loneliness, and depression scores, but clinical differences were shown on levels of burden and depression. Considering factors other than nationality, caregivers who were spouses of the care recipient, who had not provided care for more than 5 years, who provided more than 80 hours of care per week, or who did not receive help from either a care aide or informal social network were more likely to suffer from negative consequences of caregiving. Unique predictors for the psychological health of caregivers in each country, and those universal in the total sample, were identified. The results also found that loneliness, not burden was highly correlated with depression. Informal support provided by family and friends, and formal support provided by health care professionals, were considered the most helpful and the most unhelpful support in both groups. Improving the understanding of dementia among family members of adults with dementia, and encouraging other family members to get more involved in caregiving tasks, may be helpful for relieving caregiver burden, and maintaining better psychological health of the caregivers. In addition, specific needs for services in each country were addressed.