Mediating role of care partner burden among dementia care partners during post-hospital transition

Figures & data

Figure 1. Hypothesized model of the mediating role of care partner burden between patient clinical characteristics (cognition, physical function, and BPSD) and care partner mental health (anxiety and depression). Note. *Behavioral and Psychological Symptoms of Dementia. a-path represents the direct effects from patient clinical factors to the mediator, b-path indicates the direct effects from the mediator to care partner mental health outcomes, c-path signifies the total effect from patient clinical factors to care partner mental health outcomes without considering the mediator, and c’-path represents the direct effect from patient clinical characterizes to care partner mental health outcomes after accounting for the mediator.

Table 1. Characteristics of study participants (N = 431).

Characteristics	Mean (SD)	n (%)
Care Partners
Age	61.7 (14.2)
Hours employed outside of home per week	40.3 (14.2)
Anxiety (HADS-A)	5.3 (4.7)
Depression (HADS-D)	3.5 (3.8)
Burden (ZBI-12)	9.8 (9.4)
Gender
Female		314 (72.9)
Male		117 (27.1)
Race
White		279 (64.7)
Black		152 (35.3)
Education
<High school		35 (8.1)
High school graduate		106 (24.6)
>High school		282 (65.4)
Unknown		8 (1.9)
Marital Status
Single		78 (18.1)
Married		260 (60.3)
Widowed/divorced/separated		88 (20.4)
Unknown		5 (1.2)
Relationship with Patient
Son/daughter		222 (51.5)
Partner/spouse		132 (30.6)
Other family member or friend		77 (17.9)
Cohabitation with Patient		258 (59.9)
Patients
Age	81.5 (8.4)
Cognition (MoCA)	11.8 (7.0)
Comorbidities (CCI)	4.33 (2.8)
Physical Function (BI)	68.14 (27.3)
BPSD^a (NPI-Q)	6.35 (5.9)
Length of hospital stay, days	6.5 (4.4)
Gender
Female		251 (58.2)
Male		180 (41.8)
Race
White		277 (64.3)
Black		154 (35.7)
Education
<High school		87 (20.2)
High school graduate		174 (40.4)
>High school		160 (37.1)
Unknown		10 (2.3)
Marital Status
Single		32 (7.4)
Married		160 (37.1)
Widowed/divorced/separated		236 (54.8)
Unknown		3 (0.7)
Admitting Diagnosis	Infection	85 (19.7)
	Pneumonia/respiratory failure	33 (7.7)
	Heart failure	39 (9.0)
	Falls/syncope	43 (10.0)
	Altered mental status	49 (11.4)
	Pain	46 (10.7)
	Metabolic conditions	29 (6.7)
	Cardiac problems	33 (7.7)
	Gastrointestinal issues	27 (6.3)
	Cancer	18 (4.2)
	Arthritis	13 (3.0)
	Other	16 (3.7)

Note. ^aBehavioral and Psychological Symptoms of Dementia. HADS-A, Hospital Anxiety and Depression subscale for anxiety. HADS-D, Hospital Anxiety and Depression subscale for depression. ZBI-12, Zarit Burden Interview. MoCA, Montreal Cognitive Assessment. CCI, Charlson Comorbidity Index. CAM-S, Confusion Assessment Method Short Form. CSDD, Cornell Scale for Depression in Dementia. CAM-S = Confusion Assessment Method Short Form. BI = Barthel Index. NPI-Q, Brief Neuropsychiatric Inventory.

Table 2. Results Of pearson correlation analysis.

Variables	1	2	3	4	5	6
1. Patient Cognition	–	.34**	−0.27**	−0.17**	−0.18**	−0.20**
2. Patient Function	–	–	−0.27**	−0.18**	−0.25**	−0.16**
3. Behavioral and Psychological Symptoms of Dementia	–	–	–	.37**	.32**	.40**
4. Care Partner Anxiety	–	–	–	–	.61**	.63**
5. Care Partner Depression	–	–	–	–	–	.60**
6. Care Partner Burden	–	–	–	–	–	–

*p < 0.05; **p < 0.01.

Table 3. Mediation effects of patient clinical characteristics on care partner mental health through care partner burden.

Variables	B (SE)	BootLLCI	BootULCI
Care Partner Anxiety
Patient Cognition (Model 1)
Total Effect	−0.112 (.033)*	−0.176	−0.046
Direct Effect	−0.029 (.025)	−0.077	.020
a-path	−0.264 (.064)*	−0.385	−0.135
b-path	.314 (.019)*	.273	.353
Indirect Effect (ab)	−0.083 (.021)	−0.124	.042
Patient Physical Function (Model 2)
Total Effect	−0.030 (.009)*	−0.049	−0.014
Direct Effect	−0.013 (.007)*	−0.028	−0.003
a-path	−0.056 (.016)*	−0.088	−0.025
b-path	.312 (.019)*	.272	.349
Indirect Effect (ab)	−0.017 (.005)*	−0.028	−0.008
Patient BPSD (Model 3)
Total Effect	.296 (.041)*	.219	.377
Direct Effect	.110 (.036)*	.045	.185
a-path	.640 (.070)*	.484	.786
b-path	.290 (.020)*	.245	.335
Indirect Effect (ab)	.186 (.026)*	.138	.239
Care Partner Depression
Patient Cognition (Model 4)
Total Effect	−0.097 (.028)*	−0.153	−0.044
Direct Effect	−0.035 (.020)	−0.076	.006
a-path	−0.264 (.064)*	−0.385	−0.135
b-path	.234 (.016)*	.200	.269
Indirect Effect (ab)	−0.062 (.016)	−0.094	.032
Patient Physical Function (Model 5)
Total Effect	−0.034 (.008)*	−0.050	−0.019
Direct Effect	−0.021 (.007)*	−0.034	−0.009
a-path	−0.056 (.016)*	−0.088	−0.025
b-path	.229 (.016)*	.196	.265
Indirect Effect (ab)	−0.013 (.004)*	−0.021	−0.006
Patient BPSD (Model 6)
Total Effect	.203 (.032)*	.140	.268
Direct Effect	.059 (.027)*	.007	.118
a-path	.640 (.070)*	.484	.786
b-path	.224 (.017)*	.187	.265
Indirect Effect (ab)	.144 (.021)*	.106	.190

Note. BPSD: Behavioral and Psychological Symptoms of Dementia; B: unstandardized regression coefficient; SE: standard error; BootLLCI: bootstrap lower limit within 95% confidence interval; BootUPCI: bootstrap upper limit within 95% confidence interval.