Types of Empathy Among Certified Caregivers of Older Adults with Dementia

Figures & data

Figure 1 Q-distribution.

Table 1 Characteristics and Factor Weights of P Samples by Types

Type (n) ID		Gender	Age	Marital Status	Religion	Education Level	Workplace	Career as a Caregiver	Factor Weights
Type I (N=4)	6	F	55	Unmarried	None	College	Daycare center	2Y	0.4653
	14	F	47	Married	None	College	Daycare center	3Y5M	0.6749
	24	F	59	Married	Religious	Elementary school	Nursing home	4Y8M	0.2977
	30^a	F	63	Married	Religious	Middle school	Nursing home	8Y	1.0963
Type II (N=6)	3	F	50	Married	Religious	High school	Nursing home	4Y6M	0.6245
	8^a	M	33	Unmarried	Religious	College	Daycare center	4Y2M	1.2898
	9	M	49	Divorced	None	Middle school	Daycare center	8Y6M	0.6485
	15	F	39	Unmarried	Religious	College	Daycare center	1Y10M	0.4228
	18	F	50	Married	None	High school	Daycare center	2Y	0.5751
	20	F	68	Married	None	Elementary school	In-home care service	9Y3M	0.7858
Type III (N=3)	16^a	F	45	Married	Religious	College	In-home care service	1Y4M	1.1756
	22	F	49	Bereaved	Religious	High school	Nursing home	1Y8M	0.4152
	27	F	60	Married	Religious	High school	Nursing home	6Y8M	0.6679
Type IV (N=8)	4	F	48	Married	None	High school	Nursing home	3Y2M	0.4299
	5	F	50	Married	None	Middle school	In-home care service	2Y	0.2830
	7	M	48	Married	Religious	College	Daycare center	5Y	0.6933
	11	F	47	Married	None	College	Nursing home	6Y	0.4655
	12	F	52	Married	Religious	College	Daycare center	7Y3M	0.2398
	19	F	51	Married	Religious	High school	Nursing home	6Y	0.5177
	23^a	F	56	Divorced	Religious	High school	Nursing home	13Y6M	0.7594
	29	F	57	Married	Religious	High school	Nursing home	3Y	0.3857
Type V (N=2)	21	F	62	Bereaved	Religious	Middle school	In-home care service	8Y	0.6759
	26^a	F	52	Married	Religious	High school	Daycare center	1Y4M	1.1421
Type VI (N=3)	1	F	62	Divorced	None	High school	Nursing home	1Y6M	0.2077
	17	M	52	Married	Religious	College	In-home care service	5Y7M	0.7013
	28^a	F	59	Bereaved	Religious	Elementary school	Nursing home	4Y	0.7390
Type VII (N=4)	2	F	62	Divorced	Religious	High school	In-home care service	3Y	0.4026
	10	F	60	Married	Religious	Middle school	Nursing home	9Y4M	0.2610
	13^a	F	51	Married	None	Middle school	Daycare center	3Y7M	0.5664
	25	M	54	Married	Religious	College	Daycare center	7Y	0.3324

Notes: ^aParticipant with the highest value factor weight.

Abbreviations: ID, Identification; I, Information-oriented cognition; II, Sensory communication; III, Compassion; IV, Performance-seeking through self-reflection; V, Intuitive empathy; VI, Role-Centered sincerity; VII, Passive obligation; M, Male; F, Female; Y, Years; M, Months.

Table 2 Z-Score by Type

Q Statement		Z-Score by Type
		I	II	III	IV	V	VI	VII
Q1	This work can only be accomplished with a sincere and caring heart for the older adults with dementia.	2.39	0.47	1.79	1.07	1.05	2.11	−1.17
Q2	Knowing what the older adults with dementia liked or did during their younger years helps to understand their lives.	−0.03	1.69	−1.34	0.71	0.24	1.97	−0.33
Q3	It becomes tedious and exhausting when an older adult with dementia repeatedly says the same thing.	−0.40	−0.97	−2.20	−1.74	−0.15	−1.28	2.96
Q4	Even if an older adult with dementia expresses words and actions in an incomprehensible way, I can recognize what they are trying to say or do.	−1.72	−0.83	−0.70	−0.89	1.45	−0.55	0.33
Q5	As the conditions of the older adults with dementia may change from day to day, they must be monitored and asked frequently about their state.	0.14	1.76	0.47	0.97	0.24	1.21	0.46
Q6	The older adults with dementia rely more on a caregiver who can understand them.	−0.45	−0.08	0.02	0.85	0.24	0.93	0.48
Q7	I feel sorry for the older adults with dementia who have the loving heart of a parent and do not criticize their children, even though their family members do not visit as it is difficult to care for them.	−0.62	1.18	0.59	−0.20	0.55	1.30	−0.29
Q8	I believe older adults with dementia feel good when a caregiver often checks on them and tries to converse.	1.60	0.04	−0.45	0.76	−0.57	0.72	−1.49
Q9	Treating an older adult with dementia as a family member when they recognize me as such makes them more comfortable	−0.83	0.61	0.58	0.02	−0.24	−1.53	1.05
Q10	I believe the older adults with dementia instinctively know whether they are loved or hated.	−1.06	0.33	0.45	1.67	1.77	−0.46	−0.85
Q11	There must be a reason when an older adult with dementia behaves forcefully or is irritated. Therefore, I try to find the reason.	0.34	−0.60	0.12	1.13	1.12	1.54	−0.50
Q12	Making physical contact while maintaining an appropriate distance by understanding the gender and the personal characteristics of the older adults with dementia calms them.	0.04	1.40	−0.99	−0.19	−1.05	0.33	0.06
Q13	When the older adults with dementia tell me secrets or their innermost feelings, which they do not even share with their family, it feels rewarding because it is like they believe in me.	−0.49	0.29	0.12	0.10	1.53	−0.004	0.28
Q14	When the older adults with dementia suddenly wander around at night and act violently, I feel scared and avoid them.	−1.60	−1.54	−1.23	−1.98	−0.55	−0.40	−0.03
Q15	When I see the older adults with dementia pack delicious food because they want to give it to their children, I can feel the heart of a parent.	0.32	0.30	1.29	−0.25	0.72	−0.97	1.25
Q16	When I see the older adults with dementia sleep soundly, although they do not usually sleep well, or respond to programs (eg, clapping) despite their being irresponsive in the past, it feels as if I am being rewarded for caring for them.	0.45	0.47	−1.09	−0.25	0.48	0.44	0.81
Q17	When I see an older adult with dementia who shows sexually abnormal behaviors, such as making sexual comments or brushing past my body, it is distressing, and I avoid them.	0.02	−1.43	−0.41	−1.85	−1.12	−1.04	−0.05
Q18	I feel that the older adults with dementia read my heart and know that I want to do my best.	0.05	0.34	1.65	0.48	1.69	−1.85	−0.85
Q19	The older adults with dementia who are violent are difficult to understand and are angry, so I only want to provide the necessary help and avoid them otherwise.	−1.13	−1.74	−1.54	−1.71	−0.31	−1.71	1.66
Q20	The older adults with dementia are like children. When I suggest dislike, they seem to notice my feelings.	−0.18	−0.18	−0.49	0.05	0.07	−0.18	−0.39
Q21	I think that knowing about the past personality, tendencies, environment, and the daily life of the older adults with dementia helps in interactions with them.	1.18	0.72	0.26	0.59	−1.21	0.59	−0.90
Q22	Abruptly responding to the older adults with dementia with “do not do that” or “just stay still” worsens their abnormal behaviors.	1.56	−1.75	0.85	1.58	−0.72	−0.25	−1.93
Q23	When the older adults with dementia do not speak, I notice their discomfort and check on them regularly to help and observe whether there is anything different from the usual.	1.28	0.69	0.58	0.89	−1.86	0.34	−0.90
Q24	When an older adult with dementia swears or insults me, I get angry because I do not know why they are doing it.	−0.77	−2.38	−2.03	−2.06	−0.07	−1.43	0.59
Q25	I feel uncomfortable when I isolate or scold violent older adults with dementia.	0.02	−0.93	0.50	−1.01	−0.88	0.26	1.40
Q26	If I see the older adults with dementia get embarrassed when changing diapers or trying not to spill when eating, I feel that they also have a sense of self-esteem.	0.81	0.18	−0.08	0.99	−1.05	0.92	−0.73
Q27	When I see an older adult with dementia, I feel as if they are my parents and my future.	−0.40	1.35	1.09	0.53	−0.24	−0.15	0.75
Q28	Although I care for them with sincerity, it is difficult to get along well with all the older adults with dementia.	−0.93	−1.55	−1.54	−1.20	0.74	−0.31	0.27
Q29	When the older adults with dementia lift their backside during diaper change, I feel they are being considerate of me.	−1.52	0.23	−0.14	0.52	1.62	0.95	1.21
Q30	It is important to promptly notice physical discomfort to know the emotional state of the older adults with dementia (sensitivity to verbal and nonverbal postures).	0.15	0.01	0.35	0.52	−0.74	−0.61	−0.48
Q31	I feel sad when I see the older adults with dementia constantly call their children’s names daily because I understand how a mother feels.	−0.24	0.65	1.77	−0.27	0.40	−0.02	0.66
Q32	When I see the older adults with dementia pack their bags every day saying they will go home, pretending to be fine so their family does not have a hard time, I can feel their consideration for their children.	0.67	0.60	1.23	−0.60	−0.64	−1.04	0.11
Q33	Even when an older adult with dementia does not say it out loud, I feel like we understand each other when they smile, make eye contact, or greet me.	−0.97	1.12	0.31	0.61	−0.40	1.11	−1.40
Q34	Even the older adults with dementia who are anxious and unresponsive begin to feel comfortable when they get used to being around others.	1.02	0.37	0.19	0.12	0.40	0.46	−0.46
Q35	The older adults with dementia who are violent appear to be sorry when they feel that they have hurt others once they calm down and settle.	−1.29	−0.41	−0.82	−0.11	1.62	−1.10	−1.40
Q36	I think it is better not to be too sensitive to the behaviors of the older adults with dementia.	1.14	−0.47	0.04	−0.26	−1.69	0.58	1.03
Q37	When the older adults with dementia mistreat caregivers and are told that such behavior is wrong, they apologize, and it feels like we were able to communicate.	−0.52	−0.50	−0.14	−0.87	−0.81	−0.30	−0.67
Q38	Being older adults with dementia does not mean they have lost all their memories. They are able to discern what they like and dislike.	1.97	0.54	0.93	1.30	−1.62	−0.55	−0.56

Table 3 Top Three Q-Statements in Which Each Type of Participant Agreed/Disagreed More Than Other Types

Type	No	Q-Statements	Z-Score	Average	Difference
I	38	Being older adults with dementia does not mean they have lost all their memories. They are able to discern what they like and dislike.	1.97	0.01	1.96
	8	I believe older adults with dementia feel better when a caregiver often checks on them and tries to converse.	1.60	−0.16	1.77
	1	This work can only be accomplished with a sincere and caring heart for the older adults with dementia.	2.39	0.89	1.50
	4	Even if an older adult with dementia expresses words and actions in an incomprehensible way, I can recognize what they are trying to say or do.	−1.72	−0.20	−1.52
	10	I believe the older adults with dementia instinctively know whether they are loved or hated.	−1.06	0.49	−1.55
	29	When the older adults with dementia lift their backside during diaper change, I feel they are being considerate of me.	−1.52	0.73	−2.25
II	12	Making physical contact while maintaining an appropriate distance by understanding the gender and the personal characteristics of the older adults with dementia calms them.	1.40	−0.30	1.70
	33	Even when an older adult with dementia does not say it out loud, I feel like we understand each other when they smile, make eye contact, or greet me.	1.12	−0.12	1.24
	5	As the conditions of the older adults with dementia may change from day to day, they must be monitored and asked frequently about their state.	1.76	0.58	1.17
	19	The older adults with dementia who are violent are difficult to understand and are angry, so I only want to provide the necessary help and avoid them otherwise.	−1.74	−0.79	−0.95
	28	Although I care for them with sincerity, it is difficult to get along well with all the older adults with dementia.	−1.55	−0.50	−1.06
	11	There must be a reason when an older adult with dementia behaves forcefully or is irritated. Therefore, I try to find the reason.	−0.60	0.63	−1.20
III	31	I feel sad when I see the older adults with dementia constantly call their children’s names daily because I understand how a mother feels.	1.77	0.20	1.57
	32	When I see the older adults with dementia pack their bags every day saying they will go home, pretending to be fine so their family does not have a hard time, I can feel their consideration for their children.	1.23	−0.15	1.38
	15	When I see the older adults with dementia pack delicious food because they want to give it to their children, I can feel the heart of a parent.	1.29	0.23	1.06
	16	When I see the older adults with dementia sleep soundly, although they do not usually sleep well, or respond to programs (eg, clapping) despite their being irresponsive in the past, it feels as if I am being rewarded for caring for them.	−1.09	0.40	−1.49
	3	It becomes tedious and exhausting when an older adult with dementia says the same thing repeatedly.	−2.20	−0.26	−1.93
	2	Knowing what the older adults with dementia liked or did during their younger years helps to understand their lives.	−1.34	0.71	−2.05
IV	22	Abruptly responding to the older adults with dementia with “do not do that” or “just stay still” worsens their abnormal behaviors.	1.58	−0.37	1.95
	26	If I see the older adults with dementia be embarrassed when changing diapers or trying not to spill when eating, I feel that they also have a sense of self-esteem.	0.99	0.01	0.98
	30	It is important to promptly notice physical discomfort to know the emotional state of the older adults with dementia (sensitivity to verbal and nonverbal postures).	0.52	−0.22	0.74
	25	I feel uncomfortable when I isolate or scold violent older adults with dementia.	−1.01	0.06	−1.07
	14	When the older adults with dementia suddenly wander around at night and act violently, I feel scared and avoid them.	−1.98	−0.89	−1.09
	17	When I see an older adult with dementia who shows sexually abnormal behaviors, such as making sexual comments or brushing past my body, it is distressing, and I avoid them.	−1.86	−0.67	−1.18
V	35	The older adults with dementia who are violent appear to be sorry when they feel that they have hurt others once they calm down and settle.	1.62	−0.86	2.48
	4	Even if an older adult with dementia expresses words and actions in an incomprehensible way, I can recognize what they are trying to say or do.	1.45	−0.73	2.18
	10	I believe the older adults with dementia instinctively know whether they are loved or hated.	1.77	0.01	1.76
	36	I think it is better not to be too sensitive to the behaviors of the older adults with dementia.	−1.70	0.34	−2.04
	38	Being older adults with dementia does not mean they have lost all their memories. They are able to discern what they like and dislike.	−1.62	0.60	−2.22
	23	When the older adults with dementia do not speak, I notice their discomfort and check on them regularly to help and observe whether there is anything that differs from the usual.	−1.86	0.48	−2.34
VI	2	Knowing what the older adults with dementia liked or did during their younger years helps us understand their lives.	1.97	0.16	1.81
	11	There must be a reason when an older adult with dementia behaves violently or is irritated. Therefore, I try to find the reason.	1.54	0.27	1.27
	7	I feel sorry for the older adults with dementia who have the loving heart of a parent and do not criticize their children, even though their family members do not visit them due to the difficulty of caring for them.	1.30	0.20	1.10
	15	When I see the older adults with dementia store delicious food because they want to give it to their children, I can feel the heart of a parent within them.	−0.97	0.61	−1.57
	9	Treating an older adult with dementia as a family member when they recognize me as such makes them more comfortable	−1.53	0.20	−1.73
	18	I feel that the older adults with dementia are able to read my feelings and know that I want to do my best.	−1.85	0.56	−2.41
VII	3	It becomes tedious and exhausting when an older adult with dementia says the same thing repeatedly.	2.96	−1.12	4.08
	19	The older adults with dementia who are violent are difficult to understand and are angry, so I only want to provide the necessary help and avoid them otherwise.	1.66	−1.36	3.02
	24	When an older adult with dementia swears or insults me, I get angry because I do not know why they are doing it.	0.59	−1.46	2.05
	8	I believe older adults with dementia feel good when a caregiver often checks on them and tries to converse.	−1.49	0.35	−1.84
	22	Abruptly responding to the older adults with dementia with “do not do that” or “just stay still” worsens their abnormal behaviors.	−1.93	0.21	−2.14
	1	This work can only be accomplished with sincerity and a caring heart for the older adults with dementia.	−1.17	1.48	−2.65