Quality of in-home care, long-term care placement, and the survival of persons with dementia

Abstract

Purpose of the study: Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.

Design and methods: We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.

Results: Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.

Implications: It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.

Keywords:

• quality of caregiving
• coping
• long-term care
• dementia caregiving
• survival

Acknowledgements

We thank project managers Linda Rechlin, Nancy Catalini, Vanessa Farro, and Riane Ramsey for their outstanding assistance with recruitment, instrumentation, data entry, and other tasks. We are grateful to the Alzheimer's Associations of Cleveland and Akron-Canton-Youngstown, and the Memory and Cognition Center, University Hospitals Case Medical Center for their assistance with recruitment. We also thank Tim Degnan, Kevin Hennosy, and Dennis Farney for their insightful comments at Aixois.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Alzheimer's Association [grant number IIRG-08-91014, 11/1/2008–10/31/2011]. Supplemental financial support was graciously provided by Alan Lerner, MD, Director, Memory and Cognition Center, University Hospitals of Cleveland Case Medical Center.