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Effects of Burden and Family Resilience on the Family Adaptation of Family Caregivers of Elderly with Dementia

Hye Young Jang1, Myungsun Yi2
Korean Journal of Adult Nursing 2013;25(6):725-735.
Published online: December 18, 2013

1Graduate School, College of Nursing, Seoul National University, Seoul

2College of Nursing ․ Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Jang, Hye Young College of Nursing, Seoul National University,28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea. Tel: +82-2-740-8829, Fax: +82-2-6442-8829, E-mail: gogo0108@snu.ac.kr
• Received: August 12, 2013   • Accepted: December 19, 2013

© 2013 Korean Society of Adult Nursing

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.

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  • Purpose
    The purpose of this study was to investigate the levels of burden, family resilience and adaptation of caregivers of elderly patients with dementia, and further to identify factors influencing their adaptation.
  • Methods
    A cross-sectional descriptive study was designed. Data were collected from questionnaires distributed to 131 family caregivers of elderly patients who visited at the Centers for Dementia in Seoul during 2012~2013. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation analysis, and stepwise multiple regression.
  • Results
    The average age of the care giving subjects was 63.58, and 31.3% were male, and 41.2% were the spouses. Statistically significant relationships were found between burden and adaptation (r=-.38, p<.001), and between family resilience and adaptation (r=.52, p<.001), and between burden and family resilience (r=-.35, p=.001). Thirty percent of adaptation was explained by burden and family resilience. The most influencing factor to adaptation was family resilience which explained about 27% of the variance.
  • Conclusion
    The results of the study clearly indicate that family resilience explains better than burden on adaptation of family caregivers. Thus, to develop more effective nursing intervention for family caregivers of elderly patients with dementia, it would be necessary to integrate family resilience in the programs. 27% is not that much and I wonder if we have to do more work to identify the factors that influence care giving.
  • Key Words: Dependency burden; Psychological resilience; Adaptation; Dementia; Caregivers
Table 1.
General Characteristics of the Family Caregivers and the Elderly with Dementia (N=131)
Variables Characteristics Categories n (%) or M±SD
Family caregivers Gender Male 41 (31.3)
Female 90 (68.7)
Age (year)   63.6±11.3
＜50 13 (9.9)
50~59 38 (29.0)
60~69 35 (26.7)
≥70 45 (34.4)
Education Elementary school 30 (22.9)
Middle school 22 (16.8)
High school 47 (35.9)
≥College 32 (24.4)
Marital status Married 104 (79.4)
Others 27 (20.6)
Religion Yes 97 (74.0)
No 34 (26.0)
Occupation Employed 34 (26.0)
Unemployed 97 (74.0)
Perceived economic status High 3 (2.3)
Middle 70 (53.4)
Low 58 (44.3)
Relationship Spouse 54 (41.2)
Child 69 (52.7)
Others 8 (6.1)
Caring hours per day   14.96±8.43
＜5 20 (15.3)
5~9 21 (16.0)
10~14 20 (15.3)
15~19 14 (10.7)
≥20 56 (42.7)
Chronic disease Yes 61 (46.6)
No 70 (53.4)
Elderly with dementia Gender Male 56 (42.7)
Female 75 (57.3)
Age (year)   80.0±8.5
＜70 13 (9.9)
70~79 45 (34.4)
80~89 56 (42.7)
≥90 17 (13.0)
Years since diagnosis   4.53±3.09
＜5 78 (59.5)
5~9 40 (30.5)
≥10 13 (10.0)
Table 2.
Dependency Burden, Family Resilience, and Family Adaptation (N=131)
Variables Total score Item score Possible range Actual range
M±SD M±SD
Dependency burden 97.32±19.79 3.48±0.71 28~140 51~140
        Social activity restriction 22.53±5.45 3.76±0.91 6~30 6~30
        Negative change of elderly-caregiver relationship 24.11±5.87 3.45±0.84 7~35 11~35
        Negative change of family relationship 15.28±5.06 3.06±1.01 5~25 5~25
        Psychological burden 12.66±4.01 3.16±1.00 4~20 4~20
        Financial and job-related burden 11.17±2.93 3.72±0.98 3~15 4~15
        Health-related burden 11.56±2.69 3.86±0.90 3~15 3~15
Family resilience 183.63±24.55 2.78±0.37 66~264 119~247
        Belief systems 50.97±7.381 2.83±0.41 18~72 28~69
        Organizational patterns 72.78±10.19 2.70±0.38 27~108 45~102
        Communication processes 59.88±8.79 2.85±0.42 21~84 32~81
Family adaptation 43.03±15.91 5.38±1.99 0~80 10~80
Table 3.
Differences of Family Adaptation according to General Characteristics of the Family Caregivers and the Elderly wit Dementia (N=131
Variables Characteristics Categories Family adaptation
M±SD t or F p
Family caregivers Gender Male 42.91±18.58 -0.07 .944
Female 43.12±13.72
Age (year) ＜50 46.00±14.05 0.18 .912
50~59 42.89±16.21
60~69 42.97±16.98
≥70 42.33±15.73
Education Elementary school 36.27±16.92 2.58 .056
Middle school 43.95±11.74
High school 44.51±14.99
≥College 46.56±17.50
Marital status Married 44.04±16.51 1.65 .105
Others 39.15±12.89
Religion Yes 42.72±16.24 -0.37 .709
No 43.91±15.14
Occupation Employed 47.85±17.31 2.08 .040
Unemployed 41.34±15.13
Perceived economic status High 56.67±20.26 1.70 .187
Middle 44.06±16.54
Low 41.09±14.73
Relationship Spouse 42.83±17.66 0.25 .782
Child 42.74±14.61
Others 46.88±15.74
Caring hours per day ＜5 41.55±16.15 0.63 .641
5~9 46.95±15.62
10~14 45.10±15.16
15~19 39.71±14.12
≥20 42.18±16.78
Chronic disease Yes 41.79±16.83 0.83 .406
No 44.11±15.11
Elderly with dementia Gender Male 42.91±18.58 -0.07 .944
Female 43.12±13.72
Age (year) ＜70 43.77±16.39 0.21 .887
70~79 44.07±17.33
80~89 42.79±15.71
≥90 40.53±13.09
Years since diagnosis ＜5 42.45±16.14 0.13 .881
5~9 43.88±15.07
  ≥10 43.92±18.11
Table 4.
Correlation between Dependency Burden, Family Resilience, and Family Adaptation (N=131)
Variables 1 2 3 3-1 3-2 3-3
r (p) r (p) r (p) r (p) r (p) r (p)
1. Family adaptation 1          
2. Dependency burden -.38 1        
  (＜.001)          
3. Family resilience .52 -.35 1      
  (＜.001) (＜.001)        
      3-1. Belief systems .46 -.31 .93 1    
  (＜.001) (＜.001) (＜.001)      
      3-2. Organizational patterns .53 -.35 .94 .81 1  
  (＜.001) (＜.001) (＜.001) (＜.001)    
      3-3. Communication processes .45 -.32 .93 .81 .79 1
  (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)  
Table 5.
Factors Influencing Family Adaptation (N=131)
Variables B SE β t p Tolerance VIF
(Constant) 8.55 12.86   0.67 .507    
Family resilience 0.29 0.05 .44 5.61 ＜.001 .88 1.14
Dependency burden -0.18 0.06 -.23 -2.90 .004 .88 1.14

R

2=.31, Adjusted R2=.30, F=29.30, p＜.001, Durbin-Watson=2.05

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      Effects of Burden and Family Resilience on the Family Adaptation of Family Caregivers of Elderly with Dementia
      Korean J Adult Nurs. 2013;25(6):725-735.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.725
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      Effects of Burden and Family Resilience on the Family Adaptation of Family Caregivers of Elderly with Dementia
      Korean J Adult Nurs. 2013;25(6):725-735.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.725
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      Effects of Burden and Family Resilience on the Family Adaptation of Family Caregivers of Elderly with Dementia
      Effects of Burden and Family Resilience on the Family Adaptation of Family Caregivers of Elderly with Dementia

      General Characteristics of the Family Caregivers and the Elderly with Dementia (N=131)

      Variables Characteristics Categories n (%) or M±SD
      Family caregivers Gender Male 41 (31.3)
      Female 90 (68.7)
      Age (year)   63.6±11.3
      ＜50 13 (9.9)
      50~59 38 (29.0)
      60~69 35 (26.7)
      ≥70 45 (34.4)
      Education Elementary school 30 (22.9)
      Middle school 22 (16.8)
      High school 47 (35.9)
      ≥College 32 (24.4)
      Marital status Married 104 (79.4)
      Others 27 (20.6)
      Religion Yes 97 (74.0)
      No 34 (26.0)
      Occupation Employed 34 (26.0)
      Unemployed 97 (74.0)
      Perceived economic status High 3 (2.3)
      Middle 70 (53.4)
      Low 58 (44.3)
      Relationship Spouse 54 (41.2)
      Child 69 (52.7)
      Others 8 (6.1)
      Caring hours per day   14.96±8.43
      ＜5 20 (15.3)
      5~9 21 (16.0)
      10~14 20 (15.3)
      15~19 14 (10.7)
      ≥20 56 (42.7)
      Chronic disease Yes 61 (46.6)
      No 70 (53.4)
      Elderly with dementia Gender Male 56 (42.7)
      Female 75 (57.3)
      Age (year)   80.0±8.5
      ＜70 13 (9.9)
      70~79 45 (34.4)
      80~89 56 (42.7)
      ≥90 17 (13.0)
      Years since diagnosis   4.53±3.09
      ＜5 78 (59.5)
      5~9 40 (30.5)
      ≥10 13 (10.0)

      Dependency Burden, Family Resilience, and Family Adaptation (N=131)

      Variables Total score Item score Possible range Actual range
      M±SD M±SD
      Dependency burden 97.32±19.79 3.48±0.71 28~140 51~140
              Social activity restriction 22.53±5.45 3.76±0.91 6~30 6~30
              Negative change of elderly-caregiver relationship 24.11±5.87 3.45±0.84 7~35 11~35
              Negative change of family relationship 15.28±5.06 3.06±1.01 5~25 5~25
              Psychological burden 12.66±4.01 3.16±1.00 4~20 4~20
              Financial and job-related burden 11.17±2.93 3.72±0.98 3~15 4~15
              Health-related burden 11.56±2.69 3.86±0.90 3~15 3~15
      Family resilience 183.63±24.55 2.78±0.37 66~264 119~247
              Belief systems 50.97±7.381 2.83±0.41 18~72 28~69
              Organizational patterns 72.78±10.19 2.70±0.38 27~108 45~102
              Communication processes 59.88±8.79 2.85±0.42 21~84 32~81
      Family adaptation 43.03±15.91 5.38±1.99 0~80 10~80

      Differences of Family Adaptation according to General Characteristics of the Family Caregivers and the Elderly wit Dementia (N=131

      Variables Characteristics Categories Family adaptation
      M±SD t or F p
      Family caregivers Gender Male 42.91±18.58 -0.07 .944
      Female 43.12±13.72
      Age (year) ＜50 46.00±14.05 0.18 .912
      50~59 42.89±16.21
      60~69 42.97±16.98
      ≥70 42.33±15.73
      Education Elementary school 36.27±16.92 2.58 .056
      Middle school 43.95±11.74
      High school 44.51±14.99
      ≥College 46.56±17.50
      Marital status Married 44.04±16.51 1.65 .105
      Others 39.15±12.89
      Religion Yes 42.72±16.24 -0.37 .709
      No 43.91±15.14
      Occupation Employed 47.85±17.31 2.08 .040
      Unemployed 41.34±15.13
      Perceived economic status High 56.67±20.26 1.70 .187
      Middle 44.06±16.54
      Low 41.09±14.73
      Relationship Spouse 42.83±17.66 0.25 .782
      Child 42.74±14.61
      Others 46.88±15.74
      Caring hours per day ＜5 41.55±16.15 0.63 .641
      5~9 46.95±15.62
      10~14 45.10±15.16
      15~19 39.71±14.12
      ≥20 42.18±16.78
      Chronic disease Yes 41.79±16.83 0.83 .406
      No 44.11±15.11
      Elderly with dementia Gender Male 42.91±18.58 -0.07 .944
      Female 43.12±13.72
      Age (year) ＜70 43.77±16.39 0.21 .887
      70~79 44.07±17.33
      80~89 42.79±15.71
      ≥90 40.53±13.09
      Years since diagnosis ＜5 42.45±16.14 0.13 .881
      5~9 43.88±15.07
        ≥10 43.92±18.11

      Correlation between Dependency Burden, Family Resilience, and Family Adaptation (N=131)

      Variables 1 2 3 3-1 3-2 3-3
      r (p) r (p) r (p) r (p) r (p) r (p)
      1. Family adaptation 1          
      2. Dependency burden -.38 1        
        (＜.001)          
      3. Family resilience .52 -.35 1      
        (＜.001) (＜.001)        
            3-1. Belief systems .46 -.31 .93 1    
        (＜.001) (＜.001) (＜.001)      
            3-2. Organizational patterns .53 -.35 .94 .81 1  
        (＜.001) (＜.001) (＜.001) (＜.001)    
            3-3. Communication processes .45 -.32 .93 .81 .79 1
        (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)  

      Factors Influencing Family Adaptation (N=131)

      Variables B SE β t p Tolerance VIF
      (Constant) 8.55 12.86   0.67 .507    
      Family resilience 0.29 0.05 .44 5.61 ＜.001 .88 1.14
      Dependency burden -0.18 0.06 -.23 -2.90 .004 .88 1.14

      R

      2=.31, Adjusted R2=.30, F=29.30, p＜.001, Durbin-Watson=2.05
      Table 1. General Characteristics of the Family Caregivers and the Elderly with Dementia (N=131)

      Table 2. Dependency Burden, Family Resilience, and Family Adaptation (N=131)

      Table 3. Differences of Family Adaptation according to General Characteristics of the Family Caregivers and the Elderly wit Dementia (N=131

      Table 4. Correlation between Dependency Burden, Family Resilience, and Family Adaptation (N=131)

      Table 5. Factors Influencing Family Adaptation (N=131)

      R

      2=.31, Adjusted R2=.30, F=29.30, p＜.001, Durbin-Watson=2.05

      Table 1.

      Table 2.

      Table 3.

      Table 4.

      Table 5.

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