The Relationships between Caregiver Burden, Physical Frailty, Race, Behavioral and Psychological Symptoms (BPSD), and Other Associated Variables: An Exploratory Study

Author:

Cohen Carl I.1,Hashem Saeed2,Kyaw Kay Thwe1ORCID,Brangman Sharon A.3,Fields Suzanne4,Troen Bruce R.5ORCID,Reinhardt Michael1

Affiliation:

1. Division of Geriatric Psychiatry, SUNY Downstate Health Sciences University, MSC 1203, 450 Clarkson Avenue, Brooklyn, NY 11203, USA

2. McLean Hospital, 115 Mill St., Belmont, MA 02478, USA

3. Department of Geriatrics, SUNY Upstate Medical University, 175 Elizabeth Blackwell Street, Syracuse, NY 13210, USA

4. Division of General, Geriatric and Hospital Medicine, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, USA

5. Division of Geriatrics and Landon Center on Aging, University of Kansas Medical Center and VA Kansas City Healthcare System, 4000 Cambridge Street, Kansas City, KS 66160, USA

Abstract

Background and Objectives: For persons with dementia, the relationships between caregiver burden, physical frailty, race, behavioral and psychological symptoms (BPSD), and other associated variables are poorly understood. Only one prior study examined the relationships among these variables but did not include race, which is an important social determinant of health outcomes in the United States. To examine these interactions, we conducted a cross-sectional exploratory study based on a model by Sugimoto and colleagues. Materials and Methods: The sample comprised 85 patient–caregiver dyads (58% White) seen in four centers in diverse regions of New York State. All patients met DSM5 criteria for a major neurocognitive disorder, had a Clinical Dementia Rating sum score of ≥3, and Mini-Mental State Examination (MMSE) score of 10 to 26. Other measures included the SHARE-Frailty Instrument(FI), the Neuropsychiatric Inventory (NPI) to assess BPSD, Zarit’s Caregiver Burden Interview (CBI), Lawton’s Activities of Daily Living (ADL) Scale, the MMSE, the Cumulative Illness Rating Scale for Geriatrics (CIRSG), age, and gender. Results: In our sample, 59% met the criteria for prefrail/subsyndromal or frail/syndromal (SSF) on the SHARE-FI. SSF had significant direct effects on the NPI and significant indirect effects on the CBI mediated through the NPI; the NPI had significant direct effects on the CBI. Race (White) had significant direct effects on the CBI (higher) and SSF (lower) but did not have significant indirect effects on the CBI. MMSE, ADL, and CIRSG were not significantly associated with the NPI or the CBI. Conclusions: Our analysis demonstrated that frailty, race, BPSD, and caregiver burden may directly or indirectly influence one another, and therefore should be considered essential elements of dementia assessment, care, and research. These results must be viewed as provisional and should be replicated longitudinally with larger samples.

Funder

HRSA

SUNY Health Network of Excellence

Publisher

MDPI AG

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