Li et al. - 2014 - Worry about caregiving performance: A confirmatory analysis

7/21/2019 Li et al. - 2014 - Worry about caregiving performance: A confirmatory analysis

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HSOR@NHGThe evidence behind your decisions

Worry about caregiving performA confirmatory an

Li Ruijie (Presentin

Dr Chong

Dr M

Dr L

Dr No

Tengku Mohd K. Shariffah M

Dr Lim W


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Background

Caregiver burden in dementia has been studiedextensively in recent years.

The Zarit Burden Interview (ZBI) is a 22-item instrdeveloped to measure caregiving burden in caregi

people with dementia (PwD).


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Background:Zarit Burden Interview

Some questions from ZBI:

03. Do you feel stressed between caring for your relative andmeet other responsibilities for your family or work?

10. Do you feel your health has suffered because of your invwith your relative?

20. Do you feel you should be doing more for your relative?

21. Do you feel you could do a better job in caring for your relat

22. Overall, how burdened do you feel in caring for your relativ


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Some questions from ZBI:

03. Do you feel stressed between caring for your relative andmeet other responsibilities for your family or work?

10. Do you feel your health has suffered because of your invwith your relative?

20. Do you feel you should be doing more for your relative?

21. Do you feel you could do a better job in caring for your relat

22. Overall, how burdened do you feel in caring for your relativ



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To better understand what caregiving is, numerouresearch groups have conducted analyses to deterthe constructs of ZBI.

ZBI ZBI

?Construct 1??(Questions

1 10)?

?Construct 2??(Questions

11 -22)?

Unidimensional MultidimensionalVs.

Construct 1(All questions)


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Whitlatch and colleagues (1991) first proposed a 2model structure consisting of:

- Role strain

> stress due to role conflict and overload

- Personal strain

> how the experience is personally stressful

These results were independently replicated by seother research groups.


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Subsequent research turned up another factor

Factor known as various names:

- self-criticism (Knight et al., 2000)

- guilt (Ankri et al., 2005)

- feelings of inadequacy (Ko et al., 2008; Lai, 2007)

- worry about caregiving performance (Cheah et al., 2


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There are indications from the various studies thatWorry about caregiving performance (WaP) lie ocontinuum.

Mild

worries and feelings of

inadequacy

self-critici

feelings


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Why is WaP important?- Evidence for its existence would create another dime

in caregiving burden.

- This dimension has the potential to be motivating asharmful.

- Stronger understanding of this dimension can allow

> Harness its motivating force

> Prevent it from becoming harmful to the caregiver


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Previous work used exploratory factor analysis (EFA) oscores in a local population.

Replicated:

- Personal strain (1 factor)

- Role strain (2 factors)

- WaP

Additional findings:

- Caregiver age is a significant predictor of WaP

(Cheah et al., 2


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Study objective

1. Conduct a confirmatory analysis in a separate samplea. To confirm the validity of the EFA results

b. To determine if the EFA results are:

i. Superior to the 2 factor model by Whitlatch and colleague

ii. Separating out role strain into 2 factors is better than keepfactor

2. Explore the link between WaP with:

a. Age of caregiver

b. Relationship with PwD


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Methods

Cross-sectional design

Patients and caregivers were recruited from the MClinic at Tan Tock Seng Hospital (TTSH) betweenJanuary 2010 to December 2011.

Descriptive statistics were used:

- Describe the sample characteristics


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Methods

Confirmatory factor analysis (CFA) was used to compafactor models:

- 1 factor model

- 2 factor model (Whitlatch et al, 1991)

- 3 factor model (1 role strain factor) (Cheah et al., 2012)

- 4 factor model (2 role strain factors) (Cheah et al., 2012)

Linear regressions were used:

- Determine the relationships between factors of ZBI withand caregiver characteristics.


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Results:Sample characteristics

Care recipient characteristics Mean (SD)

Age in years, Mean (SD) 76.4 (7.4)Female gender, n (%) 275 (59.0)

Education level in years, Mean (SD) 4.9 (4.7)

Ethnic group, n (%)

Chinese 417 (89.5)

Malay 14 (3.0)

Indian 29 (6.2)

Others 6 (1.3)

(n = 466 pairs of patients and caregivers)

Figures reported are mean (SD) unless otherwise stated.


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Results:Sample characteristics (n = 466)

Disease characteristics

Dementia types, n (%)Alzheimers dementia 217 (46.6)

Vascular dementia 79 (17.0)

Mixed dementia 26 (5.6)

Mild cognitive impairment 58 (12.4)

Others 86 (18.5)

Global Clinical Dementia Rating (CDR) score, n (%)

CDR 0.5 (mild cognitive impairment) 58 (12.4)

CDR 0.5 (very mild dementia) 60 (12.9)

CDR 1.0 (mild dementia) 206 (44.2)

CDR 2.0 (moderate dementia) 127 (27.3)

CDR 3.0 (severe dementia) 15 (3.2)


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Disease characteristics Mean (SD)

CMMSE (range 028) 16.6 (6.1)BADL (range 0100) 92.9 (36.4)

IADL (range 023) 12.2 (5.9)

NPI-Q

Severity (range 036) 5.6 (5.0)

Distress (range 060) 5.9 (7.3)

BADL = Basic Activities of Daily Living; CMMSE = ChineseMental Status Examination; IADL = Instrumental ActivitDaily Living; NPI-Q = Neuropsychiatric Inventory Questionn


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Caregiver characteristics Mean (SD)

Age in years 53.8 (13.5)Female gender, n (%) 287 (61.6)

Education level in years 11 (4.5)

Relationship with patient, n (%)

Spouse 124 (26.6)

Adult children 286 (61.4)

Sibling 8 (1.7)

Others 48 (10.3)

Living with care recipient, n (%) 351 (75.3)

ZBI score (range 088) 24.9 (17.4)


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df RMSEA SRMR NNFI CFI

Recommended* - - .950

1 factor 1336.585 209 .108 .071 .781 .802

2 factors 1025.650 134 .120 .075 .771 .800

3 factors 1059.902 206 .094 .062 .831 .850

4 factors 968.823 203 .090 .061 .847 .865

Results:Confirmatory factor analysis

*Recommendations from Hu and Bentler (1999)

RMSEA = Root Mean Square Error of Approximation; SRMR = Standardized Root Mean Squ

NNFI = Non-normed Fit Index; CFI = Comparative Fit Index; AIC = Akaike Information Crite


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1 factor 1336.585 209 .108 .071 .781 .802

2 factors 1025.650 134 .120 .075 .771 .800

3 factors 1059.902 206 .094 .062 .831 .850

4 factors 968.823 203 .090 .061 .847 .865






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1 factor 1336.585 209 .108 .071 .781 .802

2 factors 1025.650 134 .120 .075 .771 .800

3 factors 1059.902 206 .094 .062 .831 .850

4 factors 968.823 203 .090 .061 .847 .865






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1 factor 1336.585 209 .108 .071 .781 .802

2 factors 1025.650 134 .120 .075 .771 .800

3 factors 1059.902 206 .094 .062 .831 .850

4 factors 968.823 203 .090 .061 .847 .865






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1 factor 1336.585 209 .108 .071 .781 .802

2 factors 1025.650 134 .120 .075 .771 .800

3 factors 1059.902 206 .094 .062 .831 .850

4 factors 968.823 203 .090 .061 .847 .865






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Results:Regression

Total ZBI

Role strain

(Demands)

Role strain

(Control)

Personal

strainRegression

Relationship with care-recipient (Reference: Adult child)

Spouse -.124 * -.097 -.132 * -.114 *

Sibling .057 .061 .093 * .077

Others -.016 -.010 -.034 -.022

Caregiver gender (Reference: Female)Male -.002 -.001 .027 .010

Living with care-recipient (Reference: No)

Yes .015 .030 .017 .021

*p


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Results:Regression

Total ZBI

Role strain

(Demands)

Role strain

(Control)

Personal

strainRegression

Relationship with care-recipient (Reference: Adult child)

Spouse -.124 * -.097 -.132 * -.114 *

Sibling .057 .061 .093 * .077

Others -.016 -.010 -.034 -.022

Caregiver gender (Reference: Female)Male -.002 -.001 .027 .010

Living with care-recipient (Reference: No)

Yes .015 .030 .017 .021

*p


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Total ZBI

Role strain

(Demands)

Role strain

(Control)

Personal

strainRegression

Caregiver education -.064 -.046 -.105 * -.071

BADL (0-100) -.038 -.054 -.040 -.041

IADL (0-23) -.164 ** -.201 *** -.160 ** -.177 **

NPI-Q severity (0-36) .083 .018 .057 .033

NPI-Q distress (0-60) .340 *** .391 *** .345 *** .389 **CMMSE (0-28) -.035 -.036 -.023 -.030

Adjusted R2 .283 *** .293 *** .267 *** .291 **

Results:Regression

*p


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Total ZBI

Role strain

(Demands)

Role strain

(Control)

Personal

strainRegression


BADL (0-100) -.038 -.054 -.040 -.041

IADL (0-23) -.164 ** -.201 *** -.160 ** -.177 **

NPI-Q severity (0-36) .083 .018 .057 .033


Adjusted R2 .283 *** .293 *** .267 *** .291 **

Results:Regression

*p


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Total ZBI

Role strain

(Demands)

Role strain

(Control)

Personal

strainRegression


BADL (0-100) -.038 -.054 -.040 -.041

IADL (0-23) -.164 ** -.201 *** -.160 ** -.177 **

NPI-Q severity (0-36) .083 .018 .057 .033


Adjusted R2 .283 *** .293 *** .267 *** .291 **

Results:Regression

*p


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Results:Caregiving burden profiles


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Results:Caregiving burden profiles


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Summary

Evidence that WaP is a valid factor within ZBI- CFA shows that the addition of WaP improves mod

- Predictors of WaP differ from the other factors

Preliminary evidence that WaP is driven by caregi

care recipient relationship


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Discussion

WaP exist, caregiving burden not a unidimensionconstruct

- Big differences may exist in caregivers with similar Zscores.

Better understanding needed of:- Characteristics of each construct

- Their relationship with caregiver and care recipientcharacteristics


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Implications

Better understanding of WaP- Better equipped to manage burden in different grou

- Provide directions to formulate more questions for W

Better understand of other factors of ZBI

- Factors conceptually different but trend similarly- Finer differentiation of the factors needed


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Limitations

Cross-sectional design Fit indices do not meet criteria considered as good

R2 for the regressions were small


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Acknowledgements

I would like to thank my co-authors from TTSH Cogand Memory Disorders Service and the IGA for makstudy possible.

I would also like to thank Dr Lim and Dr Chong for

providing me the opportunity to take part in this stuthe guidance provided.


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References

Ankri, J., Andrieu, S., Beaufils, B., Grand, A., & Henrard, J. C. (2005). Beyo

global score of the Zarit Burden Interview: useful dimensions for clinicianInternational Journal of Geriatric Psychiatry, 20(3), 254260. doi:10.1002/gps.

Cheah, W. K., Han, H. C., Chong, M. S., Anthony, P. V., & Lim, W. S. (2012Multidimensionality of the Zarit Burden Interview across the severity specognitive impairment: an Asian perspective. International Psychogeriatrics,18461854. doi:10.1017/S104161021200110X

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance analysis: Conventional criteria versus new alternatives. Structural EquatioA Multidisciplinary Journal, 6(1), 155. doi:10.1080/10705519909540118

Knight, B. G., Fox, L., & Chou, C.-P. (2000). Factor Structure of the BurdenJournal of Clinical Geropsychology, 6(4), 249258.


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References

Ko, K.-T., Yip, P.-K., Liu, S.-I., & Huang, C.-R. (2008). Chinese version of th

caregiver Burden Interview: a validation study. The American Journal of GePsychiatry: Official Journal of the American Association for Geriatric Psychiatry513518. doi:10.1097/JGP.0b013e318167ae5b

Lai, D. W. L. (2007). Validation of the Zarit Burden Interview for Chinese Caregivers. Social Work Research, 31(1), 4553. doi:10.1093/swr/31.1.45

Lim, W. S., Cheah, W. K., Ali, N., Han, H. C., Anthony, P. V., Chan, M., & C

S. (2014). Worry about performance: a unique dimension of caregiver burInternational Psychogeriatrics / IPA, 26(4), 677686. doi:10.1017/S1041610213

Whitlatch, C. J., Zarit, S. H., & von Eye, A. (1991). Efficacy of interventioncaregivers: a reanalysis. The Gerontologist, 31(1), 914.

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Li et al. - 2014 - Worry about caregiving performance: A confirmatory analysis