Burden among Family Caregivers of Dementia in the Oldest-Old: An Exploratory Study.

Khin Khin Win,Mei Sian Chong,Mark Chan,Noorhazlina Ali,Wee Shiong Lim

doi:10.3389/fmed.2017.00205

Khin Khin Win, Mei Sian Chong + Show 3 more

Open Access

https://doi.org/10.3389/fmed.2017.00205

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Abstract

With >85 years, the fastest growing age segment in developed countries, dementia in the oldest-old is projected to increase exponentially. Being older, caregivers of dementia in oldest-old (CDOO) may experience unique challenges compared with younger-age groups. Thus, we aim to explore demographic characteristics and burden pattern among CDOO. We studied 458 family caregiver-patient dyads attending an outpatient memory clinic. We classified patients into three age-groups: <75, 75-84, and ≥85 years. We measured caregiver burden using the Zarit Burden Interview (ZBI) 4-factor structure described by Cheah et al. (1). We compared care recipient characteristics, caregiver demographics, and ZBI total/factors scores between the three age-groups, and performed 2-way analysis of variance (ANOVA) to ascertain the effect of age-group by disease severity interaction. Oldest-old care recipients were more impaired in cognitive function and instrumental ADL; there was no difference in behavior and basic ADL. Compared with the other two age-groups, CDOO were older (mean age: 50.4 vs 55.5 vs 56.8 years, P < 0.01), and overwhelmingly adult children (85.9%) as opposed to spouses (5.3%). CDOO also had higher ZBI total score, role strain, and personal strain (all P < 0.05). However, there was no difference in worry about performance scores. 2-way ANOVA did not reveal significant age-group by disease severity interaction for ZBI total and factor scores, although distinctive differences were seen between role/personal strain with worry about performance in mild cognitive impairment and very mild dementia. Our study highlighted that CDOO were mainly older adult children who experienced significant role and personal strain independent of disease severity while caring for their family member with more impaired cognitive and physical function. These results pave the way for targeted interventions to address the unique burden faced by this rapidly growing group of caregivers.

Highlights

The oldest-old population, variously defined as 80 or 85 years and older, has emerged as the fastest growing age segment, especially in developed countries
Our results reveal that caregivers of dementia in oldest-old (CDOO) are older and typically an older adult–child or a younger non-spousal/ non-child family member
Compared with their counterparts looking after the middle-old and young-old age groups, CDOO experience higher caregiver burden in the domains of role strain and personal strain but not worry about performance, even in the earliest stages of mild cognitive impairment (MCI) and very mild dementia

Summary

Introduction

The oldest-old population, variously defined as 80 or 85 years and older, has emerged as the fastest growing age segment, especially in developed countries. The prevalence of age-associated diseases such as dementia is expected to mirror this worrying global demographic trend of population aging, such that growth of dementia in the oldest-old (DOO) is expected to exhibit a corresponding exponential rise that far outstrips other age groups. Recent studies support this assertion that the oldest-old represents the fastest growing population with dementia. We aim to explore demographic characteristics and burden pattern among CDOO

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