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*221. Caregivers' Confidence in their Ability to Prevent Home Injury to a Care-Recipient with Dementia

KJ Horvath, ENRM Veterans Hospital, Bedford, MA; A Hurley, ENRM Veterans Hospital, Bedford, MA; S Smith, ENRM Veterans Hospital, Bedford, MA; PB Cipolloni, ENRM Veterans Hospital, Bedford, MA; M Gauthier, ENRMVH and Northeastern University; S Trudeau, ENRM Veterans Hospital

Objectives: The purpose of this study is to describe the phenomena of accidents, risky behaviors and caregivers’ perceived self-efficacy in home environments with a care-recipient with dementia. Specifically, we aim to: 1) Describe gradations of unsafe – safer home environments for care recipients with dementia; 2) Explore the range of less effective – more effective caregiver behaviors used to manage a dementia care-recipient at home; 3) Identify sub-populations of caregivers for whom future interventions should be targeted

Methods: A purposive sample of 20 interdisciplinary professionals who support caregivers living with a person with dementia are being interviewed; sampling continues until theoretical saturation is attained. Data Collection consists of semi-structured interviews to elicit detail about gradations of safety problems in the home and the range of caregivers’ confidence in managing risky behaviors. Data Analysis includes thematic analysis using low-inference descriptors and verbatim statements to identify recurring themes; concurrent data collection/analysis to pursue emerging themes; constant comparison of parts and whole of text; member-checking and peer-checking; comparison and integration with extant literature.

Results: Initial interviews reflect several recurring themes. (1) Factors that interfere with a caregiver’s willingness or ability to make needed modifications in the home and contribute to a more risky environment include: social isolation, fear of assaultive behavior, and lack of knowledge of available and low-cost resources to enhance home safety. (2) Diminished memory and judgment can be masked with socially learned responses that allow the patient and others to minimize the extent of illness. (3) Caregiver lack of sleep and/or lack of support contribute to incidents and accidents in the home. (4) Low awareness and/or resistiveness to home safety modifications by the family can be overcome sometimes with guidance and technical support. (5) Even the most effective caregivers sometimes underutilize available resources because of past habits and family traditions. (6) Inexperience in an advocate role contributes to decreased confidence and effectiveness in managing the home environment safety.

Conclusions: Conclusions: Safer home environments for care-recipients with dementia require a caregiver who is willing to make some safety modifications and has learned to be an advocate for themselves and the care-recipient. Caregivers who may be more vulnerable to allowing risky behaviors are persons who are socially isolated, fear assault by the person with dementia, have not acted in an advocacy role in the past, and who have limited knowledge of available and low-cost resources. Caregiver actions to enhance safety are subject to the family’s traditions and habits which may act as mediating factors.

Impact: Impact: As the population ages, the incidence of dementia also increases, while a restructured health environment tries to provide care in the least-costly setting. Professional care providers will need a full understanding of how to help caregivers of veterans with dementia manage their care-recipient at home longer, without increased risk of morbidity for either the caregiver or care-recipient.

Supported by the Department of Veterans Affairs (NRI-97030), and School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA.