Decision Making and Caregivers

12 important questions on Decision Making and Caregivers

Early stages of dementia

memory disturbances
personality changes
diagnosis: e.g. Alzheimer's disease > relief but also many questions and concerns

Middle stages of dementia

  • Severer memory disturbances
  • greater personality changes
  • impairments in abstract thinking and judgment
  • anger and agitation
  • depression

Late stages of dementia

  • Often: nursing home placement
  • Not necessarily a decrease in caregiver burden
  • Improvement in burden might occur
  • Increase in financial strain
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What do caregivers with a high burden show?

Increased activity in the HPA-axis
Poor antibody response to influenza vaccine
Cardiovascular disease

Financial Capacity Instruments

  1. Basic monetary skills
  2. Financial conceptual knowledge
  3. Cash transactions
  4. Checkbook management
  5. Bank Statement management
  6. Financial judgment
  7. Bill payment
  8. Knowledge of personal assets/ estate arrangements
  9. Investment decision making

Prodormal phase of dementia

Mild cognitive impairment 
Difficulties emerge in:
  • Financial conceptual knowledge
  • Bank statement management
  • Bill payment skills
Impairments in financial capacities are not present in all MCI patients

Financial decision making- mild dementia

  • Patients with a mild AD early on have a broad range of impaired financial skills
  • These skills hsow relatively rapid further decline over a one-year period
  • Declines emerges on both simple and complex tasks on almost all domains.

Caregiver predictors are gender difference:

  • Female caregivers experience more depressive symptoms, anxiety and general psychiatric symptoms than male caregivers
  • Women spend more time on caregiving tasks than men 
  • Women perceive greater strain and burden related to caregiving than men and are more likely to experience role conflicts (e.g. with work and social activities)
  • Women are more likely to attempt to be “supercaregivers” and accomplish several tasks simultaneously whereas men are likely to plan a smaller number of tasks and accomplish then in a linear manner

Caregiver predictors relation to patient

Spouse caregivers exhibit higher levels of depression and stress and lower levels of life satisfaction and participation in social activities than other family members
Maintain the caregiving role for long periods
Spouse caregivers have a greater likelihood of having health problems themselves
Adult child-caregivers are more often juggling multiple roles
Adult child-caregivers frequently experience conflict with their siblings over caregiving issues

Caregiver predictors coping

Coping: Cognitive and behavioural attempts to manage specific demands that are appraised as stressful
Problem-focused coping: efforts to change a stressful situation in some way
Emotion-focused coping: internal strategies that are used to manage one’s emotions
Emotion-focused coping is associated with higher levels of distress
Active problem-focused coping is associated with a greater caregiver well-being

Caregiver predictors personality

Some caregivers are more likely than others to appraise a caregiving situation as stressful
Caregivers with certain personality characteristics may be less effective in arranging effective social support
Optimism and mastery ++
Neuroticism –
High levels of anger –

Caregiver predictors other factors

Social support
Health behaviour
Companion animals

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