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a Department of Psychiatry, University of California, San Francisco
b Department of Family and Community Medicine, University of California, San Francisco
Correspondence: Morton A. Lieberman, PhD, Center for Health & Community, 3333 California Avenue, U.C. San Francisco, San Francisco, CA 94143. E-mail: mal{at}itsa.ucsf.edu.
Decision Editor: Eleanor S. McConnell, RN, PhD
Purpose: This study sought to determine the effects of nursing home placement (NHP) for patients with Alzheimer's disease, compared to maintaining community placement, on changes in family caregiver health and well-being over time. Design and Methods: We utilized a 2-year, longitudinal study with one baseline and four follow-up assessments for patients' spouses, adult offspring, and in-laws (married to offspring). Families were recruited from eight clinical outpatient centers, supported by the State of California, and followed in the community over time. A multidisciplinary clinical evaluation was undertaken by the centers, and follow-up assessments included questionnaire and interview data. Results: Family caregiver health and well-being did not improve over time following NHP, and there were no significant differences in health and well-being between family caregivers who placed their ill elder in a nursing home and those who kept the elder at home or in the community. However, female family caregivers and spouses displayed greater declines in health and well-being over time, compared to other family caregivers, regardless of whether or not NHP occurred. Implications: Families considering NHP need to be advised of what may and may not change following NHP. In particular, spouses and female family caregivers may not experience those changes in life satisfaction and well-being that are hoped for. Variation in the effects of NHP may be more related to pre-NHP family processes and relationships than to the severity of the patient's disability, caregiver strain, patient and caregiver demographics, and use of community-based professional services.
Key Words: Alzheimer's disease • Dementia • Placement • Caregiver burden
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