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Strategies Used by Families to Simplify Tasks for Individuals With Alzheimer's Disease and Related Disorders

Psychometric Analysis of the Task Management Strategy Index (TMSI)

^a Community and Homecare Research Division, College of Health Professions, Thomas Jefferson University, Philadelphia, PA
^b Department of Health Care Sciences, School of Medicine and Health Sciences, George Washington University, Washington, DC
^c Department of Medicine, Division of Clinical Pharmacology, Biostatistics Section, Thomas Jefferson University, Philadelphia, PA

Correspondence: Laura N. Gitlin, PhD, Director, Community and Homecare Research Division (CHORD), College of Health Professions, Thomas Jefferson University, 130 South 9th Street, Suite 513, Philadelphia, PA 19130. E-mail: laura.gitlin{at}mail.tju.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: Little is known about the specific behavioral strategies used by families to manage the physical dependency of persons with Alzheimer's disease and related disorders (ADRD). This study reports the psychometric properties of the Task Management Strategy Index (TMSI), a measure designed to identify actions taken by caregivers to simplify everyday self-care tasks for persons with ADRD. Relationships between use of these strategies and caregiver and care-recipient characteristics were also examined. Design and Methods: A pool of 20 items was developed and initially tested with 202 family caregivers (Sample 1) recruited for a dementia-management intervention study. Principal axis factor analysis was performed to determine scale structure. Convergent and discriminant evidence was examined using Pearson cor-relation and multiple regression analyses with a separate sample of 255 family caregivers (Sample 2) recruited for the Philadelphia site of the National Institutes of Health multisite initiative, Resources for Enhancing Alzheimer's Caregiver Health. Results: Exploratory principal axis factoring yielded one general factor accounting for 60.2% of variance in the first sample. Nineteen items, loading at .3 or above, constituted the final scale (Cronbach's alpha = .81 in Sample 1 and .74 in Sample 2). In Sample 2, TMSI scores were significantly associated with greater functional dependency of ADRD patients, high self-efficacy, and greater use of positive coping strategies. As expected, caregiver upset with disruptive behaviors and caregiver use of criticism-based strategies were not associated with TMSI scores. Higher caregiver education was significantly associated with greater use of task strategies. Implications: Results provide preliminary evidence that the TMSI is an easily administered, reliable, valid scale. Caregivers with lower education may benefit from instruction in the use of these strategies.

Key Words: Home care • Dementia management • Caregiving

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