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Long-Term Adaptation to Institutionalization in Dementia Caregivers

Correspondence: Address correspondence to Joseph E. Gaugler, PhD, Center on Aging, Center for Gerontological Nursing, School of Nursing, The University of Minnesota, 6-150 Weaver-Densford Hall, 1331, 308 Harvard Street SE, Minneapolis, MN 55455. E-mail: gaug0015{at}umn.edu

Purpose: Longitudinal research in dementia has acknowledged the importance of transitions during the course of family caregiving. However, long-term adaptation to institutionalization has received little attention. This study attempts to describe caregivers' adaptation (changes in stress, well-being, and psychosocial resources) to placement up to 4 years following institutionalization. Design and Methods: Using data from the Caregiver Stress and Coping Study, this analysis constructed four longitudinal panels, each consisting of a preplacement assessment and either two (n = 146), three (n = 109), four (n = 75), or five (n = 38) waves after placement. We used growth curve models to examine longitudinal trajectories of adaptation in various measures of stress, global well-being, and psychosocial resources. Results: The findings suggested sharper decreases in stressors (e.g., role overload) and indicators of negative mental health in the shorter term panels. However, more significant intraindividual variation existed in caregivers' adaptation to placement in the longer term panels (four and five waves of postplacement). Implications: There is relative stability in caregiver long-term adaptation to institutionalization. However, the variability in adaptation emphasizes the need to target postplacement clinical interventions to families most at risk for negative outcomes during the transition to institutional care.

Key Words: Nursing home placement • Nursing home admission • Alzheimer's disease • Family caregiving • Informal long-term care