title: Caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease.
abstract: This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease (AD).
  
  
  METHODS
  A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect).
  
  
  RESULTS
  In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% CI, .883, .977). In contrast, levels of caregivers' positive and negative emotion did not reliably predict institutionalization.
  
  
  CONCLUSIONS
  The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.
authors.affiliation: Rush Institute for Healthy Aging, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Gilley
authors.forename: Judith J
authors.initials: JJ
authors.lastname: McCann
authors.forename: Julia L
authors.initials: JL
authors.lastname: Bienias
authors.forename: Denis A
authors.initials: DA
authors.lastname: Evans
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000544:Alzheimer Disease; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States