title: Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.
abstract: OBJECTIVE
  This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination.
  
  
  METHODS
  Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination.
  
  
  RESULTS
  As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = -0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress.
  
  
  CONCLUSIONS
  We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.
authors.affiliation: Duke University School of Nursing, Trent Drive, DUMC 3322, Durham, NC 27710, USA. joshua.thorpe@duke.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Betsy L
authors.initials: BL
authors.lastname: Sleath
authors.forename: Carolyn T Kalinowski
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Courtney H
authors.initials: CH
authors.lastname: Van Houtven
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Blalock
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Landerman
authors.forename: William H
authors.initials: WH
authors.lastname: Campbell
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Clipp
mesh_terms: D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003625:Data Collection; D003704:Dementia; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007251:Influenza, Human / Q000276:immunology*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011647:Puerto Rico; D013315:Stress, Psychological