title: The effects of incident and persistent behavioral problems on change in caregiver burden and nursing home admission of persons with dementia.
abstract: BACKGROUND
  The individual contributions of behavior problems to key and related outcomes in dementia, such as nursing home admission (NHA) or caregiver burden, remain unclear.
  
  
  OBJECTIVE
  This study sought to determine the ramifications of temporal change in individual behavior problems when accounting for increases in caregiver burden and time to NHA. Although burden is sometimes conceptualized as an antecedent to NHA, it has also emerged as a relevant outcome in dementia caregiving research.
  
  
  METHODS
  A sample of 4545 dementia caregivers who participated in the Medicare Alzheimer disease Demonstration Evaluation was selected for this secondary analysis. Various patterns of change in individual behavior problems were considered as predictors of increases in caregiver burden and time to NHA over a 3-year period via mixed effects and Cox proportional hazards models, respectively.
  
  
  RESULTS
  Caregivers who did not indicate a care recipient's dangerous behavior initially but did so subsequently (ie, an "incident" behavior problem) were more likely to experience increases in burden (P < 0.0026). Alternatively, the persistent occurrence of behavior disturbances (particularly memory problems) emerged as the strongest predictors of time to NHA.
  
  
  CONCLUSIONS
  The findings of this study suggest the benefit of examining temporal patterns of individual behavioral disturbances, and that incident and persistent problems account for different dementia outcomes over time. Considering the temporal ramifications and potency of specific behavior problems can facilitate the targeted and timely delivery of effective clinical interventions.
authors: Adult and Gerontology Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA. gaug0015@umn.edu
authors: Joseph E
authors: JE
authors: Gaugler
authors: Melanie M
authors: MM
authors: Wall
authors: Robert L
authors: RL
authors: Kane
authors: Jeremiah S
authors: JS
authors: Menk
authors: Khaled
authors: K
authors: Sarsour
authors: Joseph A
authors: JA
authors: Johnston
authors: Don
authors: D
authors: Beusching
authors: Robert
authors: R
authors: Newcomer
mesh_terms: D000328:Adult; D000368:Aged; D002055:Burnout, Professional / Q000453:epidemiology* / Q000523:psychology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D003704:Dementia / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012931:Social Environment; D014481:United States / Q000453:epidemiology