title: Exemplary care as a mediator of the effects of caregiver subjective appraisal and emotional outcomes.
abstract: OBJECTIVE
  Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs.
  
  
  METHODS
  We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes.
  
  
  RESULTS
  Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity.
  
  
  CONCLUSIONS
  Overall, CGs' perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care.
authors.affiliation: Department of Psychology, The University of Alabama, Tuscaloosa, AL 35487-0315, USA. grantharris4@gmail.com
authors.forename: Grant M
authors.initials: GM
authors.lastname: Harris
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Durkin
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Allen
authors.forename: Jamie
authors.initials: J
authors.lastname: DeCoster
authors.forename: Louis D
authors.initials: LD
authors.lastname: Burgio
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000523:psychology; D005006:Ethnicity / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology*; D055815:Young Adult