title: Does caregiver burden mediate the effects of behavioral disturbances on nursing home admission?
abstract: OBJECTIVE
  The primary objective of this study was to determine whether caregiving burden mediated the relationship between specific behavior disturbances and time to nursing home admission (NHA) for persons with dementia (i.e., Alzheimer disease or a related disorder).
  
  
  METHODS
  The study used secondary longitudinal data from the Medicare Alzheimer's Disease Demonstration, a Medicare-covered home care benefit and case management program for family caregivers of persons with dementia. Primary caregivers of persons with dementia were assessed via in-person and telephone interviews every 6 months over a 3-year period.
  
  
  METHODS
  Dementia caregivers were recruited from eight catchment areas throughout the United States.
  
  
  METHODS
  The baseline sample included 5,831 dementia caregivers. Just more than 40% (43.9%; N = 2,556) of persons with dementia permanently entered a nursing home during the 3-year study period.
  
  
  METHODS
  Individual behavior problems were measured with the Memory and Behavior Problem Checklist. Caregiving burden was assessed with a short version of the Zarit Burden Inventory. Key covariates, including sociodemographic background, functional status, and service utilization, were also considered.
  
  
  RESULTS
  Event history analyses revealed that time-varying measures of caregiver burden fully mediated the relationship between four behavioral disturbances (episodes of combativeness, property destruction, repetitive questions, and reliving the past) and NHA.
  
  
  CONCLUSIONS
  The findings highlight the multifaceted, complex pathway to NHA for persons with dementia and their family caregivers. The results emphasize the need for comprehensive treatment approaches that incorporate the burden of caregivers and the behavioral/psychiatric symptoms of persons with dementia simultaneously.
authors: School of Nursing, Center on Aging, University of Minnesota, Minneapolis, 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: Kory
authors: K
authors: Schuh
authors: Robert
authors: R
authors: Newcomer