title: Quality of in-home care, long-term care placement, and the survival of persons with dementia.
abstract: OBJECTIVE
  Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.
  
  
  METHODS
  We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.
  
  
  RESULTS
  Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.
  
  
  CONCLUSIONS
  It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.
authors: a Department of Neurology, School of Medicine , Case Western Reserve University , Cleveland , OH , USA.
authors: McKee J
authors: MJ
authors: McClendon
authors: Kathleen A
authors: KA
authors: Smyth
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology* / Q000592:standards; D003704:Dementia / Q000401:mortality / Q000451:nursing*; D005260:Female; D006701:Home Nursing / Q000592:standards*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D013315:Stress, Psychological; D016019:Survival Analysis; D013997:Time Factors
keywords: coping; dementia caregiving; long-term care; quality of caregiving; survival