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Understanding behavioural and psychological symptoms in dementia and family caregiver distress

Feast, AR; (2016) Understanding behavioural and psychological symptoms in dementia and family caregiver distress. Doctoral thesis , UCL (University College London).

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Abstract

Background: There is a growing need to improve our understanding of carers’ reactions to Behavioural and Psychological Symptoms in Dementia (BPSD): symptoms of disturbed perception, thought content, mood, or behaviour (Finkel & Burns, 1999). This is due to the adverse consequences of BPSD for carer wellbeing, increased rates of psychiatric referral, and institutionalisation resulting from carer burden linked to BPSD. Aim: To understand how BPSD links to family carer distress. Methods: The complementary meta-analytic and meta-ethnographic reviews informed the subsequent empirical analysis. Psychosocial measures from 157 family carers of people with dementia were collected as part of the Challenge Famcare project; correlations, hierarchical regression, moderation, mediation, and path analyses were performed. Results: The impact of BPSD on carer wellbeing is not measured consistently, however, depressive behaviour was found to be the most distressing for carers. Family carers’ perceptions of BPSD as “challenging” were found to be associated with a sense of a declining relationship, transgressions against social norms, and an underlying belief that their relative would inevitably lose their personhood. Carer psychosocial factors explained 56% of the variance in BPSD-related distress. Once carer psychosocial factors were controlled for, frequency of BPSD was not a significant predictor of BPSD-related distress. Following path analysis, carer reactivity to BPSD, burden, competence, and relationship quality were found to directly influence BPSD-related distress. Guilt influenced distress indirectly via burden and reactivity to BPSD. The final path model accounted for 41% of the variance in BPSD-related distress and provided a good fit (Χ2 = 23.920, df = 19, p = .199). Conclusion: Interventions for the management of BPSD should acknowledge carer beliefs and unmet psychological needs. Carer psychosocial factors such as their sense of competence, relationship quality, guilt, burden, and reactivity to BPSD contribute to BPSD-related distress. Future interventions for the management of behavioural problems could provide support to address these psychosocial factors.

Type: Thesis (Doctoral)
Title: Understanding behavioural and psychological symptoms in dementia and family caregiver distress
Event: University College London
Language: English
Keywords: dementia, BPSD, Behavioural and Psychological Symptoms, caregiver distress, path analysis, caregiver wellbeing
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: http://discovery.ucl.ac.uk/id/eprint/1485653
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