TitleMagnitude and causes of bias among family caregivers rating Alzheimer disease patients.
Publication TypeJournal Article
Year of Publication2013
AuthorsSchulz, R, Cook, TB, Beach, SR, Lingler, JH, Martire, LM, Monin, JK, Czaja, SJ
JournalAm J Geriatr Psychiatry
Volume21
Issue1
Pagination14-25
Date Published2013 Jan
ISSN1545-7214
KeywordsAdult, Aged, Aged, 80 and over, Alzheimer Disease, Attitude to Health, Caregivers, Cost of Illness, Cross-Sectional Studies, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Patients, Prejudice, Quality of Life, Self-Assessment, Stress, Psychological
Abstract

<p><b>OBJECTIVE: </b>Family caregivers generally underestimate the health and well-being of Alzheimer disease (AD) patients when compared to patients' self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias.</p><p><b>METHODS: </b>One hundred five patients with AD, along with their family caregivers, were assessed twice by trained interviewers 1-year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies.</p><p><b>RESULTS: </b>Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy.</p><p><b>CONCLUSIONS: </b>Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers' ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver's own well-being is compromised.</p>

DOI10.1016/j.jagp.2012.10.002
Alternate JournalAm J Geriatr Psychiatry
PubMed ID23290199
PubMed Central IDPMC3330137
Grant ListR01 AG015321 / AG / NIA NIH HHS / United States
R24 HL076858 / HL / NHLBI NIH HHS / United States
HL076858 / HL / NHLBI NIH HHS / United States
P50AG05133 / AG / NIA NIH HHS / United States
R01 AG026010 / AG / NIA NIH HHS / United States
P50 AG026010 / AG / NIA NIH HHS / United States
R01 NR008272 / NR / NINR NIH HHS / United States
R01 NR009573-05 / NR / NINR NIH HHS / United States
R01 AG015321-10 / AG / NIA NIH HHS / United States
R24 HL076852 / HL / NHLBI NIH HHS / United States
P50 AG005133-23 / AG / NIA NIH HHS / United States
P30 MH071944 / MH / NIMH NIH HHS / United States
NR08272 / NR / NINR NIH HHS / United States
HL076852 / HL / NHLBI NIH HHS / United States
R01 AG026010-05 / AG / NIA NIH HHS / United States
R24 HL076858-05 / HL / NHLBI NIH HHS / United States
P50 AG005133 / AG / NIA NIH HHS / United States
R01 NR009573 / NR / NINR NIH HHS / United States
MH071944 / MH / NIMH NIH HHS / United States
P50 AG015321 / AG / NIA NIH HHS / United States
NR09573 / NR / NINR NIH HHS / United States
P30 MH071944-05 / MH / NIMH NIH HHS / United States
R24 HL076852-05 / HL / NHLBI NIH HHS / United States
R01 NR008272-05 / NR / NINR NIH HHS / United States