PREDICTORS OF CHANGE AND CONTINUITY IN-HOME CARE FOR DEMENTIA PATIENTS

Objective. To investigate predictors of change in the sense of compete nce of primary caregivers and continuity in home care for dementia pat ients. Design. A prospective longitudinal study with a follow-up perio d of 10 months.Setting. Dementia patients living in the community sele cted by Dutch general practitioners. Subjects. Pairs of demented patie nts and their primary caregivers (N = 138). Main outcome measures. Sen se of competence: a 27-item scale (alpha = 0.79) based on issues deriv ed from the family crisis model and the Burden Interview. Continuity i n home care is determined by the number of patient's admissions to a n ursing or retirement home. Results. Regression analysis revealed that a change in the caregiver's sense of competence was independently pred icted by characteristics of the patient, the primary caregiver and the professional social network. A decreased sense of competence was asso ciated with a longer duration of dementia and the patient's more agita ted behaviour, the caregiver's higher initial sense of competence and being a female caregiver sharing a household with the demented patient . A positive influence on the change in the sense of competence was fo und when these females received a professional intervention consisting of support for the caregiver. Reporting to be a Catholic or a Protest ant compared with not being religiously involved positively influenced the change in sense of competence. Logistic regression analysis ident ified that continuity in home care was predicted by characteristics of the demented patient and the professional social network of the patie nt. Predictors of continuation of home care were: lower severity of de mentia, patient's higher ADL impairment, the intervention and involvem ent of regular home help. Institutionalization was more likely when th e patient's behaviour was more apathetic and a district nurse was invo lved in the care. Conclusions. Caregiver characteristics influenced th e change in sense of competence but did not influence the risk for ins titutionalization. Findings suggest that health professionals should p ay attention to the negative consequences of agitated behaviour and to the most vulnerable group, females sharing a household with the demen ted patient. (C) 1997 by John Wiley & Sons, Ltd.