Caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease

Objective: This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer's disease (AD). Method: A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect). Results: In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% Cl, .883, .977). In contrast, levels of caregivers' positive and negative emotion did not reliably predict institutionalization. Discussion: The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.