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Dimensionality of burden in Alzheimer caregivers: confirmatory factor analysis and correlates of the Zarit Burden interview

Published online by Cambridge University Press:  03 June 2014

Sheung-Tak Cheng ,
Timothy Kwok  and
Linda C. W. Lam
Sheung-Tak Cheng*
Affiliation:
Department of Health and Physical Education, Hong Kong Institute of Education, Hong Kong
Timothy Kwok
Affiliation:
Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong
Linda C. W. Lam
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
*
Correspondence should be addressed to: Sheung-Tak Cheng, PhD, Department of Health and Physical Education, Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, N.T., Hong Kong. Email: [email protected].
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Abstract

Background:

To investigate dimensions of caregiver burden through factor analysis of the Zarit Burden Interview (ZBI), and to examine predictors of different dimensions of burden.

Methods:

Confirmatory factor analyses were performed on 395 Hong Kong Chinese Alzheimer caregivers to examine whether several proposed factor structures fit the data well. Subsequently, participants were split into two roughly equal subsamples, for the purpose of identifying the most optimal factor structure through exploratory factor analysis in Sample A (n = 183) and an independent verification through confirmatory factor analysis in Sample B (n = 212). ZBI subscales representing the established factors were correlated with caregiver and care-recipient variables known to be associated with burden.

Results:

Confirmatory factor analyses showed that factor models reported elsewhere did not fit the data well. Subsequently, exploratory factor analysis in Sample A suggested a 4-factor structure. After dropping three items due to poor factor loadings, the 4-factor structure was found to fit the data moderately well in Sample B. The four factors tapped personal strain, captivity, self-criticism, and loss of control. However, self-criticism was basically unrelated to the other three factors and showed a rather different pattern of correlations with caregiver and care-recipient variables. Self-criticism was more common among child caregivers and those who did not live with the care-recipient and was less involved in day-to-day care, yet feeling obligated and close to the care-recipient.

Conclusions:

The dimensions of caregiver burden may be culturally specific. More research is needed to examine cultural considerations in measuring caregiver burden.

Keywords

Alzheimer’s diseasecaregiver burdenconfirmatory factor analysisHong Kong Chinese
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 9 , September 2014 , pp. 1455 - 1463
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Alzheimer's Disease International. (2013). The Global Impact of Dementia 2013–2050. London: Alzheimer's Disease International.Google Scholar
Ankri, J., Andrieu, S., Beaufils, B., Grand, A. and Henrard, J. C. (2005). Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. International Journal of Geriatric Psychiatry, 20, 254–260.Google Scholar
Burnham, K. P. and Anderson, D. R. (2002). Model Selection and Multimodel Inference: A Practical Information-Theoretic Approach. New York: Springer.Google Scholar
Cheah, W. K., Han, H. C., Chong, M. S., Anthony, P. V. and Lim, W. S. (2012). Multidimensionality of the Zarit Burden Interview across the severity spectrum of cognitive impairment: an Asian perspective. International Psychogeriatrics, 24, 1846–1854. doi: 10.1017/S104161021200110X.CrossRefGoogle ScholarPubMed
Cheng, S.-T., Chou, K.-L. and Zarit, S. H. (2013). Dementia in Asia: introduction to a special section. Aging & Mental Health, 17, 911–914. doi: 10.1080/13607863.2013.837151.Google Scholar
Cheng, S.-T., Kwok, T. and Lam, L. C. W. (2012). Neuropsychiatric symptom clusters of Alzheimer's disease in Hong Kong Chinese: prevalence and confirmatory factor analysis of the Neuropsychiatric Inventory. International Psychogeriatrics, 24, 1465–1473. doi: 10.1017/S1041610212000609.CrossRefGoogle Scholar
Cheng, S.-T., Lam, L. C. W. and Kwok, T. (2013a). Neuropsychiatric symptom clusters of Alzheimer's disease in Hong Kong Chinese: correlates with caregiver burden and depression. The American Journal of Geriatric Psychiatry, 21, 1029–1037. doi: 10.1016/j.jagp.2013.01.041.Google Scholar
Cheng, S.-T., Lam, L. C. W., Kwok, T., Ng, N. S. S. and Fung, A. W. T. (2013b). The social networks of Hong Kong Chinese family caregivers of Alzheimer's disease: correlates with positive gains and burden. The Gerontologist, 53, 998–1008. doi: 10.1093/geront/gns195.Google Scholar
Cheng, S.-T., Lam, L. C. W., Kwok, T., Ng, N. S. S. and Fung, A. W. T. (2013c). Self-efficacy is associated with less burden and more gains from behavioral problems of Alzheimer's disease in Hong Kong Chinese caregivers. The Gerontologist, 53, 71–80. doi: 10.1093/geront/gns062.Google Scholar
Cheng, S.-T. et al. (in press). Benefit-finding intervention for Alzheimer caregivers: conceptual framework, implementation issues, and preliminary efficacy. The Gerontologist. doi: 10.1093/geront/gnu018.Google Scholar
Cheng, S.-T. et al. (2012). A benefit-finding intervention for family caregivers of persons with Alzheimer disease: study protocol of a randomized controlled trial. Trials, 13, 98. doi: 10.1186/1745-6215-13-98.Google Scholar
Cicirelli, V. G. (2006). Caregiving decision making by older mothers and adult children: process and expected outcome. Psychology and Aging, 21, 209–221. doi: 10.1037/0882-7974.21.2.209.Google Scholar
Cicirelli, V. G. (1993). Attachment and obligation as daughters’ motives for caregiving behavior and subsequent effect on subjective burden. Psychology and Aging, 8, 144–155. doi: 10.1037/0882-7974.8.2.144.Google Scholar
Cole, J. D. and Kazarian, S. S. (1988). The level of expressed emotion scale: a new measure of expressed emotion. Journal of Clinical Psychology, 44, 392–397. doi: 10.1002/1097-4679(198805)44:3<392::AID-JCLP2270440313>3.0.CO;2-3.Google Scholar
Cummings, J. L. (1997). The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–S16. doi: 10.1016/S0140-6736(05)67889-0.Google Scholar
Fillenbaum, G. G. and Smyer, M. A. (1981). The development, validity, and reliability of the OARS Multidimensional Functional Assessment Questionnaire. Journals of Gerontology, 36, 428–434.Google Scholar
Gallagher-Thompson, D. et al. (2012). International perspectives on nonpharmacological best practices for dementia family caregivers: a review. Clinical Gerontologist, 35, 316–355. doi: 10.1080/07317115.2012.678190 CrossRefGoogle Scholar
Gaugler, J. E., Reese, M. and Mittelman, M. S. (2013). Effects of the NYU caregiver intervention-adult child on residential care placement. The Gerontologist, 53, 985–997. doi: 10.1093/geront/gns193.Google Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23, 56–61. doi: 10.1136/jnnp.23.1.56.Google Scholar
Hayashi, S. et al. (2013). Burden of caregivers for patients with mild cognitive impairment in Japan. International Psychogeriatrics, 25, 1357–1363. doi: 10.1017/S1041610213000537.CrossRefGoogle ScholarPubMed
Knight, B. G., Fox, L. S. and Chou, C. (2000). Factor structure of the burden interview. Journal of Clinical Geropsychology, 6, 249–258. doi: 10.1023/A:1009530711710.Google Scholar
Li, C. Y. and Lewis, F. M. (2013). Expressed emotion and depression in caregivers of older adults with dementia: results from Taiwan. Aging & Mental Health, 17, 924–929.Google Scholar
Lin, W., Tsai, C., Wang, S., Hwang, J. and Fuh, J. (2012). Comparison of the burdens of family caregivers and foreign paid caregivers of the individuals with dementia. International Psychogeriatrics, 24, 1953–1961. doi: 10.1017/S1041610212001354.Google Scholar
Longmire, C. V. F. and Knight, B. G. (2011). Confirmatory factor analysis of a brief version of the Zarit Burden Interview in Black and White dementia caregivers. The Gerontologist, 51, 453–462. doi: 10.1093/geront/gnr011.Google Scholar
Lu, L., Wang, L., Yang, X. and Feng, Q. (2009). Zarit Caregiver Burden Interview: development, reliability and validity of the Chinese version. Psychiatry and Clinical Neurosciences, 63, 730–734. doi: 10.1111/j.1440-1819.2009.02019.x.Google Scholar
Marsh, H. W., Hau, K. and Grayson, D. (2005). Goodness of fit in structural equation models. In McArdle, J. J. (ed.), Contemporary Psychometrics: A Festschrift for Roderick P. McDonald (pp. 275–340). Mahwah, NJ: Lawrence Erlbaum.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.Google Scholar
Mittelman, M. (2013). Psychosocial interventions to address the emotional needs of caregivers of individuals with Alzheimer's disease. In Zarit, S. H. and Talley, R. C. (eds.), Caregiving for Alzheimer's Disease and Related Disorders: Research, Practice, Policy (pp. 17–34). New York: Springer.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. The Gerontologist, 30, 583–594.Google Scholar
Rodriguez-Sanchez, E. et al. (2013). Effects of a psychological intervention in a primary health care center for caregivers of dependent relatives: a randomized trial. The Gerontologist, 53, 397–406. doi: 10.1093/geront/gns086.Google Scholar
Satorra, A. and Bentler, P. M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In von Eye, A., Clogg, C. C., von Eye, A. and Clogg, C. C. (eds.), Latent Variables Analysis: Applications for Developmental Research (pp. 399–419). Thousand Oaks, CA: Sage.Google Scholar
Springate, B. A. and Tremont, G. (2014). Dimensions of caregiver burden in dementia: impact of demographic, mood, and care recipient variables. The American Journal of Geriatric Psychiatry, 22, 294–300.Google Scholar
Steffen, A. M., McKibbin, C., Zeiss, A. M., Gallagher-Thompson, D. and Bandura, A. (2002). The Revised Scale for caregiving self-efficacy: reliability and validity studies. Journal of Gerontology: Psychological Sciences, 57B, P74–86.Google Scholar
Tractenberg, R. E., Weiner, M. F., Cummings, J. L., Patterson, M. B. and Thal, L. J. (2005). Independence of changes in behavior from cognition and function in community-dwelling persons with Alzheimer's disease: a factor analytic approach. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 51–60. doi: 10.1176/appi.neuropsych.17.1.51.Google Scholar
Werner, P., Mittelman, M. S., Goldstein, D. and Heinik, J. (2012). Family stigma and caregiver burden in Alzheimer's disease. The Gerontologist, 52, 89–97. doi: 10.1093/geront/gnr117.Google Scholar
Whitlatch, C. J., Zarit, S. H. and von Eye, A. (1991). Efficacy of interventions with caregivers: a reanalysis. The Gerontologist, 31, 9–14. doi: 10.1093/geront/31.1.9.Google Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. The Gerontologist, 20, 649–655.Google Scholar