Caregivers' burden analytics: combining variables from patients with dementia and their caregivers

Caregivers caring for patients with dementia could experience depressive symptoms, distress from patients' behavioral symptoms, and physical morbidities. Factors associated with a caregiving burden are complex and vary with time because burden is a subjective measure influenced by physical, economic, and psychosocial strain and has an interaction among caregiver resources, vulnerabilities, and care demands. The purpose of this study was to elucidate the association of patients' and caregivers' factors especially the severity of behavior and psychiatric symptoms of dementia (BPSD) and specific activities of daily living items impairment with a moderate or even severe caregiving burden.

A cross-sectional study was conducted with 585 patients with dementia who were cared for informal caregivers and were managed by the dementia collaborative care team at Changhua Christian Hospital in Taiwan. Variables from patients with dementia included age, gender, type of dementia, clinical dementia rating, feeding, toilet use, bathing, mobility, getting lost, and Neuropsychiatric Inventory, whereas variables from caregivers consisted of age, relation to the patient, marital status, employment, type of primary care, frequency of care, and caregiving burden. The Apriori algorithm was used to find the association of patients' and caregivers' factors and a moderate or even severe caregiving burden when the minimum support and confidence were set to 1% and 85%, respectively, along with lift > 1.

One hundred and fifty rules were found for caregivers with a moderate to severe burden, and these rules can be further summarized into twenty general rules. To further explore the rules containing severe burden, the minimum confidence was reduced from 85 to 65%. Sixteen rules were found with a severe caregiving burden, and these rules were concluded into one general rule. When the caregiver was a spouse who solely cared for the male patient with moderate Alzheimer's disease (AD), the caregiver had a severe burden. Moderately severe BPSD was associated with a high caregiving burden than specific activities of daily living domain dysfunctions.

The severity of BPSD, severity of cognition, patients' and caregivers' gender, relation to the care recipient, employment, and caregiving load were associated with a moderate or severe burden for caregivers who cared for patients with dementia. A severe caregiving burden was occurred when a female caregiver solely took care of her spouse who had moderate AD. Suitable caregiving supports should be provided to female caregivers in order to reduce their caregiving burden.