Skip to main content
SpringerLink
Log in

Die Belastung pflegender Angehöriger bei Demenz

Enstehungsbedingungen und Interventionsmöglichkeiten

Carer burden in dementia

Origins and intervention

  • Übersichten
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Die Versorgung Demenzkranker in der häuslichen Umgebung ist mit einer sehr hohen Belastung für die pflegenden Angehörigen verbunden. Zu den wesentlichen Stressfaktoren zählen einerseits unveränderliche Kontextbedingungen wie Geschlecht, Verwandtschaftsverhältnis oder Ausprägung der Krankheitssymptome, andererseits aber auch der Wandel der persönlichen Beziehung, der individuelle Stil der Problembewältigung, die verfügbare Unterstützung sowie die Einstellung gegenüber der Pflegesituation. Die Mehrzahl der bisherigen Interventionen für pflegende Angehörige Demenzkranker hat den Schwerpunkt auf Wissensvermittlung und Verbesserung der Problemlösefähigkeit gelegt, aber den emotionalen Anteilen der Angehörigenbelastung nicht genügend Aufmerksamkeit gewidmet. Der Nutzen von Entlastungsprogrammen für pflegende Angehörige ist in zahlreichen kontrollierten Studien untersucht worden. Sie zeigen, dass die stärksten Wirkungen mit intensiven, langdauernden, individuell abgestimmten und alltagsnahen Interventionen zu erzielen sind. Aus diesen Erkenntnissen und Erfahrungen werden die Umrisse einer psychologisch begründeten verhaltenstherapeutischen Intervention für pflegende Angehörige Demenzkranker abgeleitet.

Summary

Caring for a demented elderly indiviudal in the home is associated with a high burden on care-providing family members. Factors contributing to this burden include invariable context conditions such as gender, type of relationship and severity of symptoms as well as role change, coping style, available support and appraisal of the caring role. Most interventions for family carers have focused on providing dementia-related information and problem solving skills but have placed less emphasis on the emotional facets of the burden. Controlled studies evaluating the efficacy of support programs for family carers suggest that the greatest benefits can be achieved by interventions which are intensive, long-term, individually tailored and targeted to the everyday context. From these findings and experiences the outline of a psychologically based behavioral intervention for family carers of dementia patients is derived.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Andrén S, Elmstahl S (2008) Psychosocial intervention for family caregivers of people with dementia reduces caregiver’s burden: development and effect after 6 and 12 months. Scand J Caring Sci 22:98–109

    Article  Google Scholar 

  2. Bedard M, Kuzik R, Chambers L et al (2005) Understanding burden differences between men and women caregivers: the contribution of care-recipient problem behaviors. Int Psychogeriatr 17:99–118

    Article  PubMed  Google Scholar 

  3. Belle SH, Burgio L, Burns R et al (2006) Enhancing the quality of life of dementia caregivers from different ethnic or racial groups. A randomized, controlled trial. Ann Intern Med 145:727–738

    PubMed  Google Scholar 

  4. Berger G, Bernhardt T, Wimer E et al (2005) Longitudinal study on the relationship between symptomatology of dementa and levels of subjective burden and depression among family caregivers in memory clinic patients. J Geriatr Psychiatry Neurol 18:119–128

    Article  PubMed  Google Scholar 

  5. Brodaty H, Gresham M (1989) Effect of a training program to reduce stress in carers of patients with dementia. Br Med J 299:1375–1379

    Article  CAS  Google Scholar 

  6. Bruder J (1988) Filiale Reife – ein wichtiges Konzept für die familiäre Versorgung kranker, insbesondere dementer alter Menschen. Z Gerontopsychol Psychiatr 1:95–101

    Google Scholar 

  7. Burgio L, Stevens A, Guy D et al (2003) Impact of two psychosocial interventions on white and African American family caregivers of individuals with dementia. Gerontologist 43:568–579

    PubMed  Google Scholar 

  8. Chappell NL, Reid RC (2002) Burden and well-being among caregivers: examining the distinction. Gerontologist 42:772–780

    PubMed  Google Scholar 

  9. Cooper C, Katona C, Orrell M et al (2008) Coping strategies, anxiety and depression in caregivers of people with Alzheimer’s disease. Int J Geriatr Psychiatry 23:929–936

    Article  PubMed  Google Scholar 

  10. Covinsky KE, Newcomer R, Fox P et al (2003) Patent and caregiver characteristics associated with depression in caregivers of patients with dementia. J Gen Intern Med 18:1006–1014

    Article  PubMed  Google Scholar 

  11. Danhauer SC, McCann J, Gilley DW et al (2004) Do behavioral disturbances in persons with Alzheimer’s disease predict caregiver depression over time? Psychol Aging 19:198–202

    Article  PubMed  Google Scholar 

  12. Dunkin JJ, Anderson-Hanley C (1998) Dementia caregiver burden. A review of the literature and guidelines for assessment and intervention. Neurology 51:53–60

    Google Scholar 

  13. Eloniemi-Sulkava U, Notkola Il, Hentinen M et al (2001) Effects of supporting community-living demented patients and their caregivers: a randomized trial. J Am Geriatr Soc 49:1282–1287

    Article  PubMed  CAS  Google Scholar 

  14. Etters L, Goodall D, Harrison BE (2008) Caregiver burden among dementia patient caregivers: a review of the literature. Am Acad Nurse Pract 20:423–428

    Article  Google Scholar 

  15. Farran CJ, Gilley DW, McCann JJ et al (2004) Psychosocial interventions to reduce depressive symptoms of dementia caregivers: a randomized clinical trial comparing two approaches. J Ment Health Aging 10:337–350

    Google Scholar 

  16. Gallagher-Thompson D, Lovett S, Rose J et al (2000) Impact of psychoeducational interventions on distressed family caregivers. J Clin Geropsychol 6:91–110

    Article  Google Scholar 

  17. Gavrilova SI, Ferri CP, Mikhaylova N et al (2008) Helping carers to care – the 10/66 Dementia Research Group’s randomized control trial of a caregiver intervention in Russia. Int J Geriatr Psychiatry 24:347–354

    Article  Google Scholar 

  18. Gitlin LN, Corcoran M, Winter L et al (2001) A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. Gerontologist 41:4–14

    PubMed  CAS  Google Scholar 

  19. Gitlin LN, Hauck WW, Dennis MP et al (2005) Maintenance of effects of the home environmental skill-building program for family caregivers and individuals with Alzheimer’s disease and related disorders. J Gerontol A Biol Sci Med Sci 60:368–374

    PubMed  Google Scholar 

  20. Gonyea J, O’connor M, Carruth A et al (2005) Subjective appraisal of Alzheimer’s disease caregiving: the role of self-efficacy and depressive symptoms in the experience of burden. Am J Alzheimer’s Dis Other Demen 20:273–280

    Google Scholar 

  21. Gonyea JG, O’Connor MK, Boyle PA (2006) Project CARE: A randomized controlle trial of a behavioral intervention group for Alzheimer’s disease caregivers. Gerontologist 46:827–832

    PubMed  Google Scholar 

  22. Gottlieb BH, Johnson J (2000) Respite programs for caregivers of persons with dementia: a review with practical implications. Aging Ment Health 4:119–129

    Article  Google Scholar 

  23. Große K, Kalytta T, Wilz G (2010) Kognitiv-verhaltenstherapeutische Interventionen für pflegende Angehörige von Demenzkranken. In: Haberstroh J, Pantel J (Hrsg) Demenz psychosozial behandeln. AKA, Heidelberg (im Druck)

  24. Haley W, Brown L, Levine EG (1987) Experimental evaluation of the effectiveness of group interventions for dementia caregivers. Gerontologist 25:232–236

    Google Scholar 

  25. Hébert R, Girouard D, Leclerc G et al (1995) The impact of a support group programme for care-givers on the institutionalization of demented patients. Arch Gerontol Geriatr 20:129–143

    Article  PubMed  Google Scholar 

  26. Hébert R, Lévesque L, Vézina J et al (2003) Efficacy of a psychoducative group program for caregivers of demented persons living at home: a randomized controlled trial. J Gerontol Soc Sci 58B:58–67

    Google Scholar 

  27. Hepburn KW, Tornatore J, Center B et al (2001) Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes. J Am Geriatr Soc 49:450–457

    Article  PubMed  CAS  Google Scholar 

  28. Hughes SL, Giobbie-Hurder A, Weaver FM et al (1999) Relationship between caregiver burden and health-related quality of life. Gerontologist 39:534–545

    PubMed  CAS  Google Scholar 

  29. Kneebone II, Martin PR (2003) Coping and caregivers of people with dementia. Br J Health Psychol 8:1–17

    Article  PubMed  Google Scholar 

  30. Kurz A, Wagenpfeil S, Hallauer J et al (2009) Evaluation of a brief educational program for dementia carers: the AENEAS Study. Int J Geriatr Psychiatry 25:861–869

    Article  Google Scholar 

  31. Markowitz JS, Gutterman EM, Sadik K et al (2003) Health-related quality of life for caregivers of patients with Alzheimer disease. Alzheimer Dis Assoc Disord 17:207–214

    Article  Google Scholar 

  32. Márquez-González M, Losada A, Izal M et al (2007) Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme. Aging Ment Health 1:616–625

    Article  Google Scholar 

  33. Marriott A, Donaldson C, Tarrier N et al (2000) Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer’s disease. Br J Psychiatry 176:557–562

    Article  PubMed  CAS  Google Scholar 

  34. Martín-Carrasco M, Franco-Martin M, Pelegrín-Valero C et al (2008) Effectiveness of a psychoeducational intervention program in the reduction of caregiver burden in Alzheimer’s disease patients‘ caregivers. Int J Geriatr Psychiatry 24:489–499

    Article  Google Scholar 

  35. Martin-Cook K, Davis BA, Hynan LS et al (2005) A randomized, controlled study of an Alzheimer’s caregiver skills training program. Am J Alzheimers Dis Other Demen 20:239–245

    Article  Google Scholar 

  36. Mausbach BT, Patterson TL, Von Känel R et al (2007) The attenuating effect of personal master on the relations between stress and Alzheimer caregiver helath: a five-year longitudinal analysis. Aging Ment Health 11:637–644

    Article  PubMed  CAS  Google Scholar 

  37. McConaghy R, Caltabiano ML (2005) Caring for a person with dementia: exploring relationships between perceived burden, depression, coping and well-being. Nurs Health Sci 7:81–91

    Article  PubMed  Google Scholar 

  38. Meuser TM, Marwit SJ (2001) A comprehensive, stage-sensitive model of grief in dementia caregiving. Gerontologist 41:658–670

    PubMed  CAS  Google Scholar 

  39. Mittelman MS, Ferris SH, Steinberg G et al (1993) An intervention that delays institutionalization of Alzheimer‘s disease patients: treatment of spouse-caregivers. Gerontologist 33:730–740

    PubMed  CAS  Google Scholar 

  40. Mittelman MS, Haley WE, Clay OJ et al (2006) Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology 67:1592–1599

    Article  PubMed  Google Scholar 

  41. Mittelman MS, Roth DL, Coon DW et al (2004) Sustained benefit of supportive intervention for depressive symptoms in caregivers of patients with Alzheimer’s disase. Am J Psychiatry 161:850–856

    Article  PubMed  Google Scholar 

  42. Mittelman MS, Roth DL, Haley WE et al (2004) Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer’s disease: reults of a randomized trial. J Gerontol Psychol Sci 59B:S27–S34

    Google Scholar 

  43. Morris RG (1988) Factors affecting the emotional wellbeing of the caregivers of dementia sufferers. Br J Psychiatry 153:147–156

    Article  PubMed  CAS  Google Scholar 

  44. Ostwald SK, Hepburn KW, Caron W et al (1999) Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. Gerontologist 39:299–309

    PubMed  CAS  Google Scholar 

  45. Ott CH, Sanders S, Kelber ST (2007) Grief and personal growth experience of spouses and adult-child caregivers of individuals with Alzheimer’s disease and related dementias. Gerontologist 47:798–809

    PubMed  Google Scholar 

  46. Pearlin LI, Mullan JT, Semple SJ et al (1990) Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 30:583–594

    PubMed  CAS  Google Scholar 

  47. Pinquart M, Sörensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. J Gerontol Psychol Sci 58B:112–128

    Google Scholar 

  48. Pinquart M, Sörensen S (2006) Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis. J Gerontol Psychol Sci 61B:33–45

    Google Scholar 

  49. Pinquart M, Sörensen S (2006) Helping caregivers of persons with dementia: which interventions work and how large are their effects? Int Psychogeriatr 18:577–595

    Article  PubMed  Google Scholar 

  50. Pusey H, Richards D (2001) A systematic review of the effectiveness of psychosocial interventions for carers of people with dementia. Aging Ment Health 5:107–119

    Article  PubMed  CAS  Google Scholar 

  51. Riedijk S, Duivenvoorden H, Rosso S et al (2008) Frontotemporal dementia: change of familial caregiver burden and partner relation in a Dutch cohort of 63 patients. Dement Geriatr Cogn Disord 26:398–406

    Article  PubMed  Google Scholar 

  52. Riedijk SR, De Vugt ME, Duivenvoorden HJ et al (2006) Caregiver burden, health-related quality of life and coping in dementia aregivers: a comparison of frontotemporal dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord 22:405–412

    Article  PubMed  CAS  Google Scholar 

  53. Rinaldi P, Spazzafumo L, Mastriforti R et al (2005) Predictors of high level of burden and distress in caregivers of demented patients: results of an Italian multicenter study. Int J Geriatr Psychiatry 20:168–174

    Article  PubMed  CAS  Google Scholar 

  54. Sanders S, Ott CH, Kelber ST et al (2008) The experience of high levels of grief in caregivers of persons with Alzheimer’s disease and related dementias. Death Stud 32:495–523

    Article  PubMed  Google Scholar 

  55. Sansoni J, Vellone E, Piras G (2004) Anxiety and depression in community-dwelling, Italian Alzheimer’s disease caregivers. Int J Nurs Pract 10:93–100

    Article  PubMed  Google Scholar 

  56. Schulz R, Martire LM, Klinger JN (2005) Evidence-based caregiver interventions in geriatric psychiatry. Psychiatr Clin North Am 28:1007–1036

    Article  PubMed  Google Scholar 

  57. Schulz R, O’Brien AT, Bookwala J et al (1995) Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist 35:771–791

    PubMed  CAS  Google Scholar 

  58. Selwood A, Johnston K, Katona C et al (2007) Systematic review of the effect of psychological interventions on family caregivers of people with dementia. J Affect Disord 101:75–89

    Article  PubMed  CAS  Google Scholar 

  59. Silverberg E (2006) Introducing the 3-A grief intervention model for dementia caregivers acknowledge assess and assist. Omega 54:215–235

    PubMed  Google Scholar 

  60. Simonelli C, Tripodi F, Rossi R et al (2008) The influence of caregiver burden on sexual intimacy and marital satisfaction in couples with an Alzheimer spouse. J Clin Pract 62:47–52

    Article  CAS  Google Scholar 

  61. Sörensen S, Duberstein P, Gill D et al (2006) Dementia care: mental health effects, intervention strategies, and clinical implications. Lancet Neurol 5:961–973

    Article  PubMed  Google Scholar 

  62. Steadman PL, Tremont G, Duncan-Davis J (2007) Premorbid relationship satisfaction and caregiver burden in dementia caregivers. J Geriatr Psychiatry Neurol 20:115–119

    Article  PubMed  Google Scholar 

  63. Thomas P, Lalloue F, Preux PM et al (2006) Dementia patients caregivers quality of life: the PIXEL Study. Int J Geriatr Psychiatry 21:50–56

    Article  PubMed  Google Scholar 

  64. Thompson CA, Spilsbury K, Hall J et al (2007) Systematic review of information and support interventions for caregivers of people with dementia. BMC Geriatr 7:18

    Article  PubMed  Google Scholar 

  65. Van Den Wijngaart MA, Vernooij-Dassen MJ, Felling AJ (2007) The influence of stressors, appraisal and personal conditions on the burden of spousal caregivers of persons with dementia. Aging Ment Health 11:626–636

    Article  Google Scholar 

  66. Wettstein A, König M, Schmid R et al (2005) Belastung und Wohlbefinden bei Angehörigen von Menschen mit Demenz. Eine Interventionsstudie. Rüegger, Zürich

  67. Wilz G, Kalytta T (2009) Förderung und Unterstützung der familiären Pflege von Demenzkranken – Schulung professioneller Berater und Pflegekräfte in der Durchführung eines therapeutischen Angehörigenberatungskonzepts sowie die Evaluation der therapeutischen Effekte der Interventionen. Abschlussbericht, Teilprojekt 5, Pflegeforschungsverbund Mitte-Süd, Förderkennzeichen: FKZ: 01GT0302

  68. Zanetti O, Frisoni GB, Bianchetti A et al (1998) Depressive symptoms of Alzheimer caregiver are mainly due to personal rather than patient factors. Int J Geriatr Psychiatry 13:358–367

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    A. Kurz

  2. Abteilung Klinisch-Psychologische Intervention, Institut für Psychologie, Friedrich-Schiller-Universität, Jena, Deutschland

    G. Wilz

Authors
  1. A. Kurz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Wilz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Kurz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurz, A., Wilz, G. Die Belastung pflegender Angehöriger bei Demenz. Nervenarzt 82, 336–342 (2011). https://doi.org/10.1007/s00115-010-3108-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-010-3108-3

Schlüsselwörter

Keywords

Search

Navigation