Caregiver Assessment: A Practical Approach

Carole A. Cohen

March 10, 2008

Learning Objectives

At the end of this session the participants will be able to:

Describe opportunities & challenges the caregiving role affords

Outline a caregiver assessment framework

List 2 caregiver assessment tools

Needs Assessment

Who are you? Successes & challenges in working with

caregivers

Introduction

Primary caregivers (family/friends) Partners in care (supplements “formal

care”) “Hidden patient”

Caregiver Opportunities

Multiple tasks Changes over time Decision-making role Maintain respect, dignity, identity Positive aspects of caregiving

Caregiver Challenges

Effects of caregiving Physical consequences Psychological consequences

– Schulz et al.

Why Caregivers?

Many outcomes determined by caregiver factors

CG health, social network, knowledge, coping skills, relationship with CR

CG religious beliefs & practices, positive aspects of caregiving

Caregiver Inventory

Mittelman et al.

Schulz et al.

Others

1. Caregiver Personal History

Interpersonal relationships Caregiving experiences Relationship with care recipient

2. Caregiver Medical & Psychiatric History Current physical health problems ADL limitations Current & past psychiatric illnesses

3. Care Recipient’s History

Previous personality Diagnosis & prognosis Onset of symptoms ADL limitations Behavioural problems Response to deficits & provision of care

4. Caregiver Identity

5. Current Situation:Typical Day

Other responsibilities What needs to be done Caregiver involvement

6. Caregiver Knowledge

Dementia Problem-solving Behavioural interventions Available services

7. Caregiver Psychological Resources & Challenges Depressive symptoms Caregiver reactions & strategies Positive aspects of caregiving Desire for counseling Role of spirituality

8. Caregiver Support

Informal & formal support Availability & acceptability Willingness and ability to ask for help Expectations of family/friends

9. Ethical & Legal Issues

POA Wills Tolerance of risk Potential for exploitation

10. Future Planning

Formal support services Institutional placement Palliative care

Caregiver Risk Assessment(Schulz & Martire)

Safety Self-care & preventative health

behaviours Caregiver support; information,

instrumental, emotional Depression & distress Problem behaviours of CR

AMA Caregiver Self-Assessment

Physical symptoms Psychological symptoms Satisfaction with support Overall “stress” Overall “health”

Zarit Burden Interview

Effects of caregiving on many aspects of life ($$, social life, privacy etc.)

Overall “burden”/”stress” Psychological affects

Successful Caregiver Interventions

Multiple strategies Continuing relationship over time Involving CG & CR together if possible

Caregivers: What Do They Need

One size does not fit all Brodaty: 1)Information & Education

2) Psychological support

3) Mobilizing social support

Using the assessment findings

Caregiver identity

Using the Assessment Findings

Conclusions

References

www.alzheimer.ca http://www.ama-assn.org/ama/pub/

category/5099.html (access documents on health risks of caregiving, caregiver self-assessment questionnaire, etc.)

Schulz et al. REACH study

References cont’d

M. S. Mittelman, C. Epstein, A. Pierzchala, Counseling the Alzheimer’s Caregiver. AMA Press, 2003

S.M. Parks & K.D. Novielli, (2000) A Practical Guide to Caring for Caregivers American Family Physician Vol 62 No 12. available at http://www.aafp.org/afp/20001215/2613.html

(includes the Zarit Burden scale)