Patient Safety and Caregiver Burden in Dementia Care: A Cross-sectional Analysis
Objective:
Examine the association between patient safety and caregiver burden in dementia care.
Background:
Dementia can impact the safety of both patients and caregivers. We hypothesized that patient safety concerns would positively correlate with caregiver distress.
Design/Methods:
This cross-sectional retrospective secondary use study examined patient and caregiver completed questionnaires (N=483). Caregiver burden was quantified with the 4-item Zarit Burden Interview (ZBI-4). In addition, seven domains of patient safety were included as binary (yes/no) variables: driving, home safety concerns (e.g. burners left on), social isolation, wandering, falls, financial mismanagement and thoughts of suicide. Each patient safety domain was assessed as an exposure in separate linear regression models (7 models total) with ZBI-4 score as the outcome, equivalent to a two-sample t-test of mean ZBI-4 scores between groups while allowing for covariate adjustment. All models were adjusted for Functional Activity Questionnaire score (disease severity), diagnosis, age and sex.
Results:
The mean ZBI-4 score was 4.6 (SE=0.17; range 0–15), with higher mean scores observed among males (5.1, SE=0.25) than females (3.9, SE=0.24) and among individuals with greater disease severity. Measures of association were expressed as beta coefficients and represent the average difference in ZBI-4 score between those with and without concerning safety flags. Significant associations were found between home safety concerns (β=1.3; 95% CI, 0.58–2.0, p<0.001, n=383), financial mismanagement (β=2.9; 95% CI, 0.96–4.8, p<0.01, n=59), patient thoughts of suicide (β=1.3; 95% CI, 0.22–2.4, p<0.05, n=295) and ZBI-4 score. Associations between driving, wandering, falls, living alone and ZBI-4 score were statistically insignificant.
Conclusions:
Caregivers of dementia patients tend to have higher ZBI-4 scores if patients have home safety concerns, experience financial mismanagement or have thoughts of suicide. Future research using cohort or prospective design should be considered to further characterize these associations.
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