Hepburn K W, Gates B A
Department of Family Practice and Community Health, School of Medicine, University of Minnesota, Minneapolis.
Clin Geriatr Med. 1988 Nov;4(4):925-40.
The extensive literature on dementia (primarily AD) suggests that informal caregiving will play a significant role in patient well-being, will have an impact of some kind on the caregiver, and will benefit from tailored intervention on the part of the clinician. It should be clear from the review of six disorders that dementing conditions emanate from many diseases, affect widely diverse age groups, produce very different symptoms sets, and are a primary or secondary patient management issue for the clinician. In particular, the review points out the need for a comprehensive caregiver assessment and training program. Caregiver assessment needs to consider physical, emotional, social, and financial domains. The assessment should determine the physical demands of caregiving and the exceptional and particular emotional issues of the situation; this should take into account the physical and emotional demands already placed on the caregiver by a pre-existing condition to which the present dementia might be secondary. The assessment should examine the nature and extent of the social isolation of the caregiver, again factoring in the unique isolating effects of concurrent disorders. The clinician should explore what financial resources are available for helping with caregiving and examine the degree to which legal and financial planning have occurred. The assessment should also determine the strengths of the caregiver (skills, personality, physical well-being) as well as his or her information and training needs. This detailed data base will assist the clinician in providing the kind of training and management support that the literature suggests can be most beneficial for sustaining the caregiving situation as well as the caregiver. Within the context of particular disorders, optimal support provides the caregiver with needed information, skill and problem-solving training, opportunity for emotional outlet, attention to the need for social support, acknowledgement of the caregiver's pivotal role, and clinical care as needed.
