2 Resilience and Transitions from Dementia Caregiving Joseph E. Gaugler, Ph.D. Assistant Professor Center on Aging, Center for Gerontological Nursing.

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2 Resilience and Transitions from Dementia Caregiving Joseph E. Gaugler, Ph.D. Assistant Professor Center on Aging, Center for Gerontological Nursing The University of Minnesota April 20, 2006

Acknowledgements Collaborators Robert L. Kane, M.D., Minnesota Chair in Long-Term Care and Aging, University of Minnesota Robert Newcomer, Ph.D., Professor, Department of Social and Behavioral Science and Institute for Health and Aging, The University of San Francisco Funding Support The Alzheimer’s Association, NIRG-2249 Health Care Financing Administration,

Background Resilience as a concept Child development and developmental psychopathology Processes that may encompass resilience (Masten et al., 1990; Wyman et al., 1999) –Positive outcomes despite negative circumstance; resilience as “overcoming the odds” –Sustained competence of positive development while facing continual threat or stress: resilience as “stress resistance” –Recovery from negative life experience or trauma: resilience as “recovery” Resilience in aging

Resilience in Dementia Caregiving Cross-sectional vs. longitudinal research The “wear and tear hypothesis” Uplifts and rewards of dementia caregiving Small-scale descriptive reports of resilience (Garity, 1997; Ross et al., 2003)

Conceptual Model Conceptual overlap of resilience with similar constructs Resilience in dementia caregiving as “stress resilience” Research question and hypothesis  What factors are associated with resilience among dementia caregivers?  Dementia caregivers who indicate low resilience at baseline will be less likely to remain in their caregiving roles when compared to the high resilience group.

Methods Medicare Alzheimer’s Disease Demonstration Measures: Resilience Burden Care Demands Construction of resilience measure –High resilience vs. low resilience Measures: Covariates Context of care Care recipient function and cognitive status Resources Analysis Correlates of resilience: Logistic regression Resilience as a predictor of transitions from dementia caregiving: Multinomial logistic regression

Discussion Care recipient function and sociodemographic context associated with resilience Complex effects of baseline resilience Low resilience as predictive of institutionalization and loss to follow-up Low resilience negatively associated with care recipient death Complex effects of change in resilience Anticipation of the termination of at-home care

Implications Limitations Capturing heterogeneity of dementia caregivers A typology approach Assessment strategies Incorporation of intrinsic dimensions of resilience