Testing The Moderating Effect Of Social Support And Mediating Effect Of Positive Aspects Of Caregiving In Caregiver Of Alzheimer's Disease

Objective:The study examined whether caregiving social support moderated the relationship between patient factors and caregiver burden of caring for community-dwellingolder adults with mild Alzheimer's disease(AD),and whether these relationship was mediated by positive aspects of caregiving.Methods:We conducted a cross-sectional study of patients diagnosed with AD from two hospitals and three communities in Taiyuan,China and their caregivers.For this survey,210 patients with mild AD and their caregivers were selected.Caregiver subjective burden assessment included Caregiver Burden Inventory,Self-Rating Anxiety Scale,and Self-Rating Depression Scale.The caregivers also completed the Social Support Rating Scale and the Positive Aspects of Caregiving.Montreal Cognitive Assessment and the Geriatric Depression Scale were used to evaluate patients' cognitive function and depression.Latent moderated structure equations(LMS)and bias-corrected percentile Bootstrap method were used to estimate the parameters of moderating and mediating effects,respectively.Results:LSM showed that the interactions between cognitive appraisal(?a11=0.147,p<0.001),depression(?a12=-0.146,p=0.001)of patients with AD and caregiving social support were statistically significant for caregiver burden.This indicated caregiving social support functioned as a buffer and moderated the relationship between patient factors and the caregiver burden,in which the relationship was strongest for individuals with relatively low levels of social support and lowest for individuals with relatively high levels of social support.Bias-corrected percentile Bootstrap method showedpositive aspects of caregiving completely mediatedthe associationbetween patients depression and caregiver burden(=0.197,p=0.006),anxiety(=0.225,p=0.007),depression(=0.178,p=0.034)were statistically significant,while no significant mediator of caregiving positive aspects were found for associations between patients cognitive function and caregiver subjective burden.Caregiving social support did not moderate the above mediating effect(p>0.05).Conclusions:This study made an early effort to identify not only how but also when patient factors impacted caregiver burden.Given that the relationship between the cognitive appraisal,depression of patients with AD and caregiver burden was lowest in the case of individuals who reported relatively high levels of social support,we should pay more attention to caregiver with low levels of social support and provide help for them to reduce their burden.In addition,depressive symptoms detrimentally affected positive aspects of caregiving,which was associated with more caregiver burden.Health care providers should be aware of these associations to monitor and manage changes in patient factors and positive aspects of caregiving and thereby potentially mitigatecaregiver burden.