The Caregiver Burden Of Alzheimer’s Disease: A Latent Variable Interaction Model Analysis Based On The Two-stage Least Squares Method

Objective:The aims of this study were to explore direct or indirect influence of related factors of patients with Alzheimer’s disease(AD) and caregivers which may have on caregiver burden, and to explore if there were interactions within patients’ factors, caregivers’ factors as well as between them so as to analyze comprehensively the latent relations among the factors related to caregiver burden.Methods:The study subjects were patients with AD and their caregivers from either Department of Neurology or Geriatrics in the First Affiliated Hospital of Shanxi Medical University and the Taiyuan Central Hospital or communities of Laojunying, Xikuang Street and Heping in Taiyuan, Shanxi Province using cluster sampling method. A total of 210 pairs of patients and their caregivers were investigated by the self-made questionnaires.Face-to-face interviews were used to collect information. The two-stage least squares method(2SLS) were performed to explore the influence factors of caregiver burden and their interactions.Results:1. The study investigated a total of 210 AD patients and their caregivers with average age 73.24±8.32 and 51.06±14.71, respectively. The average cognition and depression among patients were 16.24±8.41 and 14.84±8.47, respectively. The average caregiver burden was 49.50±15.92. The average social support and positive feelings among caregivers were 32.00±12.59 and 25.46±11.78, respectively.2. Latent variable interaction model showed that caregiver burden model(F=59.20,P<0.001), anxiety model(F=28.80, P<0.001) and depression model(F=29.16, P<0.001)were all statistically significant. Family population had positive effects in caregiver burden model(b=0.481, t=2.31, P=0.022), caregiver anxiety model(b=2.028, t=2.17, P=0.031), and caregiver depression model(b=2.151, t=2.45, P=0.015). No interaction between cognition and depression in patients and interaction between positive feelings and social support in caregivers on caregiver burden were found(P>0.05) in the three models.3. Simplified caregiver burden model showed that:(1) The following interactions were found statistically significant on caregiver burden: interaction between patients’ cognition and depression(t=-1.99, P=0.048), interaction between patients’ cognitive level and caregivers’ social support(t=3.31,P=0.001), interaction between patients’ cognitive level and caregivers’ positive feelings(t=5.62, P<0.001) and anxiety(t=2.03, P=0.044),interaction between patients’ depression and caregivers’ positive feelings(t=-3.09,P=0.002), and interaction between caregivers’ positive feelings and social support(t=2.09,P=0.038).(2) The caregivers’ social support had negative effects on caregiver burden, anxiety and depression(P<0.05). Patients’ cognition had a negative effect on caregiver depression(P<0.05); the family population had positive effects on caregiver burden, anxiety and depression(P<0.05); the caregivers’ positive feelings had negative effects on caregiver burden, anxiety and depression(P<0.05). The work status had positive effects on caregiver burden and anxiety(P<0.05); the caregivers’ educational level had negative effects on caregiver burden and anxiety(P<0.05).Conclusions:1. Direct relation the caregivers’ work status and family population show positive effects on caregivers’ burden and anxiety. Family population has a positive effect on caregivers’ depression. Caregivers’ educational level has negative effects on caregivers’ burden and anxiety. Patients’ cognition has a negative effect on the caregivers’ depression.The caregivers’ social support and positive feelings have negative effects on the caregivers’ burden, anxiety, and depression.2. Interaction There are some weak interactions between the patients’ cognitive level and depression, the caregivers’ positive feelings and social support on caregivers’ burden,between the patients’ cognitive level and caregivers’ positive feelings, and between the caregivers’ social support positive feelings on the caregivers burden. Patients’ depression and caregivers’ positive feelings have a weak interaction on caregivers’ anxiety.