Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants

Dias, Rachel; Santos, Raquel Luiza; Sousa, Maria Fernanda Barroso de; Nogueira, Marcela Moreira Lima; Torres, Bianca; Belfort, Tatiana; Dourado, Marcia Cristina Nascimento

doi:10.1590/2237-6089-2014-0032

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Review Articles • Trends Psychiatry Psychother. 37 (1) • Jan-Mar 2015 • https://doi.org/10.1590/2237-6089-2014-0032 copy

Resilience of caregivers of people with dementia: a systematic review of biological and psychosocial determinants

Resiliência de cuidadores de pessoas com demência: revisão sistemática de determinantes biológicos e psicossociais

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

Although caregivers of people with dementia may face difficulties, some positive feelings of caregiving may be associated with resilience.

Objective:

This study systematically reviewed the definitions, methodological approaches and determinant models associated with resilience among caregivers of people with dementia.

Methods:

Search for articles published between 2003 and 2014 in ISI, PubMed/MEDLINE, SciELO and Lilacs using the search terms resilience, caregivers and dementia.

Results and conclusions:

Resilience has been defined as positive adaptation to face adversity, flexibility, psychological well-being, strength, healthy life, burden, social network and satisfaction with social support. No consensus was found about the definition of resilience associated with dementia. We classified the determinant variables into biological, psychological and social models. Higher levels of resilience were associated with lower depression rates and greater physical health. Other biological factors associated with higher levels of resilience were older age, African-American ethnicity and female sex. Lower burden, stress, neuroticism and perceived control were the main psychological factors associated with resilience. Social support was a moderating factor of resilience, and different types of support seemed to relieve the physical and mental overload caused by stress.

Psychological resilience; caregiver; dementia; depression

Domains	Exclusion criteria	Excluded
Participants	n = 31
	↓
	Other pathologies	03
	Healthy aging	01
	Children that live with people with dementia	01
	Caregivers of elderly with or without dementia that live in an institution	03
	Resilience of people with dementia	01
	Euthanasia of people with severe dementia	01
	Older veteran caregivers	01
	Caregivers of healthy elderly	02
	↓
	n = 18
Study design	Review	03
	Conference	01
	↓
	n = 14
Interventions	Non-pharmacological	03
	↓
	n = 11
Assessment	Validation of instruments	02
	Salivary cortisol	02
	↓
	n = 7
Other factors that affect caregivers and people with dementia	Mourning	01
	Implication on caregiving	02
	Effects of bonds	01
	Job satisfaction and career commitment	01
	↓
	n = 2
Only abstract	Resilience and suicide	02
	↓
	n = 0

Author	Objectives	Sample	Design	Instrument	Results
Gaugler et al.²⁸	Ascertained whether resilience influences transitions from dementia caregiving, such as institutionalization, care recipient death, or loss to follow-up.	n = 1,979 AD or similar disorder.	Longitudinal, 3 years, randomized	Demographic questionnaire, ZBI, ADL e IADL.	High baseline resilience (low burden, high care demands) was associated with less frequent institutionalization and loss to follow-up, as well as with more frequent care recipient mortality.
Wilks & Croom¹⁸	Examined whether social support functioned as a protective factor and improved resilience among AD caregivers.	n = 229 AD	Cross-sectional	Demographic questionnaire, PSS, PSSS and RS.	Stress negatively influenced and accounted for most variations in resilience. Social support positively influenced resilience, and caregivers with high family support had the highest probability of greater resilience.
Clay et al.²⁹	Compared resilience between African Americans and whites.	n = 166 AD	Longitudinal, 5 years	Demographic questionnaire, CES-D, SSQSR and SES.	The resilience of African American caregivers, as demonstrated by their fewer depressive symptoms and higher levels of life satisfaction, was partially explained by their higher levels of satisfaction with social support.
O’Rourke et al.⁴	Assessed whether psychological resilience predicts the relative absence of depressive symptoms one year later.	n = 105 AD	Longitudinal, 1 year	Demographic questionnaire, DRS, CES-D and FRS.	Baseline resilience (control and challenge) and change in challenge over time contributed significantly to prediction of depressive symptoms one year later.
Fitzpatrick et al.¹³	Explored the association between resilience and marital satisfaction in caregivers of spouses with dementia.	n = 30 90% AD 10% other types of dementia	Cross-sectional	Demographic questionnaire, GDS, MSQFOP, RS, SE and SCB.	Spouses perceived greater caregiver burden and reported less marital satisfaction. An inverse association was found with age: older caregivers reported more marital satisfaction. Resiliency, sex, and stage of cognitive impairment were not associated with marital satisfaction.
Lavretsky et al.⁷	Examined the potential of an antidepressant drug, escitalopram.	n = 40 AD	Randomized placebo-controlled double-blinded	HRSD, CD-RISC, RMBPC, SERS, HARS, MMSE, CRFPC, Cumulative Illness Rating Scale and ZBI.	Depression was less severe and remission rate was greater with drug than with placebo. Measures of anxiety, resilience, burden and distress improved when escitalopram was used.
Wilks et al.¹²	Assessed impact of aggression of patient with Alzheimer on caregiver coping strategies and caregiver resilience.	n = 419 AD	Cross-sectional	Demographic questionnaire, RMBPC; CITS and RS.	Task-focused coping was positively associated with resilience, and aggression negatively predicted caregiver resilience.
Garces et al.¹⁴	Factors associated with resilience of caregivers of elderly people with AD.	n = 6 AD	Observational descriptive case study	Demographic questionnaire, SRQ, ZBI and RS.	Although some reported fatigue and overload, most had a high tendency to resilience. There was a significant association between resilience and age.
Gaiole et al.³	Described demographic and health variables of caregivers of elderly people with AD and associated care provided with resilience.	n = 101 AD	Exploratory and descriptive study	Demographic questionnaire, BDI and RS.	Degree of kinship, medical treatment, use of medication, tiredness, prostration, discouragement and caregivers’ mental health had significant associations with resilience.
Contador et al.⁶	Investigated the predictors of burden for caregivers of people with dementia. Assessed the moderating role of generalized expectancies of control (GEC) between caregiver stress and burden.	n = 130 53 – AD 37 – VD 40 – MD	Cross-sectional	Demographic questionnaire, BEEGC, ZBI, GADS.	Family caregivers with high expectancies of self-efficacy and contingency were less vulnerable to stress.
Fernández-Lansac et al.²	Analyzed factors associated with resilience among caregivers of patients with dementia.	n = 53 40 – AD 9 – VD 4 – MD	Cross-sectional	Demographic questionnaire, GDS, IADL, RMBPC, ZBI, CSS, SSQSR, NEO-FFI (NyE scales), SE, RSES, Questionnaire COPE, BDI, HAD-A and CD-RISCK.	Resilience was associated with poor emotional and physical status. High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion-focused coping strategies.
Bekhet¹	Examined mediating and moderating effects of positive cognitions on association between caregiver burden and resourcefulness.	n = 80 AD	Descriptive, correlational, and cross-sectional	Demographic questionnaire, ZBI DCS and Resourcefulness Scale.	Positive cognitions mediated but did not moderate effects on association between caregiver burden and resourcefulness.
Sun¹⁰	Investigated caregiving stressors and coping strategies.	n = 18 15 – AD 3 – VD	Descriptive and cross-sectional	Demographic questionnaire and qualitative interview.	Stressors were role strains, family conflicts and pressure from social environment. Yet, caregivers demonstrated resilience by drawing on their coping resources from several sources, such as personal experience, family, technology and information, religion and governmental support.
Bull⁵	Described strategies that family caregivers use to help them continue to provide care, and described these family caregivers’ resilience and psychological distress.	n = 18 Does not specify type of dementia.	Descriptive and cross-sectional	Demographic questionnaire, RS, SDQ.	Caregivers used four strategies to sustain self: drawing on past life experiences, nourishing self, relying on spirituality and seeking information about dementia
Shuter et al.²⁴	Explored key positive and negative factors that have an impact on grief resolution and health outcomes of caregivers.	n = 13 Does not specify type of dementia.	Descriptive and cross-sectional	Demographic questionnaire and qualitative interview.	Psychological resilience and satisfaction with caregiving were protective against negative outcomes, whereas unresolved grief was a risk factor.

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[1] No conflicts of interest declared concerning the publication of this article.