Objectives

Behavioral and psychological symptoms of dementia (BPSD) are common, often challenging to manage, and may erode caregivers' well-being. Few studies have explored caregivers' perspectives of what causes these behaviors, but such attributions may be important-particularly if they negatively impact the care dyad. This study examined causal attributions about BPSD among individuals caring for a family member with dementia.

Design

In-depth qualitative data were obtained from family caregivers of older adults with dementia.

Setting

As part of a larger study (NINR R01NR014200), four focus groups were conducted with caregivers by an experienced facilitator.

Participants

A total of 26 family caregivers participated in the four focus groups.

Measurements

Caregivers reported their own attributions about the causes of their care recipient's BPSD. Sessions were audio-recorded. Data were transcribed, coded to determine relevant concepts, and reduced to identify major categories.

Results

Five categories were determined. Caregivers attributed BPSD to: 1) neurobiological disease factors; 2) physical symptoms or comorbid health conditions; 3) psychological reactions to dementia; 4) shifting social roles and relationships following dementia onset; and 5) environmental changes such as lack of routine and medical transitions (e.g., hospitalization). Despite this seemingly multifactorial attribution to BPSD etiology, a number of respondents also indicated that BPSD were at least partly within the care recipient's control.

Conclusions

Family caregivers attribute BPSD to a range of care recipient and environmental factors. Caregivers' own causal beliefs about BPSD may reflect unmet educational needs that should be considered in the development of targeted interventions to minimize caregiving stress.

BACKGROUND/OBJECTIVES:: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviors have implications for both care partners’ well-being. Yet the specific strategies that caregivers use in their daily management of BPSD are relatively unknown. This study used in-depth focus group data to examine family caregivers’ strategies for managing BPSD. DESIGN:: As part of a larger study (NINR R01NR014200), four focus groups were conducted with a total of 26 family caregivers of older adults with dementia. Caregivers were asked to describe the strategies they use to manage BPSD. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major categories. RESULTS:: Caregivers managed BPSD through: 1) modifying interactions within the care dyad (e.g., simplifying communication); 2) modifying the care environment (e.g., using written prompts); 3) activity engagement; 4) humor; 5) self-care; and 6) social support. CONCLUSION:: Family caregivers manage BPSD using strategies to minimize stress and address the needs of both care partners. Caregivers’ own accounts of these approaches reveal a window into their everyday management of difficult behaviors. The present findings generate key information for routine clinical care and targeted interventions to promote caregiver well-being.