The literature review was based on extensive survey of books, journals and international nursing studies. A review of literature relevant to the study was undertaken which helped the investigator to develop insight into the problem and gain information on what has been done in the past. An extensive review of literature was done by the investigator to lay a broad foundation for the study and a conceptual framework based on Wiedenbach’s Helping Art Clinical Nursing Theory to proceed with the study under the following headings.
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For the purpose of logical sequence the chapter was divided into the following sections:
2.1 Section A: Studies related to dementia and caregivers burden of clients with
dementia.
2.2 Section B: Studies related to psychological interventions on level of burden among caregivers of clients with dementia.
SECTION A: STUDIES RELATED TO DEMENTIA AND CAREGIVERS BURDEN
Harrison BE (2012) conducted a study to identify the evidence of factors influencing dementia related caregivers burden. 565 caregivers participated who were selected by purposive sampling technique. Caregiver’s Interview Schedule were given to the caregivers of clients with dementia. The findings of the study revealed that, many factors influence the impact of the caregiving experience such as gender, relationship to the patient, culture and personal characteristics.
Hepworth JT (2012) conducted a cross -sectional study on burden experienced by caregivers of clients with dementia in Taiwan. 150 caregivers were participated from outpatient clinics of three hospitals by convenience sampling technique. The Caregiver Burden Inventory and Cost of Care Index Scale were used to assess the caregiver burden. The findings of the study revealed that 62% of caregivers had high level of burden.
Rosenheck R (2012) conducted a cross – sectional study on caregiver burden in dementia. 421 ambulatory outpatients with a diagnosis of dementia, those caregivers were participated as sample who were selected by convenient sampling technique. Burden Interview, caregiver distress scale, The Beck Depression Inventory Scales were administered. The findings of the study revealed that 80% of caregivers had severe behavioural disturbances, and psychiatric symptoms.
Scheltens P (2012) conducted a epidemiological study on identifying a target group depression among caregivers of clients with dementia in Netherland. 725 caregivers participated who were selected by convenient sampling technique. Depression scale was administered to the caregivers. The findings of the study revealed that 72% caregivers had increased risk for depression and psychological distress.
Steven H. Zarit (2012) conducted a longitudinal study to assess the subjective burden of husbands and wives in the care of clients with dementia. 1585 caregivers participated and selected by convenient sampling technique. Zarit Burden Assessment Scale was administered to caregivers of clients with dementia. The findings of the study revealed that among spouses, 65% of wives are having more burden than husbands.
Christofoletti G (2011) conducted a cross – sectional study to assess the neuropsychiatric disturbance of caregivers of clients with dementia and mental burden of their caregivers. 59 caregivers participated .Semi structured Burdren Interview Scale was used to assess the data. The result of the study revealed that 40% of caregivers had neuropsychiatric disturbance and mental burden.
Papastavrou E (2011) conducted a descriptive study to investigate the burden experienced by families providing care to a relative with dementia in Cyprus. 172 caregivers are participated in the study. Convenient sampling technique was used. Data collected by using Burden Interview Scale, Behaviour Memory Problem Checklist, Depression Scale and Ways of Coping Questionnaire. The results showed that 68.02% of caregivers were highly burdened and 65% of caregivers exhibited depressive symptoms.
Aizcorbeurrozc (2010) conducted a cross – sectional study to evaluate the association between caregiver’s burden and psychological distress and to estimate the prevalence of mental disorder among the caregivers. 40 caregivers participated and assessed by Zarit Burden Scale and GHQ – 28 to evaluate psychological distress. Convenient sampling technique was used. The result of the study showed that 80.7% of caregivers had high level of psychological distress.
Ebenezer E, Prince MJ (2010) conducted a cross – sectional study to examine selected factors of dementia patients and their caregivers that were associated with the burden of family caregivers. 225 caregivers participated in the study. Participants were selected by convenient sampling. Zarit Burden Interview Schedule was used to measure the caregiver’s burden. The result of the study showed that 78% of caregivers had high level of burdened because of informal support and ethnicity.
Rinaldi P (2010) conducted a cross – sectional study to investigate the burden perceived by caregivers of clients with dementia in different aspects of caregiver’s life and caregivers characteristics on its difference dimension in Italy. 419 caregivers participated. Caregivers burden inventory scale was used to quantify burden. The findings revealed that 80% of caregivers experienced that high level of anxiety and depression.
Rothkopf M (2010) conducted a descriptive study to assess the distress and burden associated with sleep disturbance in dementia caregiver. 60 female caregivers participated through convenient sampling technique. Actigraphic Sleep Parameter and Burden Interview Schedule was used to measure the sleep and level of burden. The result of the study revealed that 98% of caregivers had depressive symptoms associated with poorer sleep efficiency.
Williams C (2010) conducted a descriptive correlational study to identify the factors within marital relationships that increase risk of burden and depression in USA. 5 men and 11 women caregivers of clients with dementia participated. Zarit Burden Interview Schedule was used to measure the caregiver’s burden. The results showed that 74 % of spouse’s caregivers were overburdened and had depression.
Anderson S (2009) conducted a cross-sectional study to examine association between caregiver’s burden and perceived health among caregivers of clients with dementia living at home in Netherland. 2238 samples participated. Caregivers Burden Scale was used to collect the data. The findings of the study revealed that the 84% of caregivers experienced moderate burden associated with isolation, disappointment and emotional involvement with perceived health.
Elmstnhl S (2008) conducted a cross-sectional study to assess the financial burden and psychological distress among caregivers of clients with dementia in Sweden. 50 caregivers were participated. Burden Interview Schedule was used to assess the economic and social conditions. The study revealed that caregivers experienced total burden, strain and disappointment because of low income that leads to higher degree of burden.
SECTION B: STUDIES RELATED TO PSYCHOLOGICAL INTERVENTIONS ON LEVEL OF BURDEN AMONG CAREGIVERS OF CLIENTS WITH DEMENTIA.
Hauck WW (2011) conducted a prospective study to assess the Tailored Activity Program to reduce caregivers burden of clients with dementia. 60 caregivers were participated. Tailored Activity Program was given as an intervention for 4 months to reduce the caregivers burden. Zarit Burden Interview Schedule was used to assess the burden level. The findings of the study revealed that Tailored Activity program reduce the depression and anxiety among caregivers of dementia clients.
Guetin S (2011) conducted a cross – sectional study to assess the impact of music therapy on depression for caregivers of clients with dementia. 286 caregivers were participated. Hamilton Depression and Anxiety Scale, Zarit Burden Scale was used to assess the depression and burden level of caregivers of clients with dementia. 44 session music therapy was given to the caregivers. The findings of the study revealed that music therapy was reduced 80% of caregiver’s anxiety and depression.
Jerimia Heinik (2011) conducted a cross – sectional study to assess the effectiveness of recreational activities on level of burden among caregivers of relatives with dementia. 286 caregivers were participated. Zarit Burden Scale, Hamilton Depression and Anxiety Scale was used to assess the level of burden. Recreational activities were given for 5 months. The findings of the study revealed that recreational activities reduced 75% of level of burden among caregivers of clients with dementia.
Sinder T (2010) conducted a cross – sectional study to identify the effects on deep breathing exercise to reduce the level of burden among caregivers of clients with dementia in Taiwan. 465 caregivers participated. Convenient Sampling Technique was used. Deep breathing exercise was given to the caregivers of clients with dementia for 3 months. The findings of the study revealed that deep breathing exercise reduced the anxiety, anger among caregivers of clients with dementia.
Philip D (2009) conducted a cross – sectional study to assess the effectiveness of recreational activities on level of burden experienced by caregivers of clients with dementia in Europe. 238 samples participated in this study. Zarit Burden Interview, Burden Assessment Scale was used to identify burden. Painting, drawing was given as recreational activities for 12 weeks. The findings of the study revealed that 84 % of burden level was reduced for caregivers of clients with dementia with the help of recreational activities.
Chandragupta and Bhola (2008) conducted a meta analysis studies to find the effectiveness of support groups for caregivers of dementic patients to reduce the burden and psychological well – being. 521 caregivers participated. Burden Assessment Scale was used. Purposive sampling technique was used.The result indicated that support group helps to reduce the depression, anxiety and it improves the psychological well – being.
Graff ST (2008) conducted a longitudinal study to assess the effectiveness of community based occupational therapy on level of burden among caregivers of clients with dementia in France. 10 sessions of occupation therapy was given for 5 weeks. Caregiver burden was assessed with Zarit Burden Interview Schedule. 400 samples participated in this study. The findings of the study revealed that occupational therapy reduced 60 % of level of burden among caregivers of client with dementia.
Naresh R, et al., (2007) conducted a longitudinal study on self efficacy for managing dementia and reduce the level of burden and depression among dementia caregivers. 84 caregivers participated. Zarit Burden Interview Schedule was used. Convenient sampling technique was used. The result revealed that self efficacy is used to alleviate the symptoms of burden and depression among caregivers of clients with dementia.
Mittelman M (2007) conducted a longitudinal study to assess the effectiveness of family meetings to prevent of anxiety and depressive symptoms among caregivers of clients with dementia. 420 caregivers participated. Caregiver’s Burden Assessment Scale, Hamilton Anxiety Depression Scale were used to collect the data. The findings of the study showed that family meetings help to reduce the anxiety and depressive symptoms among 75% of caregivers of clients with dementia.
Stella et al., (2007) conducted a cross – sectional study to assess the effectiveness of physical activity on the level of mental burden among caregivers of clients with dementia. Convenience sampling technique was used. 245 caregivers participated. Burden Assessment Scale was used. The results revealed that the regular practice of physical activity reduce the burden of the caregivers of dementia patients.
Gerentol GZ (2006) conducted a longitudinal study to assess the effectiveness of structured teaching program on activities of daily living on care of clients with dementia. 425 caregivers participated. Burden Assessment Scale was used to collect the data. Convenient sampling technique was used. The findings of the study showed that planned activities of daily living for dementia clients reduces the level of burden, depression and anxiety among caregivers of clients with dementia.
Cantent C (2005) conducted a cross – sectional study to assess the effectiveness of self group on level of burden among caregivers of clients with dementia. 425 caregivers participated. Zarit Burden Assessment Schedule was used to collect the data. Convenient Sampling Techinique was used.The findings of the study revealed tha self group reduces the level of burden among 65% of caregivers of clients with dementia.
Pahlavandeh S (2005) conducted a study on effectiveness of family education program on caregiver burden of dementia clients. 560 caregivers participated. Zarit Burden Assessment Scale was used in this study. The findings of the study revealed that family education program reduces the level of burden among 60% of caregivers of clients with dementia.
Kuskowski MA and Kirk LN (2005) conducted a exploratory study to examine the personal and relational impact on caregiving wives. Supportive group therapy was applied as a intervention. 115 female spouse caregivers participated. Convenient sampling technique was used. Burden Assessment Scale was used in this study. The findings of the study was revealed that supportive group therapy enhance the caregiver’s sense of personal mastery and it help to reduce the negative effects of caregivers of dementia clients.
Tuokko H (2005) conducted a cross – sectional study to assess the effectiveness of educational training program on reducing the level of burden among caregivers of clients with dementia in Lucknow. 526 caregivers participated. Burden Assessment Scale was used in this study. The findings of the study revealed that educational training programme brought awareness among caregivers and it helped to reduce the overburden and depression among 60% of caregivers of clients with dementia.
