Caregiver Assessment: A Practical Approach Carole A. Cohen March 10, 2008

Learning Objectives At the end of this session the participants will be able to: Describe opportunities & challenges the caregiving role affords Outline a caregiver assessment framework List 2 caregiver assessment tools

Needs Assessment Who are you? Successes & challenges in working with caregivers

Introduction Primary caregivers (family/friends) Partners in care (supplements “formal care”) “Hidden patient”

Caregiver Opportunities Multiple tasks Changes over time Decision-making role Maintain respect, dignity, identity Positive aspects of caregiving

Caregiver Challenges Effects of caregiving Physical consequences Psychological consequences –Schulz et al.

Why Caregivers? Many outcomes determined by caregiver factors CG health, social network, knowledge, coping skills, relationship with CR CG religious beliefs & practices, positive aspects of caregiving

Caregiver Inventory Mittelman et al. Schulz et al. Others

1. Caregiver Personal History Interpersonal relationships Caregiving experiences Relationship with care recipient

2. Caregiver Medical & Psychiatric History Current physical health problems ADL limitations Current & past psychiatric illnesses

3. Care Recipient’s History Previous personality Diagnosis & prognosis Onset of symptoms ADL limitations Behavioural problems Response to deficits & provision of care

4. Caregiver Identity

5. Current Situation:Typical Day Other responsibilities What needs to be done Caregiver involvement

6. Caregiver Knowledge Dementia Problem-solving Behavioural interventions Available services

7. Caregiver Psychological Resources & Challenges Depressive symptoms Caregiver reactions & strategies Positive aspects of caregiving Desire for counseling Role of spirituality

8. Caregiver Support Informal & formal support Availability & acceptability Willingness and ability to ask for help Expectations of family/friends

9. Ethical & Legal Issues POA Wills Tolerance of risk Potential for exploitation

10. Future Planning Formal support services Institutional placement Palliative care

Caregiver Risk Assessment (Schulz & Martire) Safety Self-care & preventative health behaviours Caregiver support; information, instrumental, emotional Depression & distress Problem behaviours of CR

AMA Caregiver Self-Assessment Physical symptoms Psychological symptoms Satisfaction with support Overall “stress” Overall “health”

Zarit Burden Interview Effects of caregiving on many aspects of life ($$, social life, privacy etc.) Overall “burden”/”stress” Psychological affects

Successful Caregiver Interventions Multiple strategies Continuing relationship over time Involving CG & CR together if possible

Caregivers: What Do They Need One size does not fit all Brodaty: 1)Information & Education 2) Psychological support 3) Mobilizing social support

Using the assessment findings Caregiver identity

Using the Assessment Findings

Conclusions

References assn.org/ama/pub/category/5099.html (access documents on health risks of caregiving, caregiver self-assessment questionnaire, etc.) Schulz et al. REACH study

References cont’d M. S. Mittelman, C. Epstein, A. Pierzchala, Counseling the Alzheimer’s Caregiver. AMA Press, 2003 S.M. Parks & K.D. Novielli, (2000) A Practical Guide to Caring for Caregivers American Family Physician Vol 62 No 12. available at (includes the Zarit Burden scale)