Bereavement Responses of Caregivers of Institutionalized vs. Community-Living Alzheimer’s Patients

This study was designed to determine whether nursing home placement had an adverse effect on the bereavement outcomes of adjustment to loss, continued perceived presence, longing, preoccupation and guilt among caregivers to elderly Alzheimer’s patients. The Stress Process Model was used as the framework guiding this study. Categories of variables included background characteristics, pre-bereavement stressors, resources and post-bereavement outcomes. The sample, N=291, consisted of caregivers to family members with Alzheimer’s Disease. Approximately half of the respondents, N=158, provided continuous care in the home until the care recipient’s death while the remaining respondents, N=133, placed the care recipient in a nursing home. Overall, results revealed that The Stress Process Model was effective in predicting bereavement outcomes for both continuous care and nursing home placement groups. Multiple regression analyses found that the model predicted 50% of the explained variance in adjustment to loss, 29% of variance in continued perceived presence, 22% of the variance in longing, 29% of the variance in preoccupation and 31% of the explained variance of guilt. Nursing home placement, which was conceptualized as a resource in this study, proved to be a significant predictor in all of the bereavement outcomes in all of the bereavement outcomes except guilt. Only two variables were significant predictors of post-bereavement caregiver guilt: levels of conflict in past relationship and caregiver role competence. The findings suggest a reconsideration of our understanding of the multiple losses and grief experienced by caregivers to family members with dementia.