Coping and caregivers of people with dementia

Purpose. To critically review the research based on Lazarus and Folkman's (1984) stress and coping model, in respect to the coping of those caring for persons with dementia in the community, in an attempt to establish its implications for interventions aimed at improving caregiver adjustment. Method. Published material on the coping of caregivers of persons with dementia was identified through computerized literature searches (Med-line, Psych-Info) to December 1999, employing search terms including Alzheimer's disease, dementia, caregiving, caregiver burden, adaptation, psychological, coping, and stress. Studies were chosen to be considered in detail, based on the reviewer's opinion that they would contribute to an understanding of the current state of the research and its clinical implications. This material was then critically reviewed against the tenets of Lazarus and Folkman's (1984) model. Results. Sixteen studies were selected to be included in the review, 12 cross-sectional and 4 longitudinal. Seven of the studies did not incorporate coping measures specific to caregiving and/or assess coping in respect of specific caregiver problems. Nine of the studies did do this. The research suggests that a general tendency towards problem solving and, acceptance styles of coping is likely to be advantageous to caregivers of people with dementia. Conclusions. Despite this finding, it is concluded that the ability of the research to inform the clinician is severely limited. It is proposed that while longitudinal studies considered specific caregiver problems which incorporate coping measures specific to the caregiving task may improve understanding, a substantial revision of methodology and, perspective may be required to produce findings that are likely to influence practice.