Carers of dementing family members can exacerbate the dementing patient’s problematic behaviour

Dutch researcher Marjolein de Vugt has found that carers of dementing family members can exacerbate the dementing patient’s problematic behaviour. If they cannot accept the behavioural problems and express this irritation towards the dementing patient then the patient can become more restless.

During her doctoral research, De Vugt identified three strategies that care-providing family members adopt to approach the dementing patient. The 'supportive strategy', in which the carer adjusts to the patient's level of functioning, is the most effective. Equally a 'caring strategy', in which the carer considers the patient to be more like a child, gives rise to little restlessness in the patient.

However, the 'non-adaptive strategy' exacerbates the patient's hyperactivity. Carers with this strategy find it harder to cope with the behavioural problems and approach the patient in an irritated and impatient manner. The way carers deal with these problems causes a lot of restlessness in the dementing patient. In this situation the patient-carer pairs exert a negative influence on each other.

The majority of dementing patients are cared for at home by either the partner or one of the children. Behavioural problems frequently occur during all stages of the dementing process and encompass a wide range of symptoms, such as gloominess, restlessness, irritability and apathy. According to De Vugt, apathy is a very frequently occurring problem among dementing patients and is a considerable burden for the carer. Partners of apathetic patients experience more difficulty with this aspect than with all other behavioural problems.

Family members often do not know the best way to deal with such problems and these therefore form a significant source of stress. The greater the amount of stress family members experience with respect to the behavioural problems, the earlier the patient will be faced with the prospect of a nursing home admission. Moreover, family members can exacerbate the problems if they fail to deal with these adequately.

De Vugt's doctoral research was part of the 'Maastricht Study of Behaviour in Dementia' (MAASBED). In this study, 199 dementing patients and 119 care-providing family members were followed over a period of two years.

The results from the study can be used to detect vulnerable patient-carer pairs more quickly. Adjusting the care provider’s caring strategy can prevent an exacerbation of the dementing patient’s behavioural problems and with this the quality of life of both the care provider and the patient can be improved.

The research was funded by the Netherlands Organisation for Scientific Research.