Role of Caregiver Beliefs About Alzheimer Disease in the Social Creation of Dependency Among Persons With Alzheimer Disease

Abstract

It is estimated that over 1.1 million people in Canada will have dementia by 2038 (Alzheimer Society of Canada, 2010). In the caregiving context it is important that independence be maintained for as long as possible. Previous research has shown that caregivers can inadvertently create excess dependency (Baltes, Burgess, & Stewart, 1980) and use talk that is patronizing when their interactions with nursing home residents are guided by age-stereotypical beliefs. Social creation of dependency has not been studied in the care of persons with Alzheimer disease (AD). This study (a) assessed professional caregivers’ attitudes toward aging using the Implicit Association Test and beliefs about aging and AD in the social, physical, and cognitive domains using the Beliefs about Aging and AD questionnaire (B-AD; Rust & Kwong See, 2010); (b) observed interactions between caregivers and persons with AD to find evidence for the social creation of dependency and patronizing speech; (c) explored the relationship between attitudes and beliefs and caregiver behaviours; and (d) using semistructured interviews, additionally probed caregivers’ beliefs about AD, views on caregiving, and communication with persons with AD. Caregiver attitudes toward aging were negative. Caregivers’ beliefs about AD were found to be the most negative in the cognitive domain, less negative in the social domain, and the least negative in the physical domain. The observational data showed that residents’ dependent behaviour secured caregivers’ dependence-supportive behaviour, the dominant script that has been found among cognitively intact older adults and their caregivers (Baltes et al., 1980), and that caregivers displayed some aspects of patronizing speech in their interactions with residents. Associating AD with increased risk of injury and resistance to help is related to the dependence-support script. Caregivers’ beliefs about poor long-term memory and resistance to help are related to greater use of patronizing speech. In the semistructured interviews caregivers’ strategies to communicate effectively with residents with AD did not always coincide with what experimental evidence suggests is effective. Three themes emerged with regard to caregivers’ goals for interactions with residents: ensuring that residents have a good day, showing residents respect, and promoting residents’ independence. The implications of the study results for caregiver training to maintain independence are discussed.