Resilience and Dementia Caregiving: An Integrative Review

Thursday, 27 July 2017: 4:30 PM

Barbara E. Harrison, PhD
Department of Nursing, West Chester University of Pennsylvania, West Chester, PA, USA

Purpose: To review the literature for evidence related to resilience in family caregivers of person with dementia. Families caring for a person with dementia can experience physical, psychological, emotional, financial, and social burdens. Family caregivers who report resilience have experienced less burden, fewer depressive symptoms, and better health outcomes. Resilience is defined as “positive behavioral patterns and functional competences” (McCubbin & McCubbin, 1996).

Methods:  : Review of research and non research papers published between 2003 and 2016 that answered the following question “What evidence based factors and practices support resilience in family caregiver of persons with dementia ? ” Databases of Cochrane, Cumulative Index to Nursing and Allied Health literature (CINAHL), PubMed, and PsycInfo were searched for key words of resilience and dementia caregivers. Inclusion criteria were quantitative and qualitative studies published in peer reviewed journals, written in English. Other keywords associated with the literature were “hardiness” and “stress”.

Results: Twenty two unique studies were identified. Samples, representing a global perspective were from Australia, Canada, England, Scotland, South Africa, South Korea, and United States. Caregivers included spouses, children, siblings with age range from 25 to 90 years. Although many samples were primarily Caucasian, others were from ethnically diverse populations. Evidence on descriptive factors and interventions were found for relationships between resilience and the following concepts: appraisal, burden, environment, marital satisfaction, personality, religious coping, resources, stress, and suicide ideation. Resilient caregivers were characterized as those who maintained positive attitudes, continued to learn and adapt as dementia progressed, had positive coping strategies, and utilized social and environmental resources to achieve goals for self and person with dementia. Non – resilience was associated with pre-existing physical and mental health conditions and family conflicts. Interventions that support resilience are usually multi-factorial programs that include dementia education, exercise, and techniques for managing behavioral symptoms.

Conclusion: Dementia prevalence is increasing worldwide and there is a dramatic need for family members to be prepared for the caregiver role. This review synthesizes the evidence on caregiver resilience and its related concepts to supports family caregivers of persons with dementia. Recommendations for practice (assessment and supportive interventions) that enhance resilience are identified. Gaps in the literature and future recommendations are described. The evidence from this review has potential to improve knowledge and practice that advances global health and nursing.