Learning Objective #1: Identify the most common resistive behaviors reported by caregivers of people with Alzheimer's during bathing

Learning Objective #2: Describe the relationship between caregiver confidence and effort level with managing resistive behaviors during bathing the person with Alzheimer's

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Purpose: Resistiveness to care (RTC) commonly occurs in people with dementia during ADLs, particularly bathing. Family caregivers, however, often assume their pivotal role without training to manage RTC and may not feel efficacious, resulting in stress and inability to continue caring at home. The purpose of this study is to describe caregivers' perceptions of care recipient (CR) behaviors and their confidence and self-efficacy, and to examine the relationship between these variables to guide future research. Methods: Home visits were made by a nurse as part of a randomized controlled trial of interventions to improve RTC and caregiver self-efficacy with bathing. Caregivers recorded their experience in a semi-structured journal after performing a bath independently. Responses from the first journal from 27 caregivers were reviewed. Caregivers (age 67.7±12.3) were primarily spouses (91%) and female (71%). Care recipients (age 76.5±7.2) were 57% male with moderate/severe dementia (MMSE 7.2±6.6). Results: Highest-frequency behaviors were saying no (55.6%), turning away (22.2%), pulling away (18.5%). While 42% of caregivers felt totally confident getting through the bath, fewer (32%)were confident responding to RTC or creating a pleasant experience(28%). Conversely, 25% expressed very low levels of confidence in these spheres. With self-efficacy, 47.6% perceived their efforts as very helpful while 1/3 reported low self-efficacy. Number of RTCs was negatively correlated with caregiver confidence (r -.51, p<.05) and self-efficacy (r -.48, p <.05). Caregiver confidence was positively correlated with perceived self-efficacy (r .58, p<.01). A striking qualitative finding was the frequency of comments relating negative bathing experiences to caregiver fatigue or ill-health. Conclusions and Implications: Findings support the need for efficacy interventions to assist caregivers in building confidence in conjunction with learning strategies to manage RTC. Data inform the need for coaching, the “dose” of interventions required, and provide insight into the reciprocal nature of caregiver-care recipient behavior