Relationships among socioeconomic factors, quality of life, family stigma and psychological outcomes in family caregivers of patients with early onset Alzheimer disease due to E280A-PSEN1 mutation and frontotemporal dementia in Antioquia-Colombia
Alzheimers Dement. 2021 Dec;17 Suppl 7:e054603. doi: 10.1002/alz.054603.
BACKGROUND: Caregiving itself does not lead to adverse psychological outcomes, burden, stigma, and/or quality of life reduction but socioeconomic factors have been hypothesized as risk factors among dementia caregivers. We aimed to analyze the associations between socioeconomic factors and type of dementia as potential predictors of family stigma, Quality of life (QoL.), depressive symptoms, anxiety, and caregiver burden METHOD: We assessed 151 family caregivers distributed as early-onset Alzheimer disease group (EOAD), frontotemporal dementia (FTD), and late-onset dementia group (LOAD) for comparative means. Participants underwent questionnaires about family stigma, caregiver burden, depression, anxiety, QoL., and a questionnaire to explore socioeconomic factors. We performed a multivariable regression model with socioeconomic factors and the group as predictors. We included age, education, patient's clinical-stage, and behavioral changes as covariates.
RESULT: Being a caregiver of an FTD patient reduced physical functioning (β=-13,5 p=0,018), working part-time increased physical functioning (β=22,1 p=0,032) while working from home increased general health (β=22,4 p=0,028). The perception of living in a safe neighborhood reduced role limitation due to emotional problems (β=46,2 p=0,013). The perception of financial problems related to patients' care or disease cost increased the role limitation due to emotional problems (β=-29,8 p=0,007). The caregiver burden increased together with the perception of financial problems related to patient's care or disease cost (β=13,9 p<0,001) and was mediated by patient's behavioral changes (β=0,47 p<0,001). Family stigma is increased by the perception of financial problems related to patient's care or disease cost (β=0,31 p=0,013) and was mediated by the caregiver's education (β=0,04 p=0,026) and patient's behavioral changes (β=0,10 p=0,001). Depression increased by the perception of financial problems related to patient's care or disease cost (β=2,01 p=0,033) and the mediation of patient's behavioral changes (β=0,06 p=0,015).
CONCLUSION: Socioeconomic factors can predict disturbances in QoL. among dementia caregivers. Education, being an FTD caregiver, and patient's behavioral changes mediated among socioeconomic factors and negative psychological outcomes. When a caregiver may have low education and is caring for a patient with FTD and/or behavioral problems the risk of negative outcomes and family stigma increases significantly.