Quality of in-home care, long-term care placement, and the survival of persons with dementia
Abstract
PURPOSE OF THE STUDY: Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival. DESIGN AND METHODS: We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival. RESULTS: Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival. IMPLICATIONS: It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Poor quality of in-home care is a risk factor for long-term care placement.
“Poor quality of in-home care is also a risk factor for LTC placement [14].”
From Towards defining quality in home care for persons living with dementia (2022) · cites this paper as [14]
Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267 · see citing works
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833 · see citing works
Handbook of Personality: Theory and Research
Krueger, R. F., & Johnson, W. (2008) · Cited by 7,884 · see citing works
The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994) · Neurology · doi:10.1212/wnl.44.12.2308 · Cited by 7,568 · see citing works
Caregiving and the stress process: an overview of concepts and their measures
Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990) · The Gerontologist · doi:10.1093/geront/30.5.583 · Cited by 4,810 · see citing works
Assessing Quality of Life in Older Adults With Cognitive Impairment
Logsdon, R. G., Gibbons, L. E., McCurry, S. M., & Teri, L. (2002) · Psychosomatic Medicine · doi:10.1097/00006842-200205000-00016 · Cited by 1,381 · see citing works
Galvin, J. E., Roe, C. M., Powlishta, K. K., Coats, M. A., Muich, S. J., Grant, E., Miller, J. P., Storandt, M., & Morris, J. C. (2005) · Neurology · doi:10.1212/01.wnl.0000172958.95282.2a · Cited by 1,144 · see citing works
Fillenbaum, G. G., & Smyer, M. A. (1981) · Journal of Gerontology · doi:10.1093/geronj/36.4.428 · Cited by 1,127 · see citing works
2012 Alzheimer's disease facts and figures Alzheimer's Association ∗
Thies, W. H., & Bleiler, L. (2012) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2012.02.001 · Cited by 984 · see citing works
The Science of Asking Questions
Schaeffer, N. C., & Presser, S. (2003) · Annual Review of Sociology · doi:10.1146/annurev.soc.29.110702.110112 · Cited by 625 · see citing works
Predictors of nursing home admission for persons with dementia
Gaugler, J. E., Yu, F., Krichbaum, K., & Wyman, J. F. (2009) · Medical Care · doi:10.1097/mlr.0b013e31818457ce · Cited by 617 · see citing works
Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease
Mittelman, M. S., Haley, W. E., Clay, O. J., & Roth, D. L. (2006) · Neurology · doi:10.1212/01.wnl.0000242727.81172.91 · Cited by 602 · see citing works
Predicting Time to Nursing Home Care and Death in Individuals With Alzheimer Disease
Stern, Y. (1997) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1997.03540340040030 · Cited by 359 · see citing works
Profiles In Caregiving The Unexpected Career
Junker, J. (2016) · Choice Reviews Online · doi:10.5860/choice.33-5748 · Cited by 332 · see citing works
Unmet Care Needs and Key Outcomes in Dementia
Gaugler, J. E., Kane, R. L., Kane, R. A., & Newcomer, R. J. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.00495.x · Cited by 282 · see citing works
Gaugler, J. E., Kane, R. L., Kane, R. L., Clay, T., & Newcomer, R. J. (2003) · The Gerontologist · doi:10.1093/geront/43.2.219 · Cited by 253 · see citing works
Williamson, G. M., Shaffer, D. R., & contributors, N. (2001) · Psychology and Aging · doi:10.1037/0882-7974.16.2.217 · Cited by 248 · see citing works
Time Until Institutionalization and Death in Patients With Dementia
Brodaty, H. (1993) · Archives of Neurology · doi:10.1001/archneur.1993.00540060073021 · Cited by 221 · see citing works
Do caregiver management strategies influence patient behaviour in dementia?
de Vugt, M. E., Stevens, F., Aalten, P., Lousberg, R., Jaspers, N., Winkens, I., Jolles, J., & Verhey, F. R. J. (2004) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1044 · Cited by 215 · see citing works
Coping and caregivers of people with dementia
Kneebone, I., & Martin, P. R. (2003) · British Journal of Health Psychology · doi:10.1348/135910703762879174 · Cited by 166 · see citing works
Mental health of caregiving spouses: Coping as mediator, moderator, or main effect?
Pruchno, R. A., & Resch, N. L. (1989) · Psychology and Aging · doi:10.1037//0882-7974.4.4.454 · Cited by 163 · see citing works
Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.05.001 · Cited by 136 · see citing works
Dementia Management Strategies and Adjustment of Family Members of Older Patients
Hinrichsen, G. A., & Niederehe, G. (1994) · The Gerontologist · doi:10.1093/geront/34.1.95 · Cited by 131 · see citing works
Mental health of caregiving spouses: Coping as mediator, moderator, or main effect?
Pruchno, R. A., & Resch, N. L. (1989) · Psychology and Aging · doi:10.1037/0882-7974.4.4.454 · Cited by 119 · see citing works
Survival of Patients with Dementia
Dijk, P. T. M. V., Dippel, D. W. J., & Habbema, J. D. F. (1991) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1991.tb03602.x · Cited by 110 · see citing works
INTRODUCTION TO THEORIES OF LEARNINGPreprint
Aeni, N. (2021) · doi:10.31228/osf.io/yd2ga · Cited by 93 · see citing works
Survival of Persons With Alzheimer's Disease: Caregiver Coping Matters
McClendon, M. J., Smyth, K. A., & Neundorfer, M. M. (2004) · The Gerontologist · doi:10.1093/geront/44.4.508 · Cited by 73 · see citing works
Self-citationLong-Term-Care Placement and Survival of Persons With Alzheimer's Disease
McClendon, M. J., Smyth, K. A., & Neundorfer, M. M. (2006) · The Journals of Gerontology Series B · doi:10.1093/geronb/61.4.p220 · Cited by 46 · see citing works
Self-citationPredicting time to nursing home care and death in individuals with Alzheimer disease
Stern, Y. (1997) · JAMA · doi:10.1001/jama.277.10.806 · Cited by 46 · see citing works
Informal care can be better than adequate: Development and evaluation of the Exemplary Care Scale.
Dooley, W. K., Shaffer, D. R., Lance, C. E., & Williamson, G. M. (2007) · Rehabilitation Psychology · doi:10.1037/0090-5550.52.4.359 · Cited by 40 · see citing works
Hester, R., Murphy, K., Brown, F. L., & Skilleter, A. J. (2010) · Journal of Neuroscience · doi:10.1523/jneurosci.2565-10.2010 · Cited by 38 · see citing works
Predicting 12-Month Mortality for Persons With Dementia
Newcomer, R., Covinsky, K. E., Clay, T., & Yaffe, K. S. (2003) · The Journals of Gerontology Series B · doi:10.1093/geronb/58.3.s187 · Cited by 37 · see citing works
Quality of informal care is multidimensional.
Christie, J., Smith, G. R., Williamson, G. M., Lance, C. E., Shovali, T. E., & Silva, L. C. C. B. (2009) · Rehabilitation Psychology · doi:10.1037/a0015705 · Cited by 37 · see citing works
Quality of informal care for persons with dementia: dimensions and correlates
McClendon, M. J., & Smyth, K. A. (2013) · Aging & Mental Health · doi:10.1080/13607863.2013.805400 · Cited by 33 · see citing works
Self-citationInfluence of Personality on Care Quality of Hospital Nurses
Teng, C., Hsu, K., Chien, R.-C., & Chang, H. (2007) · Journal of Nursing Care Quality · doi:10.1097/01.ncq.0000290418.35016.0c · Cited by 30 · see citing works
Assessing family caregiver skill in managing behavioral symptoms of Alzheimer's disease
Farran, C. J., Fogg, L., McCann, J. J., Etkin, C. D., Dong, X., & Barnes, L. L. (2011) · Aging & Mental Health · doi:10.1080/13607863.2010.536140 · Cited by 23 · see citing works
Sun, F., Durkin, D. W., Hilgeman, M. M., Harris, G., Gaugler, J. E., Wardian, J., Allen, R. S., & Burgio, L. D. (2012) · The Gerontologist · doi:10.1093/geront/gns110 · Cited by 20 · see citing works
Editing of Responses: Reporting about Sensitive Topics
Tourangeau, R., Rips, L. J., & Rasinski, K. A. (2000) · Cambridge University Press eBooks · doi:10.1017/cbo9780511819322.010 · Cited by 19 · see citing works
Flagged first, then by citations
1 of the 40 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Potentially preventable hospitalizations in dementia: family caregiver experiences
Sadak, T., Foster Zdon, S., Ishado, E., Zaslavsky, O., & Borson, S. (2017) · International Psychogeriatrics · doi:10.1017/s1041610217000217 · Cited by 52 · see citing works
Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis
Pristavec, T., & Luth, E. A. (2020) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbaa001 · Cited by 56 · see citing works
The caregiving dyad: Do caregivers’ appraisals of caregiving matter for care recipients’ health?
Pristavec, T. (2019) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2019.01.020 · Cited by 34 · see citing works
Leggett, A. N., Bugajski, B., Gitlin, L. N., & Kales, H. C. (2021) · Dementia · doi:10.1177/1471301220988233 · Cited by 18 · see citing works
Towards defining quality in home care for persons living with dementia
Saragosa, M., Jeffs, L., Okrainec, K., & Kuluski, K. (2022) · PLOS ONE · doi:10.1371/journal.pone.0274269 · Cited by 10 · see citing works
Miyawaki, C. E., Liu, M., & Markides, K. S. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22768 · Cited by 8 · see citing works
Oh, Y. J., Lee, M. H., & Kim, H. S. (2020) · Korean Journal of Adult Nursing · doi:10.7475/kjan.2020.32.2.186 · Cited by 8 · see citing works
Exemplary Care among Chinese Dementia Familial Caregivers
Lau, B. H. P., LOU, V. W. Q., & Cheung, S. L. K. (2018) · Healthcare · doi:10.3390/healthcare6040141 · Cited by 5 · see citing works
Kim, D.-M., & Jang, H. (2024) · Journal of Korean Gerontological Nursing · doi:10.17079/jkgn.2023.00276 · Cited by 1 · see citing works
Kim, C. (2018) · Journal of Korean Gerontological Nursing · doi:10.17079/jkgn.2018.20.2.57
Measuring dementia caregiving styles to improve person-centered care
Leggett, A. N., Lai, J., Tsuker, S., Miner, J. A., Troost, J., & Carlozzi, N. E. (2026) · Innovation in Aging · doi:10.1093/geroni/igag006
Cai, C., Cheng, B., Shi, C., Shi, W., Li, C., Liu, C., & Sun, J. (2026) · PLoS ONE · doi:10.1371/journal.pone.0346557
- Authors
- McClendon, M. J., & Smyth, K. A.
- Affiliations
- Case Western Reserve University (US)
- University Hospitals of Cleveland (US)
- Corresponding author
- McClendon, McKee J.
- Venue
- Aging & Mental Health
- Publisher
- Informa UK Limited
- Published
- 2015-01-29
- Volume
- 19
- Issue
- 12
- Pages
- 1093-1102
- ISSN
- 1360-7863 (ISSN-L)
- 1364-6915
- OpenAlex
- W2155164654
- Cited by
- 12
- References
- 40
- Citations by year
- 2026: 2 · 2024: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 1
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Aging & Mental Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alzheimer's Association (IIRG-08-91014, 11/1/2008–10/31/2011)
- University Hospitals of Cleveland Case Medical Center
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Keywords
- dementia, home care, quality of care, long-term care placement, survival, primary caregivers, emotion-focused coping, neuroticism, agreeableness, personality traits, caregiver interventions
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Dementia, Female, Home Nursing, Humans, Long-Term Care, Male, Nursing Homes, Quality Assurance, Health Care, Quality of Life, Stress, Psychological, Time Factors, Proportional Hazards Models, Survival Analysis, Caregivers
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
