Family stress and Alzheimer's disease

The diagnosis for Carla Lewis was caregiver role strain. Carla is a classic example of a person with caregiver role strain related to care responsibilities secondary to progressive dementia. According to NANDA (1999), this is defined as "a caregiver's felt or exhibited difficulty in performing the family caregiver role" (p. 59). Carla has expressed feelings of loss over changes in her mother, concern over her mother's future, changes in roles in the family and family relationships, depression, and anger.

In today's world, "caregiver" is not always just one person. With multigenerational families, everyone in the home is affected by the presence of a family member with dementia. Just as it is not enough to focus only on the biophysical illnesses of an individual without understanding other dimensions of the person, so it is not enough to focus on only one person in a family without understanding the family as a group.

The diagnosis for the family as a group is altered family processes related to disruption of normal family roles and routines secondary to caregiving needs of the elderly family member. Although caregiver role strain refers to the burden put on Carla as the primary caregiver, altered family processes refers to the inability of the family group to adapt in a positive way to the stressors involved. Apparently, this family functioned effectively before Mrs. Potter moved in with them. The stressors of caring for her have resulted in dysfunctional behaviors, and the emotional needs of family members are not being met.

For this intergenerational family, it is important that the nurse address issues for the primary caregiver and the family. Dementia of the Alzheimer's type is a progressive, degenerative disease that leads eventually to death. There is no hope for the caregivers that the situation will improve. The strain on the primary caregiver and family is great and can lead to disruption in family function, depression, and illness.

Nursing Interventions. Family caregiving issues are many and complex. The Modeling and Role-Modeling theory and paradigm for nursing (Erickson, Tomlin, & Swain, 1983) provides a framework for understanding the needs of these and other individuals and families. Several basic needs are not being met: physiologic needs for rest, safety and security needs such as freedom from fear,...