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Family Caregiving of Older Chinese People With Dementia: Testing a Model

Liu, Yu; Insel, Kathleen C.; Reed, Pamela G.; Crist, Janice D.

doi: 10.1097/NNR.0b013e31823bc451

Background: The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture.

Objectives: The aim of this study was to test the proposed Dementia Caregiving Model, specifying how caregiving appraisal, coping, perceived social support, and familism influence the impact of caregiving stressors on the psychological health of caregivers.

Methods: A cross-sectional correlational design with a convenience sample (n = 96) from three outpatient clinics of hospitals in China was used. Questionnaires were utilized to measure the variables in the model. Path analysis was used to assess model fit and paths.

Results: The original proposed model did not fit the data, butminor modifications produced a very good model fit (χ2 (10, n = 96) = 8.14, p = .62; goodness-of-fit index = .98, comparative fit index = 1.00, and root mean square error of approximation < .001). Care recipients’ behavioral problems had direct and indirect negative effects on caregivers’ psychological health. Perceived social support had direct and indirect positive effects on caregivers’ psychological health. Familism had indirect positive effects on caregivers’ psychological health in relation with caregiving satisfaction and coping. Caregiving appraisal and coping were mediators in the model.

Conclusions: The model findings lend support that caregivers’ cognitive appraisal and coping explain some observed individual differences in stress response and outcomes. The findings broaden understanding of the effects of familism on caregivers’ psychological health. In the future, programs should include interventions for caregivers, as well as interventions for care recipients.

Yu Liu, PhD, RN, is Associate Professor, School of Nursing, Peking University, Beijing, China.

Kathleen C. Insel, PhD, RN, is Associate Professor; Pamela G. Reed, PhD, RN, FAAN, is Professor; and Janice D. Crist, PhD, RN, FNGNA, is Associate Professor, College of Nursing, University of Arizona, Tucson.

Accepted for publication September 28, 2011.

We also thank Dr. Putt from the University of Arizona College of Nursing and American Association of University Women for generous financial support for a PhD study and this research.

This work was supported by the Doctoral Student Research Grant from the Sigma Theta Tau International Honor Society of Nursing Beta Mu Chapter.

The authors have no conflicts of interest to disclose.

Corresponding author: Yu Liu, PhD, RN, School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.