Mental Health and Self-Efficacy As Predictors of Overall Health Among Care Partners of Persons with Alzheimers Disease and Related Dementias

Background and Purpose: Telehealth services have proliferated in recent years, catalyzed by the COVID-19 pandemic. A federally funded geriatrics workforce program in the southern United States provides such services to care partners of persons with Alzheimer’s disease and related dementias (ADRD). An integrated team in social work, nursing, and medicine conducts telehealth to better understand caregiver health needs. The team noted mental health aspects of anxiety, depression and loneliness. As the burden of care increases, ADRD care partners may struggle with caregiver self-efficacy, or their self-confidence in managing their own health. The purpose of this study was to examine whether caregiver self-efficacy, juxtaposed with these common mental health issues, predicts the ADRD care partner’s sense of their overall health.

Methods: In a hospital setting in southern United States, the integrated health team employed the pilot telehealth program with a sample of ADRD caregivers (N=95). The team collected data on sample characteristics (age, ethnicity, gender, relationship to care recipient) and on the following predictors with standardized measures: loneliness (UCLA Loneliness Scale; α=.80), anxiety (Generalized Anxiety Disorder-2; α=.79), depression (Patient Health Questionnaire-2; α=.77), and caregiving self-efficacy (Family Caregiver Self-Efficacy for Managing Dementia scale; α=.91). The outcome variable, overall perceived health, was measured with a popular, General Self-Rated Health single question (Likert format 1-5). Data were analyzed using OLS multiple regression. Sample characteristics served as covariates in the model. Adjusted R² estimated the corrected goodness-of-fit.

Results: The average age in the ADRD caregiver sample was approximately 62 years (range 26–85). Most identified as female (74%); for ethnicity, most identified as Caucasian/white (66%) followed by African American (29%). The plurality identified as adult child of the person with ADRD (47%), followed by spouse (41%). An overwhelming majority (94%) scored as clinically anxious; 29% scored as clinically depressed; 33% reported loneliness; 12% reported low caregiving self-efficacy; and 20% reported poor overall health. OLS regression findings indicated depression and loneliness as negatively linked to the caregiver’s overall health (B = -.17, t = -2.48, p < .001; and B = -.15, t = -2.00, p < .05, respectively). Anxiety associated positively with the caregiver’s overall health (B = .54, t = -7.94, p < .001). Self-efficacy was not a significant predictor. Adjusted R² value was .63.

Conclusions and Implications: The study revealed an extremely high presence of anxiety with this ADRD caregiver sample, much higher than in previous literature. Moderate numbers of caregiver depression, loneliness, and sense of poor overall health echoed ranges in previous studies. Low self-efficacy appeared in a moderately low number of caregivers. As ADRD caregiver depression increased, perceived overall health worsened. Similar findings were observed for anxiety and loneliness predictors. The model of mental health and self-efficacy captured a notably high amount of variation in the health outcome. Self-efficacy did not significantly predict health. Future studies should consider broader, diverse samples to determine the reliability of this finding. Results underscore the importance of including mental health and social networks when evaluating and treating overall health of ADRD care partners.