Helen Wu

Abstract of Helen's Research

Behavioural and psychological symptoms of dementia (BPSD) cause significant distress and reduced quality of life for persons with dementia and their caregivers, resulting in increased caregiver burden and earlier institutionalisation. Following nursing home placement, caregivers are relieved of the physical exhaustion surrounding home care, however the psychological morbidity continues. Cross-cultural studies of BPSD are limited, and there are currently no cross-cultural comparative studies of the psychological morbidity of caregivers of persons with dementia in institutionalised care.

The first aim of this thesis was to increase understanding of the effects of culture on BPSD by comparing the rates of BPSD in nursing home residents across three residential facility types: mainstream nursing homes in Sydney, ethno-specific Chinese nursing homes in Sydney, and a long term high care facility in Shanghai known as a dementia hospital. The second aim of this thesis was to examine the effects of culture on psychological morbidity among Shanghai, Australian-Chinese and Australian mainstream caregivers of persons with dementia in residential care.

One hundred and forty nine residents and their caregivers voluntarily participated in this study. There were 42 participants from the ethno-specific Chinese homes, 51 from mainstream homes and 56 participants from the dementia hospital. The rates and levels of BPSD were assessed by interviewing staff with the Neuropsychiatric Inventory–Nursing home version (NPI-NH). The Mini-Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used to assess residents’ dementia severity. Levels of psychological morbidity of Shanghai, Australian-Chinese and Australian mainstream caregivers were assessed using a guilt scale, the Mental Health Component (MHC) of the RAND-36 Health Status Inventory and the Geriatric Depression Scale.

The mean NPI total score for this sample was 28.5 (SD = 17.2), with no significant differences between the three facility types. Comparison of individual NPI subscales showed that residents from ethno-specific Chinese facilities had lower rates of hallucinations than Shanghai residents, but no differences with mainstream residents. Shanghai residents had lower rates of disinhibition and irritability than ethno-specific Chinese residents, but no differences with mainstream residents. Comparison of caregiver psychological morbidity scores showed no significant differences between the three groups in guilt and mental health scores, but levels of depression were highest among Shanghai, intermediate among Australian-Chinese and lowest in Australian mainstream caregivers.

The overall prevalence of BPSD did not appear to be mediated by culture in this study. Longitudinal studies in different cultural groups are needed to elucidate the effects of culture on the development and progression of BPSD over time. Levels of depression in caregivers of institutionalised persons with dementia differed by culture and country of residence. Further studies are needed to elucidate the factors contributing to depression among caregivers of different cultural groups.