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Background: Despite the need for community services to support the intensive levels of care provided by dementia family caregivers, findings consistently indicate low rates of service utilization. This study aims to explore the extent of service use and examine the factors that may influence the use of services in a sample of family caregivers of Persons With Dementia (PWD).Methods: Two hundred and seventy-two family caregivers completed a questionnaire assessing caregiver burden, knowledge and use of services, dementia severity, frequency of problem behaviors and socio-demographic characteristics.Results: The rate of service use was modest with 39.9% using any of the available services. Reasons for non-use included lack of time (26.2%), perceived lack of need (18.5%), and presence of domestic help (21%). Separate regression models were evaluated to identify factors associated with caregiver service use and PWD service-use. Caregiver employment status (OR = 0.53, CI = 0.30–0.94) and knowledge of available services (OR = 4.22, CI = 2.23–7.98) contributed significantly to the model distinguishing caregiver service users from non-users. Knowledge of available services (OR = 2.14, CI = 1.23–3.71) was the only significant predictor of service use targeted at the PWD.Conclusions: Given that knowledge significantly increased the odds of service use, strategies should be designed to raise awareness about the availability of dementia support services in the community and provide a deeper understanding about the value of such services. Future research should employ larger sample sizes and explore factors not measured in this study that might potentially better explain use of services.

This cross-sectional study used the stress and coping paradigm to examine the factors associated with negative and positive adjustment outcomes among Asian family caregivers of persons with dementia (PWD) in Singapore. One hundred seven family caregivers completed measures assessing patient illness characteristics, general coping styles of caregivers, specific dementia management strategies, religion and spirituality, and caregiver adjustment outcomes of burden and gain. Multiple regressions revealed that behavioral problems in the PWD, dementia severity, and the use of behavioral disengagement and criticism as coping strategies were significant predictors of burden accounting for 48% of the explained variance [F(4,99)=23.12, P < 0.001]. The only significant predictor of gain was the use of encouragement as a specific dementia management strategy, explaining 18% of variance [F(3,102) = 7.39, P < 0.001]. Religion and spirituality predicted gain indirectly through the use of encouragement. Coping strategies had an independent effect on caregiver outcomes above and beyond PWD illness characteristics and caregiver characteristics. Hence, caregiver interventions should target coping strategies to improve outcomes of caregiving for dementia. Findings also support the need to examine religion and spirituality in future studies of caregiver adjustment outcomes and to explore the factors not measured in this study that might explain gain.

To describe and validate a new scale, Gain in Alzheimer care Instrument (GAIN), and to measure gains in dementia caregiving.Items in GAIN were derived through a qualitative study of family carers of persons with dementia (PWD). Content validity of GAIN was established by a team of dementia care experts (geriatrician, nurse, and social worker) and through focus group discussion with 15 family carers. Consecutive carers of PWD were administered a questionnaire containing GAIN and other measures.Ambulatory dementia clinic of a tertiary hospital and the local Alzheimer's Association.Family carers of PWD.The psychometric properties of GAIN were examined, in particular, exploratory factor analysis and construct validity through correlation with extant measures; Positive Aspects of Caregiving (PAC), Dementia Management Strategies Scale (DMSS), and Zarit Burden Interview (ZBI).Two hundred thirty-eight English-speaking carers completed the survey. Mean age of carers was 50.1 year (standard deviation [SD] 10.1) and females (68.1%) and child carers (81.3%) comprised the majority. Mean GAIN score was 30.5 (SD 6.5). Internal consistency of GAIN by Cronbach's alpha was 0.89 and test-retest reliability (2 weeks) by Intraclass Correlation Coefficient was 0.70. GAIN correlated strongly with PAC (r = 0.68, df = 236, p0.0001), moderately with DMSS (encouragement) (r = 0.35, df = 234, p0.0001) and DMSS (active management) (r = 0.42, df = 235, p0.0001), and modestly with DMSS (criticism) (r = -0.14, df = 236, p = 0.03) and ZBI (r = -0.15, df = 236, p = 0.02). Principal component analysis revealed a single component with an Eigen value1 at 5.28, accounting for 52.8% of the variance.GAIN is a psychometrically reliable and valid instrument for measuring gains in dementia caregiving. It adds an important dimension to carer assessment in dementia.

Background/aim: People with early cognitive impairment (ECI), comprising mild cognitive impairment and early dementia face the risk of diminished mental capacity with progressive disease. Advance care planning (ACP) is advocated as a means to uphold the autonomy of individuals and enable them to express their wishes for the future while they still possess mental capacity. This study aims to explore the perspectives of patients with ECI regarding ACP, and in particular, understand their reasons for resistance. Method: Consecutive patients undergoing a counselling service for persons with ECI who fulfilled inclusion criteria (Mini Mental State Examination score ≥18, Global Clinical Dementia Rating (GCDR)=0.5 or 1 were recruited. Demographic and clinical data was collected and the detailed documentation in the case records of the counselling sessions was subjected to a thematic analysis. Differences between patients who were willing to engage in ACP and those who declined were also analysed. Results: 93 patients (mean age 76, 60.2% female) were recruited of which 38.7% chose to engage further in ACP discussions. GCDR was the only factor that emerged significant on bivariate analysis for willingness to engage in ACP (t (79) =2.191, p

Introduction: This study aims to validate the Zarit Burden Interview as an instrument to measure the level of burden experienced by caregivers of patients with dementia (PWD) in Singapore. Materials and Methods: Adult family caregivers of PWD were recruited from the ambulatory dementia clinic of a tertiary hospital and the Alzheimer’s Disease Association. All subjects completed a battery of questionnaires which consisted of demographic questions and the following instruments: the Zarit Burden Interview (ZBI), Burden Assessment Scale (BAS), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), and the Revised Memory and Behaviour Problems Checklist (RMBPC). A subgroup of subjects also completed the ZBI for the second time 2 weeks after the fi rst survey. Results: A total of 238 subjects completed the survey. As hypothesised, the Zarit burden score was strongly correlated with BAS, GHQ-28, DMSS, and RMBPC scores (Pearson’s correlation coefficient: 0.53 to 0.73); caregivers who undertook the major role in caregiving, had spent >1 year in caregiving, or experienced financial problems had higher Zarit burden scores than those who were not main carers, with ≤1 year of caregiving, or reported no/minimal financial problems, respectively. The Cronbach’s alpha value for the ZBI items was 0.93; the intra-class correlation coefficient for the test-retest reliability of the Zarit burden score was 0.89 (n = 149). Conclusion: The results in this study demonstrated that the Zarit Burden Interview is a valid and reliable instrument for measuring the burden of caregivers of PWD in Singapore. Key words: Caregiver, Dementia, Scale, Validation

Aim: This study explores the effects of a weekly structured music therapy and activity program (MAP) on behavioral and depressive symptoms in persons with dementia (PWD) in a naturalistic setting. Methods: PWD attended a weekly group MAP conducted by a qualified music therapist and occupational therapist for 8 weeks. Two validated scales, the Apparent Emotion Scale (AES) and the Revised Memory and Behavioral Problems Checklist (RMBPC), were used to measure change in outcomes of mood and behavior. Results: Twenty-eight subjects completed the intervention, while 15 wait-list subjects served as controls. Baseline AES and RMBPC scores were not significantly different between the intervention and control groups. After intervention, RMBPC scores improved significantly (p = 0.006) with 95% CI of the difference between the mean intervention and control group scores compared to baseline at –62.1 to –11.20. Total RMBPC scores in the intervention group improved from 75.3 to 54.5, but worsened in the control group, increasing from 62.3 to 78.6. AES scores showed a nonsignificant trend towards improvement in the intervention group. Conclusion: The results suggest that a weekly MAP can ameliorate behavioral and depressive symptoms in PWD.

Background: Caregiver gain is an important yet less-explored phenomenon. Being conceptually distinct from burden, factors associated with burden and gain can differ. This study aims to explore factors associated with the experience of gains in dementia caregiving. Method: Cross-sectional study involving caregivers recruited from a tertiary hospital dementia clinic and the local Alzheimer’s Association. Caregivers completed a questionnaire containing the following scales: gain in Alzheimer’s care Instrument (GAIN), General Health Questionnaire (GHQ-28), Dementia Management Strategies Scale (DMSS), Revised Memory and Behavioral Problems Checklist (RMBPC) and Zarit Burden Interview (ZBI). Demographic information for the person with dementia (PWD) and the caregiver was also recorded. Initial screening with univariate analyses (t tests, ANOVAs, Pearson’s correlations) was performed to identify significant (p < 0.05) variables, which were then entered into a multiple regression model to identify variables associated with gain. Result: The final sample comprised 334 caregivers with a mean age of 51.5 years (SD = 10.9, range = 22–85), the majority of whom where Chinese (94.6%) females (71%). Mean GAIN score was 30 (SD = 6.6, range = 7–40). Regression analysis identified 3 factors significantly associated with gains (adjusted R2 32.3%): mental well-being of the caregiver, use of active management as a caregiving strategy, and participation in caregiver educational and support group programmes. Conclusion: The results have important implications for caregiver interventions. Interventions should target maintaining mental well-being, encouraging participation in educational and support programmes, and teaching appropriate coping and dementia specific management strategies to derive good outcomes.

The quality degradation of chilli during comminution was investigated through modelling. Two different comminution methods were studied, namely grinding and high-speed cutting. The colour of the chilli powders, the concentration of two major capsaicinoid compounds, and moisture loss in the powders were taken as the quality indicators. The kinetics of quality degradation was modelled. It was found that although the quality indicators of chilli powder produced by grinding were generally inferior to those by high-speed cutting, the rate of quality degradation by the former was much lower than that by the later. The mechanism behind this finding is also discussed in this paper.