Measurement issues in chronic care populations: Dementia special care

Notwithstanding the diversity of views and approaches represented by researchers, work to date has documented the negative impact of different elements of care giving (e.g., the older person's behavior, her or his health status, and other care giving contextual characteristics such as care giving level of involvement and social support) on the care giver's financial situation, family relationships, and mental and physical health. There has been less work dealing with positive aspects of care giving and with care givers to the institutionalized. Efforts to operationalize care giving constructs and develop conceptual models in the institutional setting are needed. Constructs of potential importance in the area of family care giving in the context of chronic care settings include subjective burden, impact of care giving, care giving involvement, satisfaction, mastery, coping, competence, guilt or regrets, personal gain, relational deprivation, economic strains, job-care giving conflict, and demoralization and physical health. Borrowing from state-of-the-art measurement techniques from other fields, research on family concepts needs to incorporate the use of multivariate models, large samples, multimethod approaches to measurement, theory-guided studies, and longitudinal designs to generate sound and meaningful results with practical implications. Zarit has outlined future directions for research, cautioning that while intervention studies are the next step, the design must address the problems of selection bias and include repeated measurements correctly timed. Finally, longitudinal structural equation and event history analytic models, modelling relationships over time and transitions in and out of burden, involvement, and stress states, is a requisite to understanding the dynamic aspects of care giving. These models and concepts need to be extended to include the institutionalized as well. Montgomery in this volume discusses measurement issues related to families of the institutionalized.