Cognitive Behavioral

Data collection was mainly done by the use four instruments. The instruments measured were directed to measure patient cognitive and behavioral status, and the burden level on the part of the caregiver. The methods were also meant to expose the symptoms of depression by the caregivers and find out how the caregiver coped with the stressors and burdens associated with the caregivers (Papastavrou et al., 2007, p. 448).

The researchers were excellent at picking the instruments which could specifically help them to specially pick the right information required to carry out the research. The instruments used in the data collection are reviewed as below:

Memory and Behavior Problem Checklist

This instrument was used to check the cognitive and behavioral status of the patient. Specifically the instrument determined how frequent patients with dementia engaged in problematic behaviors with special attention being given to those which particularly upset family members. The instrument had two parts consisting of 26 items. The first part was to determine the frequency, with which common problems took place. A Likert scale was used to measure this. The scale ran from 0 to 4: 4 meaning happening daily and 0 meaning never happening. The second part of was to measure the level to which the caregiver was bothered by the patient behavior (Papastavrou et al., 2007, p. 448).

The reliability of the study was quite recommendable (as high as 0.85 on Cronbach’s alpha). This was for the, ‘frequency of problem behaviors and caregiver reaction to problem behaviors’ (Papastavrou et al., 2007, p. 449). This instrument assisted in explaining 62.7 percent of the variations. This instrument was quite helpful and strategically chosen to help out in the research. Another instrument used was the Burden Interview (BI).

This instrument was used to asses the care giver burden. The instrument was specifically designed to give an assessment of the stress undergone by the family caregivers of disabled and older persons. The instrument had 22 questions to which the caregivers were to respond to. The questions were on the impact of a patient’s disabilities on the life of a caregiver. The Cronbach’s alpha was found to be 0.93 which is quite high. Four factors were revealed to explain variations. The explanation was to 63.92%. The explanation factors were: role strain, personal strain, management of care and relational deprivation. This document was equally helpful as the first as it gave more insight into the caregiver’s burden. Its reliability measure was quite high showing that it could be relied on. Another instrument used was the Depression scale (Papastavrou et al., 2007, p. 449).

Depression Scale

To measure the overall depression experienced by the caregivers in a past one week the centre for epidemiological studies–depression scale was used. The scale is itemized with 20 items. The article does not explain how this tool was used though it gives its reliability measure to be 0.69 on Cronbach’s alpha (Papastavrou et al., 2007, p. 449).

Coping with the Burden

The other last instrument used in the data collection was used to collect data on how the caregivers coped with the burden. This was done by ‘the ways of coping questionnaire instrument.’ This instrument gave five factors that explained variation to 32.2%. The factors included positive approach, wishful thinking, seeking social support, avoidance strategies and assertiveness. Next the ethical consideration for this research is considered (Papastavrou et al., 2007, p. 449).

Ethical Considerations

The researchers took the necessary steps to ensure that the research adhered to the set standards. The study got an approval from the research committee of the Institute of Neurology and genetics. The ministry of health also approved the study. Concerning the caregivers, they were well informed on the purpose of the study having being given the necessary details on what the research was about and which institutions and who were carrying out the research. The researchers took an initiative to give contacts to the caregivers. The caregivers had sign consent in order to proceed with the research. This study was carried out within the boundaries of the set ethical standards of research work (Papastavrou et al., 2007, p. 449).

The analysis of data was done by the use of independent samples of t-test, one way ANOVA with post hoc adjustments and correlation analysis. The results which were obtained are obtained as shown below:

The most number of caregivers were daughters, then husbands or wives, sons and others in the order of 48.3%, 41.3%, 5.8%, and 4.1%. It was revealed that the caregivers averaged at a mean age of 56.80 years while the patients being care for averaged 75.52. The care recipients who were at institutions had a high average age wise than those who were being cared for at the community. The articles used tables to give more of the research findings. The article clearly explains the research terms used (Papastavrou et al., 2007, p. 450).

A number of variables were found to be related to the caregivers’ burden. These are analyzed as below:

Patient Psychopathology

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The research showed in an overwhelming manner that the majority of the caregivers experienced high levels of burdens. The articles also revealed that this was the case for the care givers of patients with dementia (Papastavrou et al., 2007, p. 451). The research revealed that aggression was most related to the caregivers burden. This was in agreement to what other reports mentioned. The research showed that anger was related to terms such as: “anger, aggressive talk, and threatening manner” (p. 7). The research also attaches vigilance imposed to the caregiver with the burden. The research also shows a weak cognitive impairment association with the burden of care giving. This was done by assessing the patient memory through asking of some questions in a repeated manner (Papastavrou et al., 2007, p. 452).

Burden and Place of Patient Residence

This research showed that the place of patient was not of any significance when the question of the caregiver burden was the factor. It was shown that the level of burden does not change significantly by raising the patient in institutions or in a community. The article cites other article which claim that some caregivers are drawn more to give care to the patient because of the strong bond of love (Papastavrou et al., 2007, p. 452).

Burden and Caregiver Income, Education and Sex

It was shown that the level of the caregiver’s education and sex. High education and better remuneration seemed to buffer the care giving burden. The article makes a suggestion that there is a possibility that the education might be contributor in making the caregiver adaptive to the stressful situation. The sex was another factor: women were found to be more affected by the care giving burden as compared to men. This finding is a said to be dependent of the place in question. For instance, in Cypriot care giving is socially ascribed to women therefore they are expected to engage in care giving though they might not be prepared psychologically and otherwise to carry out the care giving service. T the research findings showed that incase the caregiver was male then always there was another member of the family who offered assistance. This is seen to one of the causes why men register few symptoms of burden (Papastavrou et al., 2007, p. 452).

It was also revealed that though both men and female suffer from burden, they did not suffer in the same way. For the women the suffering was from social relational deprivation otherwise referred to as isolation factor or restriction in life (Papastavrou et al., 2007, p. 452).

Burden and Psychiatric Morbidity of Caregivers

The research showed that the caregivers were more likely to be exposed to clinical depression development. The article attributes this to the long caregiver career which stretches up to 13 years taking into consideration the tensions involved in this activity. The articles claims that though there is a debate whether the burden precedes depressive symptoms, for the case of dementia caregiving, the patient behavior are viewed as predicting the caregiver depression. The research also proved the theory of attribution: it becomes less stressing if the depressive symptoms of a person with dementia are associated with the person and not the disease (Papastavrou et al., 2007, p. 453).


Coping Strategies Used in Caring

The research revealed that burden depended on some specific strategies with positive coping having a negative correlation and emotional coping being correlated positively. The article showed that at the initial stages of the disease are countered by avoidance but as the disease advances avoidance becomes ineffective. The use of avoidance and coping strategies was associated with the women leading to high degrees of stresses manifested in them (Papastavrou et al., 2007, p. 453).


The first weakness which comes out clearly is the use of volunteers: this limits the general grasp of the study as well as encouraging possible self selection bias. There are possibilities that those who volunteered were those who experienced the burden well above the average caregiver. The use of structured questions in the research did not give a chance for the caregivers’ views.


The caregivers who participated are likely to have a more understanding of the topic on which the research was based on.

Piaget's theory of cognitive development

Piaget observed that children go through four different stages of cognitive development in a fixed order that is common in all children. He also noticed that these stages differ in the quantity of information acquired at each stage and the quality of knowledge and understanding at the different stages. He similarly declared that the movement from one stage to another depended on the level of maturity and life exposure. The Piaget's four stages of cognitive development are:  sensorimotor, preoperational, concrete operational and formal operational (essortment, 2002).


Sensorimotor stage

This stage is from birth to two years. The child can differentiate itself from objects but cannot represent the environment using images, language or symbols. It has no awareness of objects and people that are not present at immediate time-object permanence. For example if you hide an object from an infant, it will conclude that it is gone forever.


Preoperational stage

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This stage is from the age of two to seven years. Children develop a language that represents the world and allows them to describe people events and feelings. They view the world from their own perspective assuming everybody to be reasoning the same-egocentric thoughts. They also lack the principle of conservation. They will use symbols pretending to be doing something like driving a car using toys.

Concrete Operational stage

This stage lasts between the age of 7 and 12years. Children develop the ability to think logically and overcome the egocentric thoughts. They learn the idea of reversibility. They master the principle of conservation. They can equally conceptualize events and have a better understanding of time and space.


Formal operational stage

This stage starts from 12 years to adulthood. It is signified by abstract, formal, and logical thinking. They also develop an ability to solve problems (Learning, 2010)

I don't agree with this theory. This is because; different children develop differently at each stage depending on their environment, diet and sometimes inherited genes which affect growth. Hence, although the stages are relevantly defined, what happens at those stages cannot be fixed and universal for all children.


Families are very important source of information on the issue of caregiver burden due to the role they play in taking care of their loved ones. The caregivers experience a lot of burden which is quite persistent even after the death of the patient. Burden has been to be correlated with the caregiver characteristics. The patient also makes a contribution to the whole issue.

This research has brought to light the fact that caregivers who are women show high scores for depression symptoms. The behavioral problems of patients impacted greatly on the caregivers and are more likely to influence the relatives to opt for a long term residential care for the patient. Healthcare workers need to understand and recognize the expectations of the caregivers in order to develop coping strategies which will work out well.

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