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EV0411

Difficulties experienced by dementia care staff during a care recipient’s bereavement: A factor analysis of symptom changes and care responses

DIFFICULTIES FACED BY DEMENTIA CARE STAFF AROUND RESIDENT BEREAVEMENT: A FACTOR‑ANALYTIC STUDY OF SYMPTOM CHANGES AND CARE RESPONSES

Difficulties reported by dementia care staff following bereavement cluster into three factors—neuropsychiatric symptoms, attachment-related preoccupation, and reduced vitality—and reports of difficulties decrease significantly on four items following bereavement.

The study aimed to identify the structure of the difficulties experienced by residential care staff when a resident with dementia loses a loved one and to examine the relationship between these difficulties and staff care responses. In Japan, 171 professional caregivers (nurses or care workers) who had cared for older adults with dementia and had experience of a resident’s bereavement completed a self-report questionnaire between September and December 2021; most participants had more than five years of clinical experience. The latent structure was examined using exploratory factor analysis with maximum likelihood estimation and Promax rotation; the number of factors was determined by eigenvalues greater than 1.0, the scree plot, and theoretical interpretability. McNemar’s test was also applied to 13 items in a subsample of 123 participants with paired assessments before and after bereavement. The analysis yielded three factors: Factor 1, neuropsychiatric symptoms (irritability 0.853; insomnia 0.697; delusions 0.770; behavioral and psychological symptoms of dementia (BPSD) 0.774; 7 items, including memory problems, temporal disorientation, and misidentification of people); Factor 2, attachment-related preoccupation (wanting to see the deceased person 0.807; repetitive questioning 0.958; arguing over facts 0.728; 3 items); and Factor 3, reduced vitality and depressive apathy (low energy 0.841; absent-mindedness 0.886; decreased appetite 0.745; 3 items). Interfactor correlations were reported as 0.51 between Factors 1 and 2, 0.35 between Factors 1 and 3, and 0.28 between Factors 2 and 3. McNemar’s test identified significant changes in four items: low energy, absent-mindedness, temporal disorientation, and BPSD (p = 0.007, 0.004, 0.014, and 0.035, respectively); for all four items, the proportion of staff reporting difficulties decreased following bereavement. The authors note that this decrease may be related to the items asking whether symptoms present before bereavement had subsequently worsened. The clinical implications concern the difficulty of distinguishing transient bereavement-related reactions (disorientation, BPSD, and loss of vitality) from dementia progression, and the way attachment-related behaviors that change little in the short term complicate decisions about whether to inform the resident of the loss.

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