Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Albert Copolillo


The vast majority of persons with Alzheimer’s disease and related dementias live at home and are cared for by families or close friends/neighbors. An essential element to daily care decisions is the caregiver’s appraisal of function in the family member with dementia. This dissertation comprises three separate papers exploring caregiver appraisal of functional capacity, using secondary data from a study conducted at Thomas Jefferson University of 88 patient-caregiver dyads, funded by the Alzheimer’s Association (L. Gitlin, PhD, principal investigator; Grant # IIRG-07-28686). The caregivers were primarily female (88.6%), white (77.3%), and spouses (55.7%), with a mean age of 65.8. All caregivers had a high school education or higher and had provided care from 6 months to 22 years. The majority of the participants with dementia were female (52.3%) and white (76.1) with a mean age of 81.7. Their scores on the MMSE ranged from 10 to 28 (M = 17.7, SD = 4.6, N = 87). The first paper examined construct and interrater reliability of the Functional Capacity Card Sort (FCCS), a tool designed to measure subjective caregiver appraisal. Using spearman’s rank correlations the FCCS was found to be statistically associated with the Caregiver Assessment of Function and Upset scale (r = .43, p < 0.0001, N = 86) and not statistically associated with the Neuropsychiatric Inventory scale (r = -.14, p = .16, N = 86), supporting convergent and discriminant validity respectfully. Kendall’s coefficient of concordance revealed a strong agreement among caregivers in the ranking of the six cards of the FCCS, Kendall W (5, 72) = 0.83, p = .0001, supporting interrater reliability of the FCCS. The second and third paper demonstrated the utility of the FCCS in distinguishing three groups of caregivers based on their estimation of functional capacity in the person with dementia compared to a gold standard occupational therapy assessment. Fifty-two (61%) of the caregivers overestimated function, 19 (22%) caregivers underestimated function, and 15 (17%) were concordant with the standardized assessment. Further analysis explored personal and home environment factors in relation to caregiver appraisal. The Kruskal-Wallis test showed cognitive status in the person with dementia (H (2, N = 85) = 3.67, p = .16) and caregiver depressive symptoms (H (2, N = 86) = 1.35, p = .51) were not associated with the caregiver’s appraisal of functional capacity in the person with dementia. Linear regression and proportional odds logistic regression, adjusted for cognitive status in the person with dementia, did not reveal a relationship between caregiver appraisal and the number of observed home hazards [F (1, N = 86) = .01, p = .94] or the unmet needs reported by the caregiver [Wald χ2 (1, N = 86) = .95, p = .33], respectively. Linear regression showed a trend towards the hypothesis that caregiver concordant/underestimation of functional capacity have greater home adaptations compared to caregiver overestimation [F (1, N = 86) = 3.06, p = .08]. The papers in totality demonstrate the utility of the FCCS to assess caregiver appraisal and interpret level of estimation, which can guide the therapeutic approach and treatment plan by an occupational therapist or other health professional. Further understanding of caregiver appraisal and associated factors is critical to providing best practice in dementia care. Limitations and future directions for research are discussed.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2013