Decision making by elderly community dwelling spousal caregivers about long-term care placements for their partners with Alzheimer's Disease: Seeing the Changing Reality

Background. Spousal caregivers of those with AD face the progressive deterioration of their affected partners as they themselves age in the community. This decline may be accompanied by changes in the caregiving situation as well.; Purpose. To generate a substantive theory that describes and explains how elderly, community-dwelling spousal caregivers make long-term care placement (LTCP) decisions for their partners with Alzheimer's Disease (AD).; Method. Using grounded theory, a substantive theory was constructed based on the accounts of 33 elderly, community-dwelling spousal caregivers as participants. Three groups of participants were included: Group 1 -- spousal caregivers considering longterm care options (n=11); Group 2 -- spousal caregivers who had already placed their partners with AD into a long-term care setting (nursing home or assisted living facility) (n=16); and Group 3 -- those spousal caregivers who had decided against long-term care placements for their partners with AD (n=6). Mean age was 74.4 years and mean duration of caregiving across all groups was 6.2 years.; Findings. The basic social psychological problem was identified as caregiver readiness to make a decision. Seeing the Changing Reality was identified as the central phenomenon linked to the problem of caregiver readiness. When spousal caregivers saw the reality of caregiving demands presented by AD over time, then they were able to make long-term care placement decisions for their ill spouse. Caregivers experienced an eclipsing of themselves, their needs, and their ability to continue managing caregiving. Differences were identified between younger spousal caregivers (in their 50s and 60s) and older ones (in their 70s and 80s). Of note, spouses who decided against long-term care placement (the negative case) were also investigated. Seven caregiver strategies were associated with Seeing the Changing Reality: denying, planning, accommodating, reminding, keeping, enlisting help, and seeking information.; Conclusions. The process by which spousal caregivers make long-term care placement decisions for their partners with AD is based on the caregiver's readiness to see the changing reality presented by the AD illness over time.