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Global Health Econ Sustain Elderly people with dementia

indicate poorer mental health. The reliability alpha of the It assesses functional performance and physiological needs
scale in this study was 0.90. This scale is an indicative scale across ten items: (i) bowel control, (ii) bladder control,
widely used in research. (iii) personal hygiene, (iv) voiding, (v) eating, (vi) dressing,
Subjects’ caregiving burden was measured in this study (vii) bathing, (viii) transferring, (ix) walking, and (x) stair
using a revised 22-item (Zarit et al., 1985) of the Zarit climbing. Each item is rated on a 5-point Likert scale
Burden Interview (Zarit et al., 1980). This scale measures ranging from “0” (indicating “inability to perform”) to “5”
the caregivers’ burden across economic and social life, (indicating “complete independence”). The single-factor
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physical health, and interpersonal, emotional, and model yielded a χ statistic of 74.9 (df = 35), goodness
psychological pressures on a 5-point Likert scale ranging of fit index (GFI) = 0.88, adjusted goodness of fit index
from “0” (indicating “never”) to “4” (indicating “almost (AGFI) = 0.81, and root mean square error of approximation
always”). The reliability alpha of this scale was 0.92, and it (RMSEA) = 0.096, with path coefficients for each item
was chosen due to its extensive use in research. ranging from 0.44 to 0.95. The alpha coefficient for the full
10-item scale was 0.93 (Ohura et al., 2014). We selected this
Furthermore, CJCS, developed by Dilworth-Anderson scale due to its perceived reliability and credibility.
et al. (2004; 2005), was used to measure attitudes regarding
the cultural aspects of caregiving. The scale consists of Finally, we utilized the scale developed by Lawton
ten items rated on a 4-point Likert scale ranging from “1” et al. (1982) to assess functional performance in daily
living. This scale assesses nine activities: (i) telephone
(indicating “strongly disagree”) to “4” (indicating “strongly
agree”). In this study, the reliability alpha of the scale was use, (ii) transportation, (iii) shopping, (iv) medication
0.87. This scale has a high-reliability rating and was used as management, (v) money management, (vi) meal
a reference in previous Asian studies. preparation, (vii) household chores, (viii) laundry, and
(ix) handyman tasks. Each activity is rated on a 4-point
Caregiver coping was measured using the Brief COPE Likert scale from 0 to 3, with “0” indicating “unable,” “1”
Scale (BCOPE) (Carver, 1997), a shortened version of the indicating “needs help,” “2” indicating “able but difficult,”
60-item COPE scale developed by Carver et al. (1989). and “3” indicating “independent.” The total score ranges
The 28-item BCOPE consists of 14 coping strategies, with from 0 to 27, with higher scores indicating a higher level of
two items for each type, rated on a 4-point Likert scale functioning. Widely used in research, this scale is believed
ranging from “1” (indicating “not at all”) to “4” (indicating to correctly assess the ability to perform activities of daily
“often”). Four coping strategies were selected for analysis living.
based on their correlation with the dependent variable,
the GHQ. The Spearman-Brown reliability ρ was 0.60 for 2.3.2. Statistical analysis
self-transference, 0.61 for behavioral withdrawal, 0.86 for Descriptive analyses and the assessment of measure
substance use, and 0.76 for self-blame. We opted to use this reliability were performed using IBM SPSS version 25.0.
scale due to its reliability in assessing coping behavior. Missing values were imputed based on the mean values of

The MMSE has historically been the most widely valid data for each country group across all variables.
used screening test for dementia worldwide and is also Simple statistics and the χ test were used to evaluate
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commonly employed to assess cognitive impairment. It attribute factors (yes, no) related to elderly patients with
consists of 11 items that assess various cognitive abilities dementia and their family caregivers. Differences were
such as orientation, memory, attention, reading, writing, considered significant at p-values <0.05, < 0.01, and
naming objects, understanding verbal and written < 0.001. One-way ANOVA facilitated post hoc comparisons
instructions, dictating or reading sentences, and copying between regions. Similarly, the Games-Howell test, applied
polygons. The overall score ranges from 0 to 30, with a when the assumption of uniformity of variances is violated,
cutoff point of 23/24 in the original testing instrument was used to analyze attribute factors (numerical values)
(Folstein et al., 1975). Given that this study was conducted and scales such as age. In addition, a series of multiple
with family caregivers, each reflecting on the situation of comparisons was conducted, employing the Tukey HSD
an elderly patient with dementia, this scale is appropriate test (which assumes uniformity of variance) to identify
as it accurately assesses individual symptoms. significant differences between group means. All statistical
To measure individuals’ functional independence tests were two-tailed, with a significance level of 0.05.
in mobility, we used the Modified Barthel Index (MBI),
a modification of the Barthel Index. This index can be 3. Results
completed by a health-care professional based on medical The attributes of the study subjects (family caregivers) are
records or direct observation, or it can be self-administered. presented in Tables 1 and 2. A total of 563 respondents (164

Volume 2 Issue 1 (2024) 4 https://doi.org/10.36922/ghes.1954