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. Author manuscript; available in PMC: 2023 Mar 13.
Published before final editing as: J Nurs Meas. 2021 Sep 13:JNM-D-20-00087. doi: 10.1891/JNM-D-20-00087

Evaluation of the Caregiver Preparedness Scale in African American and White Caregivers of Persons with Dementia During Post-Hospitalization Transition

Ashley Kuzmik 1, Marie Boltz 2, Barbara Resnick 3, Rhonda BeLue 4
PMCID: PMC9514879  NIHMSID: NIHMS1833015  PMID: 34518397

Abstract

Background and purpose:

The Preparedness for Caregiving Scale (PCS) is a widely used instrument to measure caregiver preparedness. The purpose was to evaluate the PCS in African American and White caregivers of patients with dementia upon discharge from the hospital.

Methods:

Factor structure, measurement invariance and predictive validity of the PCS were assessed in a sample of 292 family caregivers/patient dyads.

Results:

One-factor structure of the PCS and measurement invariance by race was fully supported. Predicative validity revealed significant association between the PCS and anxiety (β =−.41, t =−7.61(287), p <.001), depression (β =−.44, t =−8.39(287), p <.001), and strain (β =−.48, t =−9.29(287), p <.001).

Conclusion:

The PCS is a valid and meaningful tool to measure preparedness in African American and White family caregivers of persons with dementia during post-hospitalization transition.

Keywords: preparedness, caregivers, dementia, hospital discharge

INTRODUCTION

In the United States, more than 5 million people are living with Alzheimer’s disease and related dementias (ADRD), and by 2050, this figure is projected to almost triple (Alzheimer’s Association [AA], 2020). Most people with dementia are community-dwelling and are usually cared by informal caregivers (Garre-Olmo et al., 2016). Approximately 83% of caregivers for persons with dementia are family or friends, with majority being relatives (i.e., spouses and children) (Garre-Olmo et al., 2016; AA, 2020). Among persons with dementia, extensive care is generally required due to declines in cognitive and physical function. Caregivers assume the role of care managers (informants, advocates, and coordinators) and/or care providers (providing direct care in instrumental and basic activities of daily living) (Archbold et al., 1992), providing 18.6 billion hours of care, which is substantially higher than caregivers of people with other conditions (AA, 2020).

Although caregiving often offers positive and rewarding experiences, high demands often lead to psychological morbidity including increased levels of stress, anxiety, and depression on caregivers for persons with dementia (Ma et al., 2018; McGillick & Murphy-White, 2016; Sallim et al., 2015). Factors such as gender, age, education, caregiving relationship, and cohabitation with persons with dementia can influence caregiver burden (Chiao et al., 2015) and psychological morbidity (Watson et al., 2019). Additionally, a systematic review and meta-analysis reported racial and ethnic differences in dementia caregivers’ well-being with better psychological well-being in African American caregivers compared with white caregivers in both population-based and convenience sample studies (Liu et al., 2020).

Challenges of caring for persons with dementia usually escalate in hospital settings and caregiver stress intensifies (Boltz & Galvin 2013a; Clissett et al., 2013; Shankar et al., 2014). Compared to other older adults who are cognitively intact, persons with dementia are more likely to have frequent hospital stays and increased needs following hospitalization (Boltz et al., 2015; Callahan et al., 2012; Mukadam & Sampson, 2011). At discharge, most caregivers for patients with dementia want them to return home (Boltz & Galvin, 2013b). However, the transition can be a difficult adjustment and caregivers report lack of readiness and preparedness to meet the increased needs after hospitalization (Boltz et al., 2015; Adkison, 2014; Clissett et al., 2013; Mukadam & Sampson, 2011).

Across various caregiver populations, caregiver preparedness can predict depression (Petruzzo et al., 2019; Schumacher et al., 2008), anxiety (Henriksson & Årestedt, 2013), and aspects of role strain (Archbold et al., 1990). Higher preparedness of caregiving is generally associated with better mental health (Shyu et al., 2010) and increased hope (Henriksson & Årestedt, 2013). Also, when caregiving demand is high, caregivers who are more prepared report reduced levels of strain (Yang et al., 2014; Wang et al., 2013). On the other hand, lack of preparedness is significantly associated with greater levels of caregiver burden (Fujinami et al., 2015).

The Preparedness for Caregiving Scale (PCS) developed by Archbold et al. (1990), is a widely used instrument to measure caregiver preparedness. This scale was developed for family caregivers supporting older adults residing at home; several studies have administered the PCS to evaluate caregiver preparedness in different patient populations, including persons with Parkinson’s disease (Carter et al., 2010) and cancer (Fujinami et al., 2015). The PCS has demonstrated high internal consistencies in caregivers of persons with life threatening illness (α=0.93; Henriksson et al., 2012), stroke (α=0.94; Pucciarelli et al., 2014), and heart failure (α=0.91; Petruzzo et al., 2017), as well as caregivers of individuals receiving palliative care (α=0.93; Hudson & Hayman-White, 2006). Validity of the PCS has been supported by significant correlations between the scale and other instruments, for example, the Caregiver Competence Scale (Henriksson et al., 2012), the Rewards of Caregiving Scale (Henriksson et al., 2012), the Caregiver Contribution to Self-Care of HF Index (Petruzzo et al., 2017), Caregiver Role Strain (Archbold et al., 1990), and the Hospital Anxiety and Depression Scale (Petruzzo et al., 2017). A few studies have also investigated the factorial structure of the PCS, and the findings indicated adequate fit (≥0.95) with a one-factor model; none tested for equivalence of the scale across different racial groups (Petruzzo et al., 2017; Pucciarelli et al., 2014; Henriksson et al., 2012; Hudson & Hayman-White, 2006). Psychometric evaluation of the PCS in African American caregivers has been limited, with only 1% (Archbold et al., 1990) to 8% (Schumacher et al., 2007; Schumacher et al., 2008) representation in previous studies.

Although previous research shows good measurement properties of the PCS, no prior studies have evaluated the psychometric properties of the PCS in caregivers of patients with dementia upon discharge from the hospital, and examine differences by race. Therefore, the aims of this study were to: 1) examine the factorial structure of the PCS; 2) test measurement invariance by race; and 3) evaluate its predicative validity. We hypothesized that: 1) items of the PCS will conform to a one-factor model; 2) measurement invariance will be confirmed; and 3) there would be a significant association between the PCS and mood and strain experienced by the caregivers (based on the Hospital Anxiety and Depression subscales and the Modified Caregiver Strain Index).

METHODS

Design

This study is based on a secondary analysis of an ongoing cluster randomized clinical trial known as the Family-centered Function-focused Care (Fam-FFC), which tests the efficacy on patient and caregiver-centered outcomes in hospitalized persons with ADRD who live at home (Boltz et al., 2018). Fam-FFC is a multi-component intervention that includes family caregiver education, staff education, and a care pathway, in a nurse-caregiver partnership model of planning, delivering, and evaluating function-focused care. This study was approved by the university institutional review board, and before data collection, written informed consent was obtained by all participants.

Setting

Data was collected from six medical units (three intervention units and three control units), in three hospitals that were located in Pennsylvania. The hospitals included one large academic medical center, a medium-sized teaching hospital, and a small community hospital.

Sample

The sample included 292 family caregivers who agreed to enroll as study partners. The inclusion criteria were: age ≥ 18 years, spoke English or Spanish, related to the patient by blood, marriage, adoption, or affinity as a significant other (defined so by the patient/legally authorized person as the primary person providing oversight and support on an ongoing basis). Family caregivers were excluded if they were unable to recall at least two words of a three-word recall. This study also enrolled hospitalized patients who were age ≥ 65 years, spoke English or Spanish, screened positive for dementia on the Montreal Cognitive Assessment (MoCA ≤ 25) Nasreddine et al., 2005) and AD8 ≥ 2 (Galvin et al., 2006), had a diagnosis of very mild to moderate stage dementia as confirmed by a score of 0.5 to 2.0 on the Clinical Dementia Rating Scale (CDR) (Morris, 1997), lived in the community prior to admission to the hospital, and had a family caregiver as the designated study partner for the duration of the study. Patient exclusion criteria were: admission from a nursing home, hospice enrollment, absence of family caregiver to participate, any significant neurological condition associated with cognitive impairment other than dementia (e.g., brain tumor), and a major acute psychiatric disorder.

Procedures

Patient/family caregiver dyads were enrolled within 48 hours of hospital admission if they met inclusion criteria. Following eligibility and consent, trained research staff who were blinded to the intervention collected patient and family caregiver data. Patient demographic and descriptive information was obtained through electronic medical records or from the report of the family caregiver within 48 hours of admission. Caregiver data collection was completed at the family caregiver’s home within one-week of the patient’s discharge. Interviews with the family caregiver also took place in the home, six months after discharge from the hospital to explore their perspectives on the intervention and the study measures.

Measures

Descriptive characteristics of the dyads included age, gender, race, ethnicity, education, and marital status. We also collected data on the relationship between the family caregiver and patient (e.g., spouse or son/daughter), whether the family caregiver lived with the patient, family caregiver employment status outside of home, and the number of hours the family caregiver was employed outside of home. Patient clinical data included length of hospital stay and comorbidities. Length of hospital stay were evaluated based on the number of days the patient was in the hospital (counting admission and discharge dates). Comorbid conditions were classified using the Charlson Comorbidity Index (CCI), which has been found to be a valid and reliable measure of disease burden (van Doorn et al., 2001). The CCI is a weight index that takes into account both the number and seriousness of different co-morbid diseases (Charlson et al., 1987). Cognition was evaluated with the Montreal Cognitive Assessment (MoCA), a cognitive screening tool that measures executive function, orientation, memory, abstract thinking, and attention and demonstrates excellent sensitivity and specificity, differentiating between mild cognitive impairment, no dementia, and dementia (Nasreddine et al., 2005). The MoCA has been validated in culturally diverse populations and differing educational levels (Bernstein et al., 2011; Goldstein et al., 2014).

Caregiver Preparedness

Caregiver preparedness was evaluated using the self-rated Preparedness for Caregiving Scale (PCS; Archbold et al., 1990), an 8-item instrument that measures perceived preparation of the multiple tasks related to the caregiving role such as providing emotional and physical support, arranging for services, handling emergent situations, and managing the stress of caregiving. Responses are rated on a 5-point Likert scale ranging from 0 (not at all prepared) to 4 (very well prepared). The PCS has well established validity and reliability in samples of caregivers of individuals with heart failure, stroke, life threatening illness, and palliative care (Petruzzo et al., 2017; Pucciarelli et al., 2014; Henriksson et al., 2012; Hudson & Hayman-White, 2006).

Outcome Variables

Caregiver anxiety and depression were assessed with the Hospital Anxiety and Depression subscale for Anxiety (HADS-A) and the Hospital Anxiety and Depression subscale for Depression (HADS-D) (Herrmann, 1997). Each subscale consists of seven items, with all response rated on a 4-point Likert scale ranging from 0 to 3. Possible total scores range from 0 to 21 in each subscale and higher scores reflect greater anxiety or depressive symptoms. Both of the subscales have demonstrated good psychometric properties (Bjelland et al., 2002).

Caregiver strain was measured by the Modified Caregiver Strain Index (MCSI; Thornton & Travis, 2003), a self-administered 13- item tool that measures five domains of caregiver strain (financial, physical, psychological, social, and personal). For each response, a 3 point-scale is used: 2=yes, 1=sometimes, and 0=no. Total scores can range from 0 to 26, with higher scores corresponding to higher levels of caregiver strain. The MCSI has demonstrated excellent internal consistency and reliability (Thornton & Travis, 2003)

Data Analysis

Statistical analyses were performed using SPSS and AMOS versions 25 (IBM Corp, Armonk, NY). Descriptive statistics of demographic and clinical characteristics were presented as frequencies for categorical data and mean ±standard deviation (SD) for continuous variables. Mean, standard deviation, skewness, and kurtosis of each item on the PCS were also examined. Based on prior research, a confirmatory factor analysis (CFA) using maximum likelihood estimation procedure was conducted to confirm the single factor structure of the PCS (Petruzzo et al., 2017; Pucciarelli et al., 2014; Henriksson et al., 2012; Hudson & Hayman-White, 2006). The following values were used to evaluate acceptable model fit: χ2 (p> 0.05), chi-square/degree of freedom (χ2/df) <3 (Kline, 1998), Comparative Fit Index (CFI) ≥0.95 (Bentler, 1990), and Tucker and Lewis’s Incremental Index (TLI) ≥0.90 (Tucker, & Lewis, 1973). Root mean square error of approximation (RMSEA) ≤0.08 suggested reasonable fit or 0.08–0.1 indicated mediocre fit (Byrne, 2013; Hu & Bentler, 1999). A factor loading higher than 0.40 was considered acceptable (Ford et al., 1986). Modification indices were also used to further examine error covariances to improve model fit.

After confirming the factor structure of the PCS, multigroup CFA of the PCS was performed to test measurement invariance by race. Separate CFAs were performed for each group (African American and White) using maximum likelihood estimation procedure and model fit criteria stated above. Three nested models were then explored to determine invariance of the PCS by race. First, configural invariance (Model A) was evaluated to test the latent structure between the two groups (i.e., a one-factor model). Second, metric invariance (Model B) tested the relationship between each item and the latent variable among the groups (i.e., same factor loadings). Third, scalar invariance (Model C) assessed latent mean differences among the groups (i.e., means can be compared). To evaluate invariance for each model, the invariance criteria used were Δχ2 (p > 0.05), ΔCFI ≤0.01, ΔTLI ≤0.01, and ΔRMSEA ≤0.015 (Cheung & Rensvold, 2002; Chen, 2007).

To examine predictive validity of the PCS scores with anxiety, depression, and strain, three adjusted linear regression models were examined. Family caregiver’s gender, age, education and living status were significantly correlated with anxiety, depression, and strain; thus, the linear regression models included adjustment for these variables. Treatment arm and race were not controlled for, as they did not demonstrate correlation with the outcome variables. Statistical significance was set at p < 0.05.

RESULTS

Descriptive Data

Table 1 shows the characteristics of the 292 caregivers. The caregivers reported a mean age of 60.5 years (SD=13.9). The majority of caregivers were female (72%), non-Hispanic or Latino (98%), married (59%), and had some college education (31%). Almost all caregivers were either White (52%) or African American (48%). Caregivers were adult children in most of the cases (53%), and more than half lived with the patient (59%). Fifty percent were employed outside of the home and averaged 40.7 (SD= 14.4) hours of outside work per week. Table 2 indicates that the patients were primarily female (61%) with a mean age of 81.5 (SD=8.4). The sample included slightly more White patients (51%) than African American (49%), and most were high school graduates (39%) and either widowed (45%) or married (32%). The overall mean score for the MoCA was 10.9 (SD= 7.0), indicating significant cognitive impairment. The CCI score was 3.7 (SD= 2.4) and the average length of hospital stay was 6.1 days (SD=3.9).

Table 1.

Description of caregiver sample (N=292)

Variable n (%)
Gender Female 209 (72)
Male 83 (28)
Race White 152 (52)
African American 140 (48)
Ethnicity Not Hispanic or Latino 285 (98)
Hispanic or Latino 7 (2)
Education Less than high school 26 (9)
High school graduate 60 (21)
Some college or technical school 90 (31)
College graduate 61 (21)
Graduate or professional school 50 (17)
Marital status Married 172 (59)
Single 59 (20)
Divorced 31 (11)
Widowed 22 (8)
Separated 6 (2)
Relationship with patient Son/daughter 155 (53)
Spouse 76 (26)
Nephew/niece 13 (4)
Brother/sister 12 (4)
Granddaughter/grandson 11 (4)
Friend 6 (6)
Daughter-in-law 5 (2)
Paid Caregiver 5 (2)
Partner 4 (1)
Other (e.g., sister in law, ex, cousin) 3 (1)
Goddaughter 2 (1)
Living with Patient 172 (59)
Employed outside of home 145 (50)
Mean (SD)
Age 60.5 (13.9)
Hours of employment outside of home (per week) 40.7 (14.4)
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Table 2.

Patient Descriptives (N=292)

Variable n (%)
Gender Female 178 (61)
Male 114 (39)
Race White 150 (51)
African American 142 (49)
Ethnicity Not Hispanic or Latino 287 (98)
Hispanic or Latino 5 (2)
Education Less than high school 54 (18)
High school graduate 113 (39)
Some college or technical school 46 (16)
College graduate 37 (13)
Graduate or professional school 32 (11)
Marital status Widowed 132 (45)
Married 94 (32)
Divorced 36 (12)
Single 23 (8)
Separated 4 (1)
Mean (SD)
Age 81.5 (8.4)
Comorbidity 3.7 (2.4)
Duration of hospital stay (days) 6.1 (3.9)
Cognitive Status (MoCA) 10.9 (7.0)
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Descriptive analysis of the items included in the PCS is shown in Table 3. The mean scores ranged between 2.75 (Item 4) to 3.28 (Item 6) and the standard deviations were from 0.95 (Item 6) and 1.24 (Item 4). The skewness and kurtosis of the items were within acceptable range (−2 to +2), indicating normal distribution of the data (George & Mallery, 2010). All the items were negatively skewed due to caregivers having high scores. The PCS had a total mean score of 24.46 (SD=6.88).

Table 3.

Descriptive statistics of items on the PCS in patients with dementia

Mean (SD) Skewness Kurtosis
1. How well prepared do you think you are to take care of your family member’s physical needs? 3.03 (1.11) −0.953 0.091
2. How well prepared do you think you are to take care of his or her emotional needs? 2.90 (1.12) −0.770 −0.137
3. How well prepared do you think you are to find out about and set up services for him or her? 3.17 (0.99) −1.076 0.536
4. How well prepared do you think you are for the stress of caregiving? 2.75 (1.24) −0.753 −0.308
5. How well prepared do you think you are to make caregiving activities pleasant for both you and your family member? 2.94 (1.13) −0.880 −0.035
6. How well prepared do you think you are to respond to and handle emergencies that involve him or her? 3.28 (0.95) −1.319 1.296
7. How well prepared do you think you are to get the help and information you need from the health care system? 3.23 (0.99) −1.276 1.163
8. Overall, how well prepared do you think you are to care for your family member? 3.16 (0.98) −1.179 1.146
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Confirmatory Factor Analysis

The initial single factor structure of the PCS suggested that the hypothesized model was a poor fit with the data (χ2/df >3; CFI<0.95; RMSEA>0.08). After error covariances were identified using modification indices, there was an improvement in model fit. With the exception for the chi-square test for goodness-of-fit χ2(17) =44.96 (p<0.001), other indices confirmed adequate fit of the modified one-factor model (χ2/df =2.645, CFI = 0.979, TLI = 0.966, RMSEA=0.075). All 8 items on the PCS significantly loaded into one factor, and the loadings ranged from 0.71 to 0.86 (Figure 1). In our model, modification indices pointed weak error covariance between items 2 and 5, 3 and 7, and 4 and 6. The error covariance between these items were allowed to correlate since other parameters in the model were not altered.

Figure 1.

Figure 1

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PCS items and factor loadings

Measurement Invariance by Race

The findings from the one-factor CFAs for each group are shown in Table 4. Among Whites, χ2 was significant (p=0.020), however, established criteria for acceptable fit were met among the other indices (χ2/df=1.83, CFI=.980, TLI=.966, and RMSEA=.074). Similarly, Among African Americans, χ2 was also significant (p=0.004), but, the other fit indices met established criteria for acceptable fit (χ2/df=2.13, CFI=.972, TLI=.953, and RMSEA=.090). RMSEA was fairly high indicating mediocre fit among African Americans.

Table 4.

Measurement invariance of the PCS by race (N=292)

χ2(df), p-value χ2/ df CFI TLI RMSEA Comparison Δχ2(Δdf), p-value ΔCFI ΔTLI ΔRMSEA
African American (n=140) 36.19 (17), 0.004 2.13 .972 .953 .090 - - - - -
White (n=152) 31.06 (17), 0.020 1.83 .980 .966 .074 - - - - -
Model A, configural invariance 67.26 (34), 0.001 1.98 .976 .960 .058 - - - - -
Model B, metric invariance 79.35(41), <0.001 1.94 .972 .962 .057 vs. Model A 12.09 (7), .098 −.004 −.002 −.001
Model C, scalar invariance 79.44 (42), <0.001 1.89 .973 .964 .055 vs. Model B 0.09 (1), 0.758 −.001 −.002 −.002
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The configural model (Model A) had adequate fit across the two groups (χ2/df=1.98; CFI=.976, TLI=.960, and RMSEA=.058) except for χ2 (p=0.001). Comparisons across models (Model A and Model B) show that Δχ2 were not statistically significant (p> 0.05) and ΔCFIs (≤0.01), ΔTLIs (≤0.01), and ΔRMSEAs (≤0.015) are below the cut-offs.

Predictive Validity

Table 5 shows the results of the adjusted linear regression models examining the predictive validity of the PCS. After controlling for family caregiver’s gender, age, education and living status, the PCS scores were significantly associated with the outcome measures in our sample of African American and White caregivers of persons living with dementia. Higher PCS scores were significantly associated with lower scores on the HADS-A (β =−.41, t=−7.61(287), p<.001), HADS-D (β =−.44, t=−8.39(287), p<.001), and MCSI (β =−.48, t=−9.29(287), p<.001).

Table 5.

Regression models for predication of outcome measures (N=292)

B β t (p) 95% Confidence Level
Lower Upper
HADS-A −.28 −.41 −7.61 (.000) −.35 −.21
HADS-D −.24 −.44 −8.39 (.000) −.29 −.18
MCSI −.48 −.48 −9.29 (.000) −.58 −.38
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DISCUSSION

This study examined the factor structure and validity of the PCS among caregivers of persons with dementia after hospitalization. To the best of our knowledge, this is the first study to evaluate psychometric properties of the CPS in caregivers of person with dementia at hospital discharge in a robust sample representing both African and White caregivers. As hypothesized, items fit the model with parameters >0.40 thus confirming a one-factor model. The CFA indicating that the PCS is a unidimensional measure of caregiver preparedness, is consistent with the findings of studies in other populations (Petruzzo et al., 2017; Pucciarelli et al., 2014; Henriksson et al., 2012; Archbold et al., 1990). Our findings provide further support for a one-factor structure of the PCS, specifically evaluating preparedness in caregivers for persons with dementia after hospitalization.

Results from multigroup CFA of the PCS fully supported measurement invariance, confirming our hypothesis. We found equivalence of the one-factor structure, equivalence of factor loadings, and equivalence of latent means across the groups, indicating that the PCS has the same meaning among African American and White caregivers. Future studies should further extend this work by testing measurement invariance of the PCS across other racial groups and cultures.

In our predictive validity analysis, caregiver preparedness among African American and White caregivers of persons living with dementia was associated with caregiver anxiety, depression, and strain, supporting our hypothesis. We found that higher levels of preparedness were significantly associated with lower levels of anxiety, depression, and strain. These results are consistent in other studies where caregiver preparedness was found to significantly predict depression, (Petruzzo et al., 2019; Schumacher et al., 2008), anxiety (Henriksson & Årestedt, 2013), and aspects of role strain (Archbold et al., 1990). Our findings add to the literature, suggesting that the PCS is a valid measure to examine caregiver preparedness after the vulnerable post-hospitalization period, in both African American and White caregivers of persons living with dementia. Future research is recommended to examine the validity of the PCS in samples of more diverse racial and ethnic caregiver populations.

Clinical Implications

The transitional period after hospitalization is a vulnerable period for the family caregivers of persons with dementia. Uncertainty about how to provide care or a lack of support or information can add to the caregiver’s stress and compromise their own well-being and efficacy. Results of this study suggest that the PCS offers a valid tool that could be useful in planning the care of persons with dementia before discharge, by identifying those caregivers most in need of support. Additionally, the PCS may help target specific areas for education and referral to health and social services, and thus support individualized family-centered care.

Limitations

This study has limitations. First, the PCS is a self-report measure, which entails potential social desirability as participants may exaggerate their perceived level of preparedness to minimize concerns and make them seem better prepared. Second, this study used secondary data and was limited to data collected from the primary research project. As a result, other factors that could influence caregiver preparedness such as family caregiver coping strategies, competing demands, living environments, and socio-economic status, were not examined. Third, only patients with mild to moderate dementia were included in the study, thus, caregiver preparedness was not evaluated in family caregivers taking care of patients with advanced dementia. Fourth, the generalizability of this study is limited given the inclusion of participants from only three hospitals in Pennsylvania and lack of inclusion of other racial and ethnic groups.

Conclusion

Despite these limitations, our results provide further evidence for the one-factor model of the PCS, and the validity of the scale for its use in African American and White family caregivers of persons with dementia during periods of transition from hospital to home. Results add to the science of caregiver measurement by further supporting the validity of the PCS as a tool that offers relevant data about what matters to caregivers in order to guide meaningful and effective clinician/caregiver partnerships. Future research needs to further examine the validity of the PCS among more culturally and geographically diverse caregivers for patients with dementia.

Acknowledgements

This study was funded by the National Institute of Aging (NIA), Grant: R01AG054425. The contents of the article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH/NIA.

Funding Information:

National Institute on Aging (R01AG054425)

Contributor Information

Ashley Kuzmik, The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802 USA.

Marie Boltz, The Pennsylvania State University, College of Nursing, 306 Nursing Sciences Building, University Park, PA 16802.

Barbara Resnick, University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21218.

Rhonda BeLue, St. Louis University, Salus Center, 3545 Lafayette Ave, St. Louis, MO 63103.

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