# “I Just Glove up and Do What Has to Be Done”: A Mixed-Methods Exploration of Dementia Care Challenges and Care Management Strategies

## TL;DR

This study explores how family caregivers manage dementia care challenges and finds that criticism is often used for behavioral symptoms, which can harm well-being.

## Contribution

The study introduces a mixed-methods approach to analyze how dementia caregivers adapt strategies based on symptom severity and type.

## Key findings

- Caregivers use active strategies for functional and cognitive care but employ criticism for behavioral symptoms.
- Higher dementia severity correlates with increased criticism, which is linked to worse outcomes.
- Tailored interventions could improve caregiver mental health and care quality by promoting adaptive strategies.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Family care partners adopt a variety of care management strategies to navigate care for persons living with dementia (PLwD), often without formal training.Behavioral and psychological symptoms of dementia (BPSD) are associated with burden, institutionalization, and mortality, making effective management strategies critical.

Family care partners adopt a variety of care management strategies to navigate care for persons living with dementia (PLwD), often without formal training.

Behavioral and psychological symptoms of dementia (BPSD) are associated with burden, institutionalization, and mortality, making effective management strategies critical.

Public health significance—Why is this work of significance to public health?
BPSD, particularly agitation, were the most challenging and consistently stressful dementia symptoms reported by care partners.Care partners used active management for functional and cognitive care, but BPSD coincided with more critical, rigid, and disengaging strategies that reduce well-being for both care partners and PLwD.

BPSD, particularly agitation, were the most challenging and consistently stressful dementia symptoms reported by care partners.

Care partners used active management for functional and cognitive care, but BPSD coincided with more critical, rigid, and disengaging strategies that reduce well-being for both care partners and PLwD.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Future interventions should help care partners practice more adaptive behavioral management rather than punitive strategies like criticism.Tailored interventions targeting care partners’ specific management styles and unique care stressors may improve care provision and mental health.

Future interventions should help care partners practice more adaptive behavioral management rather than punitive strategies like criticism.

Tailored interventions targeting care partners’ specific management styles and unique care stressors may improve care provision and mental health.

Family care partners for persons living with dementia (PLwD) adopt a variety of care management strategies to navigate care. We utilize a convergent parallel mixed-methods design to integrate family care partners’ descriptions of care challenges and associated management approaches. Primary family care partners for PLwD (n = 100) were interviewed about their management of a care challenge (qualitative), the PLwD’s function, behavior and cognition (quantitative), and their management strategies (qualitative/quantitative). Care challenges and strategies were compared across qualitative content analysis and t-tests. Care partners providing more functional (r = 0.34, p < 0.01) and cognitive (r = 0.30, p < 0.01) care used more active management strategies, whereas care partners providing greater behavioral care (r = 0.34, p < 0.001) reported more criticism, with similar themes seen qualitatively. Active management may be required when dementia severity increases, yet criticism may emerge with greater behavioral severity. Because criticism is associated with more negative outcomes, future interventions should help care partners practice more adaptive behavioral management.