Volume 14, Issue 3 (Autumn 2019)                   Salmand: Iranian Journal of Ageing 2019, 14(3): 284-297 | Back to browse issues page

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Ghezelsefloo M, Saadati N, Yousefi Z, Zamanpour M. Study the Effect of Resilience Training on Reducing Stress and Communication Problems in the Primary Caregivers of the Elderly With Alzheimer Disease. Salmand: Iranian Journal of Ageing. 2019; 14 (3) :284-297
URL: http://salmandj.uswr.ac.ir/article-1-1503-en.html
1- Department of Psychology, Faculty of Humanities and Sport Sciences, Gonbad Kavous University, Gonbad, Iran.
2- Department of Consulting, Faculty of Psychology and Educational Sciences, Pychology and Foreign Languages, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran. , dr.nsaadati@gmail.com
3- Department of Psychology, Faculty of Psychology and Educational Sciences, Pychology and Foreign Languages, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran.
4- Department of Psychology, Faculty of Humanities, Arak Branch, Islamic Azad University, Arak, Iran. 
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1. Introduction
Along with the rise in the proportion of older people in most countries, the number of people with dementia also increases [3], which causes serious damages to individuals, society, and the economy as a global health problem [4]. Owing to its serious consequences for the patient and the family, Alzheimer disease is one of the most worrisome disorders at present, described as "endless funerals" [8]. Because of the consequences and complications of Alzheimer disease, like psychological and psychiatric changes along with the disruption of daily living activities, memory impairment, and other cognitive functions (judgment and thinking, etc.), the caregivers should assist and supervise these patients in their daily activities [14]. This study aimed to investigate the effectiveness of resilience training in reducing stress and communication problems in the primary caregivers of older people with Alzheimer disease.
2. Materials and Methods
This research is a quasi-experimental study with the pre-test, post-test design using a control group with a tow month follow-up period. The study population consisted of all primary caregivers (spouses, children, and daughters-in-law) of families, who had benefited from rehabilitation services in Hamraz-E Zendegi Nursing Home in 2017. For sampling, we used the convenience sampling method. The caregivers complied with the principles of confidentiality and cooperated with consent. They had no history of illness or treated by medication and psychotherapy. Then, we asked the primary caregivers of 47 older people with Alzheimer's, who requested home services (medicine, nursing, occupational therapy, etc.) from the nursing home, to complete the Perceived Stress Scale (PSS) developed by Cohen et al. [32] and the Communicative Problems Survey (CPS) designed by Khatooni and Zohari [10]. After initial screening, 29 subjects earned high PSS and CPS scores, 24 of whom were selected according to the inclusion criteria and were randomly assigned to training (n=12) and control (n=12) groups.
The training group received 8 group sessions of resilience training for one month, tow sessions per week, each taking 90 minutes. At the end of the treatment sessions and after tow months, a follow-up was performed for both groups. Then, the data of three stages of pre-test, post-test, and follow-up in both groups were analyzed in SPSS, using Levene’s test, Kolmogorov-Smirnov test, Chi-squared test, and repeated measures ANOVA at a significance level of less than 0.05.
3. Results
Among caregivers in the training group, 3 (25%) were spouses, 7 (58.3%) were children, and 2 (16.7%) were daughters-in-law of the older people. In the control group, tow caregivers (16.7%) were spouses, 7 (58.3%) were children, and 3 (25%) were daughters-in-law. In terms of education in the training group, 2 caregivers had a high school diploma, 1 had an associate degree, 7 had a bachelor's degree, and 2 had a master's degree. In the control group, 3 had an associate degree, 7 had a bachelor's degree, and 2 had a master's degree. The Mean±SD age of the participants was 43.33±5.85 years in the training group and 41.50±9.05 years in the control group. 
The results presented in Table 1 show a significant reduction in stress and communicative problems in the training group compared to the control group at post-test and follow-up period. Figure 1 compares the mean values of stress and communicative problems in both groups. Based on the results of repeated measures ANOVA, the difference in the mean scores of stress and communicative problems between study groups at post-test and the follow-up period was significant (P<0.05). Also, the results of the Bonferroni post hoc test showed a significant difference between the pre-test mean scores of stress and communication problems and those of post-test and follow-up scores (P=0.0001). However, the mean difference between post-test and follow-up scores was not significant in any of the research variables, indicating that the effect of resilience training was stable in our study.

4. Conclusion
As the caregivers of older people with Alzheimer disease experience stress due to elderly care, proper strategies should be used to improve the physical and mental health of these people. The resilience training program, in other words, a multidimensional approach that affects the thoughts, emotions, and behaviors of individuals and caregivers, can have a significant impact on reducing stress and enhancing communication skills. One of the limitations of the present study was the small size of the study subjects. Thus, we suggest that more samples be selected in future studies. Moreover, the present study was conducted in Tehran, and the results cannot be generalized to other cities of Iran. Hence, it is suggested that similar studies be conducted in other cities.
Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Research Ethics Committee of Gonbad Kavous University and Deputy for Research of the Department of Welfare and Rehabilitation Affairs in Tehran, Iran. 
This article was extracted from a research proposal approved by the Gonbad Kavous University and received financial support from the Deputy for Research of the Department of Welfare and Rehabilitation Affairs in Tehran, Iran.
Authors' contributions
Conceptualization by Maliheh Zamanpour and Mehdi Ghezelsefloo; methodology and validation by Nadereh Saadati, Zahra Yousefi and Mehdi Ghezelsefloo; investigation by Nadereh Saadati and Zahra Yousefi; editing and final draft preparation by Nadereh Saadati and Mehdi Ghezelsefloo.
Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Research | Subject: Rehabilitation Management
Received: 2018/03/10 | Accepted: 2018/12/02 | Published: 2019/11/10

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