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Exemplary care as a mediator of the effects of caregiver subjective appraisal and emotional outcomes


Harris, Grant M., Durkin, Daniel W., Allen, Rebecca S., DeCoster, Jamie, Burgio, Louis D.


The Gerontologist, Volume: 51, No.: 3, Pages.: 332-342

Year of Publication



Purpose: Exemplary care (EC) is a new construct encompassing care behaviors that warrants further study within stress process models of dementia caregiving. Previous research has examined EC within the context of cognitively intact older adult care recipients (CRs) and their caregivers (CGs). This study sought to expand our knowledge of quality of care by investigating EC within a diverse sample of dementia CGs.; Design and Methods: We examined the relation between CG subjective appraisal (daily care bother, burden, and behavioral bother), EC, and CG emotional outcomes (depression and positive aspects of caregiving [PAC]). Specifically, EC was examined as a possible mediator of the effects of CG subjective appraisals on emotional outcomes. Using a bootstrapping method and an SPSS macro developed by Preacher and Hayes (2008 Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models), we tested the indirect effect of EC on the relation between CG subjective appraisals and CG emotional outcomes.; Results: Overall, EC partially mediates the relation between the subjective appraisal variables (daily care bother, burden, and behavioral bother) and PAC. Results for depression were similar except that EC did not mediate the relation between burden and depression. This pattern of results varied by race/ethnicity.; Implications: Overall, CGs’ perception of providing EC to individuals with dementia partially explains the relation between subjective appraisal and symptoms of depression and PAC. Results of this study suggest that interventions may benefit from training CGs to engage in EC to improve their emotional outcomes and quality of care.;

Bibtex Citation

@article{Harris_2011, doi = {10.1093/geront/gnr003}, url = {}, year = 2011, month = {feb}, publisher = {Oxford University Press ({OUP})}, volume = {51}, number = {3}, pages = {332--342}, author = {G. M. Harris and D. W. Durkin and R. S. Allen and J. DeCoster and L. D. Burgio}, title = {Exemplary Care as a Mediator of the Effects of Caregiver Subjective Appraisal and Emotional Outcomes}, journal = {The Gerontologist} }


activities of daily living, adult, aged, aged, 80 and over, care, caregivers, dementia, depression, ethnic groups, ethnology, exemplary, factor analysis statistical, female, health status, humans, interviews as topic, male, middle aged, psychological tests, psychology, stress, psychological, young adult

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Type of Outcomes

Carer Burden (instruments measuring burden), Depression and Anxiety



Type of Interventions

Intervention for Carers

Carer Focussed Interventions

Other, Training programmes / workshops including behavioural training