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c
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so
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K
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w
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s
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C
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b
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en
C
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s
Me
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Ps
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R
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T
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CC B
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C
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A
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:
Z
am
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liza
Ab
d
u
l M
u
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d
C
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tr
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f
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r
Nu
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s
in
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Stu
d
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Facu
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s
,
Un
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[
1
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.
Fro
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1
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[
3
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–
[
5
]
.
T
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Ma
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o
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tio
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C
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p
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I
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6
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wn
th
at
o
ld
er
f
em
ale
ca
r
er
s
with
d
e
p
r
ess
io
n
s
y
m
p
to
m
s
an
d
th
o
s
e
with
a
g
r
ea
ter
s
en
s
e
o
f
s
e
l
f
-
s
t
i
g
m
a
a
r
e
m
o
r
e
l
i
k
e
l
y
t
o
f
e
e
l
a
h
i
g
h
e
r
d
e
g
r
e
e
o
f
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
t
h
a
n
t
h
e
i
r
y
o
u
n
g
e
r
c
o
u
n
t
e
r
p
a
r
t
s
[
8
]
–
[
1
0
]
.
I
n
ad
d
iti
o
n
,
f
u
r
th
er
c
h
ar
ac
ter
is
tics
r
elate
d
to
ca
r
eg
iv
er
b
u
r
d
en
in
clu
d
e
th
e
av
aila
b
ilit
y
o
f
s
o
cial
s
u
p
p
o
r
t,
s
p
en
d
in
g
m
o
r
e
tim
e
with
p
atien
ts
,
an
d
th
e
d
u
r
ati
o
n
o
f
ca
r
in
g
.
T
h
er
e
ar
e
co
n
tr
ad
ictio
n
s
in
s
o
m
e
o
f
th
ese
in
d
icato
r
s
wh
en
p
r
ed
ictin
g
ca
r
eg
iv
er
b
u
r
d
en
.
Fo
r
ex
a
m
p
le,
e
x
ter
n
al
h
elp
r
ec
eiv
ed
b
y
ca
r
eg
iv
er
s
was
lin
k
ed
to
ca
r
eg
iv
er
b
u
r
d
en
in
Ma
lay
s
ia
[
1
1
]
.
Ho
wev
e
r
,
th
er
e
was
n
o
co
r
r
elatio
n
b
etwe
en
ca
r
e
g
iv
er
ass
i
s
tan
ce
an
d
th
e
s
am
e
co
n
d
itio
n
am
o
n
g
I
talian
ca
r
eg
iv
er
s
[
1
0
]
.
C
u
ltu
r
al
d
if
f
e
r
en
ce
s
m
ay
af
f
ec
t
h
o
w
ca
r
eg
i
v
in
g
im
p
ac
ts
ca
r
er
s
f
r
o
m
d
i
f
f
er
en
t e
t
h
n
ic
g
r
o
u
p
s
an
d
cu
ltu
r
al
b
ac
k
g
r
o
u
n
d
s
.
Desp
ite
th
e
co
n
tr
ad
ictio
n
s
in
th
e
d
ata
o
n
th
e
f
ac
to
r
s
co
n
t
r
ib
u
tin
g
to
ca
r
e
g
iv
er
b
u
r
d
e
n
,
r
esil
i
en
ce
m
ay
b
e
a
cr
u
cial
d
eter
m
in
an
t
in
u
n
d
er
s
tan
d
in
g
h
o
w
ca
r
e
r
s
"b
o
u
n
ce
b
ac
k
"
an
d
d
ea
l
with
th
e
d
i
f
f
icu
lties
o
f
ca
r
in
g
f
o
r
p
e
o
p
le
with
s
ev
er
e
m
en
ta
l
illn
ess
.
Pu
b
lis
h
ed
co
n
ce
p
t
a
n
aly
s
es
o
f
r
esil
ien
ce
h
av
e
a
d
d
r
ess
ed
co
m
p
ar
a
b
le
ch
ar
ac
ter
is
tics
o
f
th
is
co
n
ce
p
t,
s
u
ch
as
r
eb
o
u
n
d
in
g
,
f
a
v
o
u
r
a
b
le
o
u
tco
m
es,
p
er
s
o
n
al
m
aster
y
,
an
d
th
e
e
x
is
ten
ce
o
f
s
u
p
p
o
r
t
[
1
2
]
,
[
1
3
]
.
Pre
v
i
o
u
s
ly
,
s
tu
d
ies
o
n
ca
r
eg
iv
e
r
s
f
o
r
p
eo
p
le
with
Alzh
eim
er
'
s
d
is
ea
s
e,
f
em
ale
ca
r
eg
iv
er
s
o
f
p
e
r
s
o
n
s
with
m
ajo
r
m
en
tal
illn
ess
,
an
d
ch
ild
c
ar
eg
iv
er
s
in
d
icate
d
th
at
m
o
r
e
r
esil
ien
t
ca
r
eg
iv
er
s
r
ep
o
r
ted
l
o
wer
lev
els
o
f
h
ar
d
s
h
ip
[
1
4
]
,
[
1
5
]
.
Ho
wev
er
,
t
h
e
d
ata
m
ea
s
u
r
ed
th
e
f
ac
to
r
s
th
at
co
n
tr
ib
u
ted
t
o
ca
r
eg
iv
er
b
u
r
d
en
,
an
d
th
e
r
o
l
es
o
f
r
esil
ien
ce
ar
e
s
ca
r
ce
in
Ma
lay
s
ia.
T
h
u
s
,
th
e
r
e
is
a
n
e
ed
to
in
v
esti
g
ate
th
e
in
f
lu
en
ce
o
f
r
esil
ien
ce
o
n
ca
r
eg
iv
er
b
u
r
d
en
in
ca
r
eg
iv
er
s
o
f
p
atien
ts
with
s
ev
er
e
m
en
tal
illn
ess
in
Ma
lay
s
ia.
T
h
e
p
r
im
ar
y
aim
o
f
th
is
s
tu
d
y
is
to
ex
p
lo
r
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
r
esil
ien
ce
an
d
ca
r
e
g
iv
er
b
u
r
d
en
a
m
o
n
g
s
t
th
o
s
e
wh
o
c
a
r
e
f
o
r
p
e
o
p
l
e
w
i
t
h
s
e
v
e
r
e
m
e
n
t
a
l
i
l
l
n
e
s
s
.
W
e
f
o
r
m
u
l
a
t
e
d
t
h
e
f
o
l
l
o
w
i
n
g
r
e
s
e
a
r
c
h
q
u
e
s
t
i
o
n
s
t
o
g
u
i
d
e
t
h
i
s
r
e
s
e
a
r
c
h
:
i)
w
h
at
ar
e
th
e
lev
el
s
o
f
ca
r
e
g
iv
er
b
u
r
d
en
an
d
r
es
ilien
ce
am
o
n
g
ca
r
e
g
iv
er
s
o
f
p
atien
ts
with
s
ev
er
e
an
d
p
er
s
is
ten
t
m
en
tal
illn
ess
?
;
ii)
w
h
at
ar
e
th
e
p
r
ed
icto
r
s
f
o
r
ca
r
eg
iv
er
b
u
r
d
en
in
th
is
p
o
p
u
latio
n
?
;
iii)
w
h
at
i
s
th
e
ex
p
er
ien
ce
o
f
ca
r
in
g
f
o
r
p
a
tien
ts
with
s
ev
er
e
an
d
p
er
s
is
ten
t m
en
tal
illn
ess
?
2.
M
E
T
H
O
D
2
.
1
.
D
e
s
i
g
n
W
e
m
e
as
u
r
e
d
t
h
e
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
a
n
d
r
e
s
i
l
i
e
n
c
e
le
v
e
ls
a
n
d
t
h
e
i
r
a
s
s
o
c
i
a
te
d
f
a
c
t
o
r
s
u
s
i
n
g
a
c
r
o
s
s
-
s
e
c
ti
o
n
a
l
d
e
s
i
g
n
w
i
t
h
c
l
o
s
e
d
an
d
o
p
e
n
-
e
n
d
e
d
q
u
e
s
t
i
o
n
s
.
W
e
a
l
s
o
a
d
a
p
t
e
d
b
o
t
h
c
l
o
s
e
d
-
e
n
d
ed
(
q
u
a
n
t
i
t
a
t
i
v
e
d
a
t
a
)
a
n
d
o
p
e
n
-
e
n
d
e
d
(
q
u
a
l
i
t
a
t
i
v
e
d
a
t
a
)
.
Q
u
a
n
t
i
ta
t
i
v
e
d
a
ta
f
r
o
m
t
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
m
e
as
u
r
e
d
t
h
e
f
a
ct
o
r
s
c
o
n
t
r
i
b
u
t
i
n
g
to
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
s
,
s
u
c
h
as
r
es
i
li
e
n
c
e
a
n
d
c
a
r
e
g
i
v
e
r
s
t
r
ess
o
r
s
.
I
n
c
o
n
t
r
as
t
,
o
p
e
n
-
e
n
d
e
d
q
u
e
s
t
i
o
n
s
a
ll
o
w
f
o
r
e
x
p
l
o
r
i
n
g
o
t
h
e
r
f
a
c
t
o
r
s
a
f
f
e
c
tin
g
c
a
r
e
g
i
v
e
r
s
'
l
i
v
es
.
As
k
i
n
g
ad
d
i
t
i
o
n
a
l
o
p
e
n
-
e
n
d
e
d
q
u
e
s
t
i
o
n
s
a
t
t
h
e
e
n
d
o
f
t
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
al
l
o
ws
t
h
e
p
a
r
ti
c
ip
a
n
t
s
t
o
e
la
b
o
r
a
t
e
m
o
r
e
o
n
t
h
e
a
n
s
w
e
r
s
g
i
v
e
n
i
n
t
h
e
cl
o
s
e
d
-
e
n
d
e
d
[
1
6
]
.
2
.
2
.
S
e
t
t
i
n
g
a
nd
s
a
mp
l
e
T
h
e
s
a
m
p
l
e
s
i
z
e
wa
s
d
e
t
e
r
m
i
n
e
d
u
s
i
n
g
a
l
i
s
t
o
f
c
a
r
e
g
i
v
e
r
s
o
f
p
e
o
p
l
e
w
i
t
h
s
e
r
i
o
u
s
m
e
n
t
a
l
i
lln
e
s
s
w
h
o
v
i
s
i
t
a
p
s
y
c
h
i
a
t
r
i
c
f
a
c
il
i
t
y
i
n
S
el
a
n
g
o
r
,
W
es
t
M
a
l
a
y
s
i
a
.
N
o
n
-
p
r
o
b
a
b
i
l
i
t
y
,
p
u
r
p
o
s
i
v
e
s
a
m
p
li
n
g
w
a
s
u
s
e
d
t
o
r
ec
r
u
i
t
2
0
1
c
a
r
e
g
i
v
e
r
s
o
f
p
a
t
i
e
n
t
s
wi
th
s
e
v
e
r
e
m
e
n
t
a
l
i
ll
n
e
s
s
es
.
T
h
e
p
a
t
i
e
n
t
s
t
h
e
y
c
a
r
e
d
f
o
r
m
u
s
t
h
a
v
e
b
e
e
n
d
i
a
g
n
o
s
e
d
w
i
t
h
s
e
v
e
r
a
l
m
e
n
t
al
i
l
l
n
es
s
es
,
i
n
c
l
u
d
i
n
g
s
c
h
i
z
o
p
h
r
e
n
i
a
,
b
i
p
o
l
a
r
d
i
s
o
r
d
e
r
,
o
r
m
a
j
o
r
d
e
p
r
e
s
s
i
v
e
d
is
o
r
d
e
r
wi
t
h
p
s
y
c
h
o
t
i
c
c
h
a
r
a
ct
e
r
is
t
i
cs
,
f
o
r
at
l
e
as
t
tw
o
y
e
a
r
s
.
T
h
e
i
n
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a
w
e
r
e
c
a
r
e
g
i
v
e
r
s
w
h
o
w
e
r
e
:
i
)
a
t
l
ea
s
t
1
8
y
e
a
r
s
o
l
d
,
ii
)
r
e
s
i
d
i
n
g
i
n
t
h
e
s
a
m
e
h
o
u
s
e
as
t
h
e
p
a
ti
e
n
t
s
f
o
r
w
h
o
m
t
h
e
y
we
r
e
p
r
o
v
i
d
i
n
g
c
a
r
e
,
ii
i
)
a
b
l
e
t
o
c
o
m
m
u
n
i
c
a
t
e
i
n
M
al
a
y
o
r
E
n
g
l
i
s
h
,
a
n
d
iv
)
i
d
e
n
t
i
f
i
e
d
a
s
t
h
e
p
r
i
m
a
r
y
c
a
r
e
g
i
v
e
r
s
.
T
h
e
r
ese
a
r
c
h
e
r
s
a
p
p
r
o
a
c
h
e
d
c
a
r
e
g
i
v
e
r
s
w
h
o
a
c
c
o
m
p
a
n
i
e
d
p
a
t
i
e
n
ts
t
o
t
h
e
i
r
o
u
t
p
a
t
i
e
n
t
a
p
p
o
i
n
t
m
e
n
t
s
.
C
a
r
e
g
i
v
e
r
s
w
h
o
c
o
n
s
e
n
t
e
d
t
o
p
a
r
t
i
c
i
p
a
te
w
e
r
e
t
h
e
n
a
s
k
e
d
t
o
s
i
g
n
a
p
e
r
m
i
s
s
i
o
n
f
o
r
m
a
n
d
c
o
m
p
l
e
t
e
t
h
e
q
u
e
s
t
i
o
n
n
a
i
r
e
.
2
.
3
.
I
n
s
t
ru
me
n
t
s
T
h
e
ca
r
eg
iv
er
b
u
r
d
e
n
in
v
e
n
t
o
r
y
(
CBI
)
[
1
7
]
w
a
s
u
s
e
d
t
o
e
v
a
l
u
a
t
e
c
a
r
e
g
i
v
e
r
b
u
r
d
e
n
.
T
h
e
C
B
I
h
a
d
a
l
r
e
a
d
y
b
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ti
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n
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o
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l
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a
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t
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th
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i
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p
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i
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l
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i
m
p
a
ct
.
W
h
i
l
e
co
l
l
i
n
e
a
r
it
y
s
ta
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is
t
ic
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T
h
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m
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l
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t
y
w
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r
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h
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f
t
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m
p
le
t
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n
g
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h
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b
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l
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y
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v
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b
y
p
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p
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n
ts
.
A
s
u
b
s
et
o
f
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e
s
p
o
n
s
e
s
w
as
r
e
a
d
,
a
n
d
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c
o
d
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f
r
a
m
e
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d
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v
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o
d
es
we
r
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t
h
e
n
a
s
s
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n
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d
t
o
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s
p
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n
s
es
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w
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(
Z
A
M
a
n
d
N
M
)
i
n
d
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p
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SP
SS
S
t
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ti
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d
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s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
So
cio
-
dem
o
g
ra
ph
ic
cha
ra
ct
er
is
t
ics o
f
ca
re
g
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er
s
Mo
s
t
ca
r
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s
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e
Ma
lay
wo
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en
in
th
eir
m
id
-
to
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late
4
0
s
an
d
5
0
s
wh
o
wer
e
m
a
r
r
ied
,
h
ad
a
h
i
g
h
s
ch
o
o
l
q
u
alif
icatio
n
,
an
d
wer
e
em
p
lo
y
e
d
f
u
ll
-
tim
e.
Mo
s
t
c
ar
er
s
liv
ed
in
t
h
e
s
am
e
h
o
u
s
e
as
th
e
p
atien
t
an
d
o
th
er
f
am
ily
m
em
b
er
s
.
Ap
p
r
o
x
im
ately
o
n
e
-
t
h
ir
d
o
f
ca
r
er
s
r
ep
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ted
h
a
v
in
g
at
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ed
ical
co
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d
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,
wh
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ly
h
alf
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t h
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in
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r
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b
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r
d
en
.
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th
at
th
e
m
o
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d
if
f
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.
Me
an
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th
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s
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C
D
-
R
I
SC
was 7
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.
1
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(
SD=1
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)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
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,
Vo
l.
1
4
,
No
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1
,
Ma
r
ch
20
2
5
:
4
9
3
-
501
496
T
ab
le
1
.
So
cio
-
d
em
o
g
r
ap
h
ic
c
h
ar
ac
ter
is
tics
o
f
ca
r
eg
iv
er
s
an
d
ca
r
eg
iv
in
g
-
r
elate
d
s
tr
ess
o
r
s
.
C
h
a
rac
t
er
i
s
t
i
c
s
Freq
u
e
n
c
y
Perce
n
t
a
g
e
So
c
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o
-
d
em
o
g
ra
p
h
i
c
c
h
ar
act
er
i
s
t
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cs
o
f
c
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i
v
er
s
A
g
e
(
M
ea
n
,
S
D
)
4
5
.
0
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.
1
G
en
d
er
Mal
e
Fema
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1
3
1
3
4
.
8
6
5
.
2
E
t
h
n
i
ci
t
y
Mal
ay
Ch
i
n
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In
d
i
an
1
3
2
27
42
6
5
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7
1
3
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4
2
0
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9
Mar
i
t
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l
s
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a
t
u
s
Marr
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e
d
Si
n
g
l
e
W
i
d
o
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d
,
s
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ara
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e
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o
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d
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v
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rce
d
1
4
3
42
16
7
1
.
1
2
0
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8
E
d
u
cat
i
o
n
al
l
ev
el
N
o
f
o
rm
al
e
d
u
ca
t
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o
n
/
Pri
mar
y
s
c
h
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l
Sec
o
n
d
ar
y
s
c
h
o
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l
Co
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n
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v
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rs
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t
y
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1
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5
3
1
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5
E
m
p
l
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m
en
t
s
t
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t
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s
W
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k
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g
Ret
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re
e
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p
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H
o
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fe
1
1
3
24
36
28
5
6
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2
1
1
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9
1
7
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9
1
3
.
9
Rel
a
t
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o
n
s
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i
p
w
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t
h
p
at
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e
n
t
Sp
o
u
s
e
Pare
n
t
So
n
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d
a
u
g
h
t
er
O
t
h
er
42
57
56
46
2
0
.
9
2
8
.
4
2
7
.
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2
2
.
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L
i
v
i
n
g
arr
an
g
e
me
n
t
L
i
v
e
w
i
t
h
p
a
t
i
en
t
o
n
l
y
L
i
v
e
w
i
t
h
p
a
t
i
en
t
an
d
o
t
h
er
p
e
o
p
l
e/
fam
i
l
y
mem
b
er
s
33
1
6
6
1
6
.
4
8
2
.
6
H
a
v
i
n
g
me
d
i
ca
l
c
o
n
d
i
t
i
o
n
?
Y
e
s
No
75
1
2
5
3
7
.
5
6
2
.
5
Perce
i
v
e
d
h
ea
l
t
h
s
t
a
t
u
s
V
er
y
G
o
o
d
G
o
o
d
Mo
d
er
at
e
51
91
58
2
5
.
5
4
5
.
5
2
9
.
0
Care
g
i
v
i
n
g
-
re
l
at
ed
s
t
r
es
s
o
r
s
D
u
ra
t
i
o
n
o
f
care
g
i
v
i
n
g
(
M
e
d
i
a
n
,
I
Q
R
)
5
.
0
8
.
0
T
i
me
s
p
e
n
t
f
o
r
care
g
i
v
i
n
g
p
er
d
ay
L
e
s
s
t
h
a
n
4
h
o
u
r
s
4
t
o
8
h
o
u
r
s
9
t
o
1
2
h
o
u
r
s
Mo
r
e
t
h
an
1
2
h
o
u
r
s
48
60
37
52
2
4
.
4
3
0
.
5
1
8
.
8
2
6
.
4
A
v
a
i
l
a
b
i
l
i
t
y
o
f
s
u
p
p
o
r
t
o
r
as
s
i
s
t
a
n
ce
A
s
s
i
s
t
a
n
c
e
w
i
t
h
care
g
i
v
i
n
g
t
as
k
s
In
f
o
rm
at
i
o
n
al
s
u
p
p
o
rt
Fi
n
a
n
c
i
al
s
u
p
p
o
rt
E
m
o
t
i
o
n
a
l
s
u
p
p
o
rt
1
0
8
1
1
5
85
95
5
5
.
4
5
8
.
4
4
2
.
7
4
8
.
5
Pat
i
e
n
t
s
’
b
eh
av
i
o
u
ra
l
d
i
s
t
u
rb
an
ce
s
i
n
p
re
v
i
o
u
s
m
o
n
t
h
D
i
s
t
u
rb
ed
Bi
za
rre
A
g
g
res
s
i
v
e
E
m
b
ar
ra
s
s
i
n
g
V
i
o
l
e
n
t
1
1
9
94
58
33
24
5
9
.
5
4
7
.
5
2
9
.
1
1
6
.
6
1
2
.
1
3
.
2
F
a
ct
o
rs
a
s
s
o
cia
t
ed
wit
h
ca
re
g
iv
er
bu
rden
R
esu
lts
f
r
o
m
th
e
p
ea
r
s
o
n
co
r
r
elatio
n
co
ef
f
icien
t
(
r
=0
.
1
9
)
in
d
icate
d
th
at
o
ld
er
ca
r
eg
iv
er
s
wer
e
m
o
r
e
lik
ely
to
f
ee
l
b
u
r
d
en
ed
,
with
a
s
m
all,
p
o
s
itiv
e
co
r
r
elatio
n
b
etwe
en
ag
e
an
d
ca
r
e
g
iv
er
b
u
r
d
e
n
.
Ma
le
ca
r
eg
iv
e
r
s
(
M=
2
6
.
1
7
,
SD=1
8
.
7
1
)
an
d
f
e
m
ale
ca
r
er
s
(
M=
3
3
.
0
9
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0
.
7
9
;
t
(
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9
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3
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0
2
)
wer
e
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n
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ig
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ican
tly
lo
wer
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atin
g
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em
ale
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e
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iv
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(
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7
1
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.
I
t
was
s
h
o
wn
th
at
C
h
in
ese
ca
r
er
s
f
elt
a
g
r
ea
ter
b
u
r
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e
n
th
an
Ma
lay
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d
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n
d
ian
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ticip
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ts
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.
A
h
ig
h
er
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k
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em
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lo
y
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e
n
t
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F
(
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9
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0
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0
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.
C
ar
er
s
with
a
m
ed
ical
co
n
d
itio
n
wer
e
m
o
r
e
lik
ely
to
r
ep
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r
t
h
i
g
h
lev
els
o
f
ca
r
eg
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b
u
r
d
en
th
a
n
ca
r
eg
iv
er
s
with
o
u
t
a
m
ed
ical
co
n
d
itio
n
.
Fin
d
in
g
s
s
h
o
w
s
u
b
s
tan
tial
d
is
p
ar
ities
in
ca
r
eg
i
v
er
b
u
r
d
en
am
o
n
g
th
r
ee
ca
t
eg
o
r
ies
o
f
h
ea
lth
s
tat
u
s
.
C
ar
eg
iv
er
s
wh
o
p
er
ce
iv
ed
th
em
s
elv
es
to
b
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in
b
etter
h
e
alth
r
ep
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ted
lo
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b
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r
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n
lev
els
th
an
th
o
s
e
wh
o
p
er
ce
iv
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th
em
s
elv
es
to
b
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in
wo
r
s
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h
ea
lth
.
C
ar
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in
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-
r
elate
d
s
tr
ess
wa
s
ass
o
ciate
d
with
th
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am
o
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n
t
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f
tim
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en
t
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r
in
g
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o
r
p
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ts
(
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[
3
,
1
9
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7
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2
4
,
p
=0
.
0
0
1
)
,
th
e
lac
k
o
f
em
o
tio
n
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an
d
ca
r
eg
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v
in
g
ass
is
tan
ce
(
t=
-
2
.
2
9
,
p
=0
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0
2
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,
an
d
all
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atien
ts
'
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eh
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io
u
r
al
d
is
t
u
r
b
an
ce
s
(
p
=0
.
0
1
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
lth
Sci
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N:
2252
-
8
8
0
6
Dete
r
min
a
n
ts
o
f c
a
r
eg
iver b
u
r
d
en
in
c
o
mmu
n
ity
-
d
w
ellin
g
ca
r
eg
ivers
o
f p
a
tien
ts
…
(
Za
mza
liz
a
A
b
d
u
l Mu
lu
d
)
497
T
h
er
e
was
an
in
v
er
s
e
co
r
r
ela
tio
n
b
etwe
en
ca
r
eg
iv
e
r
b
u
r
d
e
n
an
d
r
esil
ien
ce
.
T
h
is
co
r
r
ela
tio
n
was
m
o
d
e
r
a
t
e
(
r
(
1
9
7
)
=
-
0
.
3
5
4
,
p
<
0
0
0
1
)
b
u
t
s
h
o
w
s
t
h
a
t
i
n
c
r
e
a
s
e
d
r
e
s
i
l
i
e
n
c
e
c
o
r
r
e
s
p
o
n
d
e
d
w
i
t
h
a
d
e
c
r
e
a
s
e
d
b
u
r
d
e
n
.
3
.
3
.
P
re
dict
o
rs o
f
ca
re
g
iv
er
bu
rden
So
cio
-
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
wer
e
en
ter
ed
in
s
tag
e
1
o
f
th
e
r
eg
r
ess
io
n
an
aly
s
is
,
f
o
llo
wed
b
y
s
tr
ess
o
r
s
r
elate
d
to
ca
r
eg
iv
i
n
g
in
s
tag
e
2
an
d
r
esil
ien
ce
in
s
tag
e
3
.
I
n
o
r
d
er
t
o
d
eter
m
in
e
i
f
r
esil
ien
ce
p
r
ed
icted
ca
r
eg
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er
b
u
r
d
en
a
f
ter
ad
ju
s
tin
g
f
o
r
s
o
cio
-
d
em
o
g
r
a
p
h
ic
ch
ar
ac
ter
is
tics
an
d
ca
r
eg
iv
in
g
-
r
elate
d
s
tr
ess
o
r
s
,
r
esil
ien
ce
was e
n
ter
ed
last
in
th
is
r
eg
r
ess
io
n
an
aly
s
is
.
A
t
t
h
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a
g
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1
,
t
h
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m
o
d
e
l
w
a
s
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n
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o
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p
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h
a
r
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t
e
r
is
t
i
cs
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r
e
e
n
t
e
r
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d
F
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1
4
,
1
6
8
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2
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9
6
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0
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0
1
a
n
d
e
x
p
l
a
i
n
e
d
1
9
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8
%
o
f
t
h
e
v
a
r
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at
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o
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i
n
c
a
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s
c
o
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es
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Ad
d
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n
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r
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t
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2
i
n
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r
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s
e
d
t
h
e
m
o
d
el'
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o
v
e
r
a
l
l
v
a
r
ian
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e
x
p
l
a
n
a
t
i
o
n
t
o
4
8
.
1
p
e
r
c
en
t
(
F
[
2
6
,
1
5
6
]
=
5
.
5
6
,
p
=
0
.
0
1
)
,
w
h
i
l
e
t
h
e
i
n
c
l
u
s
i
o
n
o
f
s
t
r
ess
o
r
s
e
x
p
la
i
n
e
d
a
n
a
d
d
i
t
i
o
n
a
l
2
8
%
v
a
r
i
a
n
c
e
i
n
c
a
r
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g
i
v
e
r
b
u
r
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e
n
.
W
e
e
n
te
r
e
d
r
e
s
i
li
e
n
c
e
t
o
a
r
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r
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i
o
n
m
o
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el
i
n
s
t
a
g
e
3
(
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(
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,
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5
5
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=
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.
3
1
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p
=
0
.
0
1
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a
f
t
e
r
a
d
j
u
s
t
i
n
g
f
o
r
s
o
c
io
-
d
e
m
o
g
r
a
p
h
i
c
a
n
d
c
a
r
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g
i
v
i
n
g
-
r
e
l
a
t
e
d
s
t
r
es
s
o
r
s
;
it
e
x
p
l
a
i
n
e
d
a
n
e
x
t
r
a
4
.
2
%
o
f
t
h
e
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a
r
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a
t
i
o
n
i
n
c
a
r
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g
i
v
e
r
b
u
r
d
e
n
.
Hier
ar
ch
ical
m
u
ltip
le
r
eg
r
ess
i
o
n
s
f
o
u
n
d
th
at
ca
r
e
g
iv
er
-
r
ela
ted
s
tr
ess
o
r
s
wer
e
th
e
m
o
s
t
s
ig
n
if
ican
t
p
r
ed
icto
r
o
f
ca
r
eg
i
v
er
b
u
r
d
en
,
ac
co
u
n
tin
g
f
o
r
2
8
.
3
%
o
f
th
e
v
ar
ian
ce
in
ca
r
e
g
iv
er
b
u
r
d
e
n
.
I
n
to
tal,
5
2
.
4
%
o
f
th
e
v
ar
ian
ce
in
ca
r
eg
iv
e
r
b
u
r
d
en
was
ac
co
u
n
ted
f
o
r
b
y
s
o
cio
-
d
em
o
g
r
ap
h
ic
ch
ar
ac
ter
is
tics
,
s
tr
ess
o
r
s
l
in
k
ed
to
ca
r
eg
iv
in
g
,
an
d
r
esil
ien
ce
.
T
a
b
le
2
s
h
o
ws th
e
r
esu
lts
o
f
th
es
e
an
aly
s
es.
T
ab
le
2
.
R
esu
lts
o
f
th
e
h
ier
a
r
c
h
ical
m
u
ltip
le
r
eg
r
ess
io
n
a
n
aly
s
es f
o
r
f
ac
to
r
s
p
r
ed
ictin
g
ca
r
eg
iv
er
b
u
r
d
e
n
C
h
a
rac
t
er
i
s
t
i
c
s
Mo
d
e
l
1
Mo
d
e
l
2
Mo
d
e
l
3
V
ar
i
a
b
l
e
s
B
9
5
%
CI
B
9
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%
CI
B
9
5
%
CI
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n
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n
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Care
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ag
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'
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o
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s
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at
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t
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wh
o
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e
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n
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o
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th
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th
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ain
ch
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g
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ciate
d
with
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ar
in
g
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o
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d
iv
id
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m
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e
c
o
n
f
r
o
n
tin
g
p
atien
ts
’
d
is
r
u
p
tiv
e
b
e
h
av
io
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r
.
“
P
a
tien
ts
fin
d
it
ch
a
llen
g
in
g
t
o
a
cc
ep
t
in
s
tr
u
ctio
n
s
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n
d
q
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ic
kly
g
et
a
n
g
r
y
a
n
d
b
ec
o
me
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g
g
r
ess
ive
.”
(
C
ar
eg
iv
er
2
3
)
“
My
s
o
n
th
r
ea
ten
s
to
d
o
s
o
me
th
in
g
to
h
ims
elf
o
r
h
is
fa
mily
w
h
en
h
e
is
d
ep
r
ess
ed
.”
(
C
ar
eg
iv
er
7
)
A
lack
o
f
s
u
p
p
o
r
t w
as a
n
o
t
h
er
ch
allen
g
e
v
o
iced
wh
ile
ca
r
in
g
f
o
r
p
atien
ts
with
s
ev
er
e
m
e
n
ta
l illn
ess
.
“
I
d
id
n
o
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et
s
u
p
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o
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t
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n
d
en
co
u
r
a
g
eme
n
t
fr
o
m
clo
s
e
f
a
mily
mem
b
ers
in
ca
r
in
g
fo
r
p
a
tien
ts
”
(
C
ar
eg
iv
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2
6
)
.
“
S
o
me
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mily
mem
b
er
s
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o
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o
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u
n
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ers
ta
n
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th
e
p
a
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n
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th
e
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o
s
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ita
l
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o
es
n
o
t
co
n
s
id
er
th
e
co
n
d
itio
n
o
f th
e
ca
r
eg
iver a
n
d
th
e
p
a
tien
t’
s
en
viro
n
me
n
t
”
(
C
ar
eg
iv
er
3
0
)
.
Desp
ite
th
e
n
eg
ativ
e
ex
p
er
ien
ce
s
,
alm
o
s
t a
th
ir
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o
f
ca
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e
r
s
r
ep
o
r
ted
th
e
p
o
s
itiv
e
em
o
tio
n
al
im
p
ac
t
o
f
ca
r
eg
iv
in
g
.
T
h
ey
b
eliev
ed
th
at
ca
r
in
g
f
o
r
f
am
ily
m
e
m
b
er
s
with
s
ev
er
e
m
en
tal
illn
ess
tau
g
h
t
th
em
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ec
o
m
e
m
o
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atien
t a
n
d
e
v
en
tu
ally
ac
ce
p
t th
eir
c
o
n
d
itio
n
.
“
Th
e
ch
a
llen
g
e
is
th
ere
b
u
t
c
a
n
b
e
o
ve
r
co
me
w
ith
p
a
tien
c
e
a
n
d
p
r
o
p
er
p
a
tien
t
ca
r
e
tec
h
n
iq
u
es
.”
(
C
ar
eg
iv
er
5
1
)
“
Th
e
p
a
tien
t
is
my
fa
th
er,
a
n
d
h
e
d
o
es
n
o
t
h
a
ve
a
n
y
p
r
o
b
lems.
I
p
r
a
y
th
a
t
h
e
w
ill
b
e
h
ea
lth
y
.”
(
C
ar
eg
iv
er
2
0
)
T
ab
le
3
.
Qu
alitativ
e
f
in
d
in
g
s
o
n
o
th
er
c
h
allen
g
es a
n
d
o
u
tc
o
m
es o
f
ca
r
eg
iv
in
g
C
o
d
e
s
f
o
r
c
h
a
l
l
e
n
g
e
s
a
n
d
o
u
t
c
o
m
e
s
F
r
e
q
u
e
n
c
y
P
e
r
c
e
n
t
(
%)
D
e
st
r
u
c
t
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v
e
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e
h
a
v
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o
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r
s
22
3
7
.
3
Emo
t
i
o
n
a
l
i
m
p
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2
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9
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p
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K
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e
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9
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14
2
3
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7
To
t
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l
59
1
0
0
4.
DIS
CU
SS
I
O
N
As
Ma
lay
s
ia
m
o
v
es
to
war
d
d
ein
s
titu
tio
n
alis
atio
n
,
r
ec
o
g
n
is
in
g
th
e
b
u
r
d
e
n
f
ac
ed
b
y
in
f
o
r
m
al
ca
r
er
s
ca
n
s
u
b
s
tan
tially
im
p
ac
t
p
atien
ts
with
s
ev
er
e
m
en
tal
illn
es
s
.
C
ar
in
g
f
o
r
p
eo
p
le
with
m
en
tal
illn
ess
at
h
o
m
e
m
ay
b
e
in
ef
f
ec
tiv
e
if
ca
r
er
s
ar
e
o
v
er
b
u
r
d
e
n
ed
.
T
h
e
r
ef
o
r
e,
th
is
s
tu
d
y
ass
e
s
s
ed
th
e
f
ac
t
o
r
s
co
n
tr
ib
u
tin
g
to
ca
r
eg
iv
er
s
’
b
u
r
d
en
i
n
Ma
lay
s
i
a.
C
ar
eg
iv
er
b
u
r
d
en
was
s
h
o
wn
to
b
e
in
v
er
s
ely
r
elate
d
to
ca
r
eg
iv
er
r
esil
ien
ce
,
s
u
g
g
esti
n
g
th
at
ca
r
eg
iv
e
r
b
u
r
d
en
is
lo
wer
wh
en
th
e
r
esil
ien
ce
is
h
ig
h
.
Sev
er
al
s
tu
d
ies
h
av
e
f
o
u
n
d
u
n
f
av
o
u
r
ab
le
co
r
r
elatio
n
s
b
et
wee
n
ca
r
eg
iv
e
r
b
u
r
d
e
n
an
d
ca
r
er
s
’
p
h
y
s
ical
an
d
m
en
tal
h
ea
l
th
.
A
s
tu
d
y
am
o
n
g
ca
r
eg
iv
er
s
o
f
p
atien
ts
with
d
e
m
en
tia
f
o
u
n
d
th
at
ca
r
eg
iv
er
s
ar
e
at
h
ig
h
er
r
is
k
f
o
r
p
h
y
s
ical
an
d
m
en
tal
h
ea
lth
p
r
o
b
lem
s
s
u
ch
as sl
ee
p
d
is
tu
r
b
an
ce
,
an
x
iety
an
d
d
ep
r
ess
io
n
[
2
2
]
.
On
th
e
o
th
er
h
an
d
,
a
f
ew
r
ec
en
t
s
tu
d
ies
r
ev
ea
l
th
at,
d
esp
it
e
th
e
d
if
f
icu
lties
o
f
ca
r
in
g
,
m
o
s
t
ca
r
er
s
ex
p
er
ien
ce
p
er
s
o
n
al
g
r
o
wth
a
n
d
r
esil
ien
ce
as
a
co
n
s
eq
u
en
c
e
o
f
th
eir
ef
f
o
r
t
[
1
4
]
.
Fin
d
in
g
s
f
r
o
m
Alzh
eim
er
'
s
d
is
ea
s
e
ca
r
eg
iv
er
s
an
d
f
e
m
ale
ca
r
er
s
o
f
a
d
u
lts
with
m
ajo
r
m
en
tal
illn
ess
wer
e
co
n
s
is
ten
t
with
th
is
co
n
clu
s
io
n
[
1
5
]
.
C
ar
eg
iv
er
s
with
h
ig
h
er
lev
els
o
f
r
esil
ien
ce
an
d
p
e
r
ce
iv
ed
h
ig
h
lev
els
o
f
s
u
p
p
o
r
t
ar
e
m
o
r
e
lik
el
y
to
r
ep
o
r
t
im
p
r
o
v
e
d
m
e
n
tal
h
ea
lth
.
Po
s
itiv
e
m
en
tal
h
ea
lth
h
as
b
ee
n
lin
k
ed
to
a
d
ec
r
ea
s
ed
ca
r
eg
iv
e
r
b
u
r
d
en
in
t
h
o
s
e
wh
o
ca
r
e
f
o
r
o
t
h
er
s
.
Ad
d
itio
n
ally
,
m
o
r
e
r
esil
ien
t
ca
r
eg
i
v
er
s
m
a
y
r
ep
o
r
t
r
ed
u
ce
d
b
u
r
d
e
n
lev
e
ls
wh
ile
ca
r
in
g
f
o
r
s
o
m
eo
n
e
with
a
m
e
n
tal
illn
ess
,
esp
ec
ially
a
f
am
ily
m
em
b
er
,
wh
ich
h
as
ca
u
s
ed
s
o
m
e
ca
r
eg
i
v
er
s
to
e
x
p
er
ien
ce
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8
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6
Dete
r
min
a
n
ts
o
f c
a
r
eg
iver b
u
r
d
en
in
c
o
mmu
n
ity
-
d
w
ellin
g
ca
r
eg
ivers
o
f p
a
tien
ts
…
(
Za
mza
liz
a
A
b
d
u
l Mu
lu
d
)
499
a
m
o
r
e
p
r
o
f
o
u
n
d
s
en
s
e
o
f
s
e
lf
-
awa
r
en
ess
an
d
in
n
e
r
s
tr
en
g
th
.
Mo
r
eo
v
er
,
m
o
r
e
r
esil
ien
t
ca
r
eg
iv
er
s
m
ay
b
e
m
o
r
e
lik
ely
to
d
ev
elo
p
h
ea
lth
y
co
p
in
g
s
k
ills
m
eth
o
d
s
an
d
,
t
h
u
s
,
less
lik
ely
to
f
ee
l
b
u
r
d
en
ed
wh
en
ca
r
in
g
f
o
r
s
o
m
eo
n
e
with
a
s
ev
er
e
m
en
tal
illn
ess
.
I
t
is
k
n
o
wn
th
at
ca
r
eg
i
v
er
s
o
f
p
er
s
o
n
s
with
m
e
n
tal
ill
n
ess
ex
p
er
ien
ce
s
ig
n
i
f
ican
t
b
u
r
d
en
s
.
Pre
v
io
u
s
r
esear
ch
h
as
also
d
em
o
n
s
tr
ate
d
th
at
ca
r
e
r
ec
ip
ien
ts
wer
e
m
o
r
e
lik
ely
to
h
av
e
u
n
m
et
n
ee
d
s
if
th
eir
p
r
im
ar
y
ca
r
eg
iv
er
was
ex
p
er
ien
cin
g
a
h
ig
h
d
eg
r
ee
o
f
b
u
r
d
en
[
2
3
]
,
[
2
4
]
.
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
in
d
icate
th
at
ca
r
eg
iv
er
s
ex
p
er
ien
c
ed
a
m
o
d
er
ate
b
u
r
d
e
n
.
W
h
en
th
is
f
in
d
in
g
was
co
m
p
ar
e
d
with
p
r
ev
io
u
s
s
tu
d
ies,
th
e
b
u
r
d
e
n
lev
el
was
h
ig
h
er
th
an
ca
r
eg
iv
er
s
o
f
el
d
er
ly
p
atien
ts
with
d
em
en
tia
in
I
taly
[
1
0
]
a
n
d
p
atien
ts
s
u
f
f
er
in
g
m
ild
d
em
en
tia
in
t
h
e
USA
[
2
5
]
.
Ho
wev
er
,
th
e
b
u
r
d
e
n
f
o
u
n
d
in
th
is
s
tu
d
y
is
lo
wer
th
a
n
ca
r
eg
iv
er
s
o
f
o
ld
er
ad
u
lts
with
d
em
en
tia
in
T
aiwa
n
[
2
0
]
an
d
C
h
in
a
[
2
6
]
.
Fin
d
in
g
s
also
r
ev
ea
le
d
th
at
ca
r
eg
iv
er
s
o
f
in
d
iv
id
u
als
with
m
en
tal
illn
ess
wer
e
less
r
esil
ien
t
th
an
th
e
g
en
er
al
p
o
p
u
latio
n
[
2
1
]
.
C
o
m
p
ar
ed
to
p
r
e
v
io
u
s
r
esear
ch
o
n
ca
r
eg
iv
e
r
r
esil
ien
ce
,
th
e
f
in
d
in
g
s
h
o
wed
th
at
ca
r
eg
iv
er
s
r
ep
o
r
ted
lo
wer
lev
e
ls
o
f
r
esil
ien
ce
th
an
ca
r
eg
iv
er
s
o
f
in
d
iv
id
u
als with
Alzh
eim
er
'
s
d
i
s
ea
s
e
[
2
7
]
an
d
m
ilit
ar
y
v
eter
a
n
s
[
2
8
]
b
u
t
h
ig
h
er
t
h
an
h
o
m
eless
y
o
u
th
[
2
9
]
.
T
h
is
i
n
d
icate
s
th
at
th
e
lev
el
o
f
b
u
r
d
en
ex
p
er
ien
ce
d
b
y
ca
r
eg
i
v
er
s
m
a
y
v
ar
y
d
e
p
en
d
in
g
o
n
p
atien
ts
'
illn
ess
es.
T
h
er
e
wer
e
alm
o
s
t
t
wo
-
th
ir
d
s
o
f
f
em
ale
ca
r
er
s
in
th
is
s
tu
d
y
.
W
e
f
o
u
n
d
th
at
wo
m
e
n
wh
o
ca
r
e
d
f
o
r
p
atien
ts
with
m
en
tal
illn
ess
wer
e
m
o
r
e
lik
ely
t
h
an
m
ales
to
f
ee
l
th
e
b
u
r
d
en
.
T
h
ese
f
in
d
in
g
s
co
n
cu
r
with
p
r
ev
io
u
s
r
esear
ch
in
th
is
ar
ea
.
Fem
al
e
ca
r
er
s
wer
e
m
o
r
e
lik
ely
to
r
ep
o
r
t
a
g
r
ea
ter
b
u
r
d
en
lev
el
th
an
m
ale
ca
r
eg
iv
er
s
,
wh
ich
m
ay
b
e
d
u
e
to
a
h
ig
h
e
r
lev
el
o
f
p
er
ce
iv
ed
s
h
am
e,
g
u
ilt,
an
d
clien
t
d
ep
e
n
d
e
n
ce
ex
p
e
r
ien
ce
d
b
y
f
em
al
e
ca
r
eg
iv
e
r
s
[
8
]
.
T
h
is
g
e
n
d
er
d
if
f
er
en
ce
m
ig
h
t
b
e
r
elate
d
to
h
o
w
m
en
an
d
wo
m
e
n
co
p
e
d
if
f
er
e
n
tly
wh
en
d
ea
lin
g
with
s
tr
ess
f
u
l sit
u
atio
n
s
[
3
0
]
.
E
th
n
ic
b
ac
k
g
r
o
u
n
d
also
im
p
a
cted
th
e
ca
r
eg
iv
e
r
b
u
r
d
en
.
M
alay
s
ia
h
as
th
r
ee
m
ajo
r
eth
n
i
c
g
r
o
u
p
s
,
a
d
iv
er
s
e
an
d
m
u
ltira
cial
n
atio
n
.
Ma
lay
m
ak
es
u
p
6
6
.
1
%
o
f
Ma
lay
s
ia'
s
p
o
p
u
latio
n
,
f
o
llo
wed
b
y
C
h
in
ese
(
2
5
.
3
%)
a
n
d
I
n
d
ian
(
7
.
4
%).
Ou
r
f
in
d
in
g
s
s
h
o
w
th
at
wh
ile
C
h
in
ese
ca
r
eg
iv
er
s
ten
d
ed
to
h
av
e
th
e
m
o
s
t
s
ig
n
if
ican
t
b
u
r
d
en
lev
els,
M
alay
ca
r
eg
iv
er
s
wer
e
f
o
u
n
d
t
o
h
av
e
th
e
lo
west
lev
els.
E
t
h
n
ic
d
if
f
e
r
en
ce
s
in
ca
r
eg
iv
er
b
u
r
d
e
n
wer
e
s
h
o
wn
to
b
e
s
im
ilar
to
p
r
e
v
io
u
s
r
es
ea
r
ch
in
Ma
lay
s
ia
an
d
its
n
ei
g
h
b
o
u
r
in
g
n
atio
n
,
Sin
g
ap
o
r
e
[
3
1
]
.
T
h
e
im
p
ac
t
o
f
C
o
n
f
u
cian
id
ea
s
o
n
th
e
Asi
an
p
o
p
u
latio
n
,
p
ar
ticu
la
r
ly
th
e
C
h
in
ese,
m
ay
b
e
a
f
ac
to
r
in
th
is
f
in
d
in
g
.
T
h
e
C
o
n
f
u
cian
p
r
in
cip
les
s
p
ec
if
y
ea
c
h
f
am
ily
m
em
b
er
'
s
d
u
ties
an
d
em
p
h
asis
e
th
e
n
ee
d
to
m
ain
tain
a
h
ar
m
o
n
io
u
s
r
elatio
n
s
h
ip
b
etwe
en
f
am
ily
m
e
m
b
er
s
.
T
h
u
s
,
an
y
d
is
r
u
p
tio
n
in
th
e
eq
u
ilib
r
iu
m
,
s
u
ch
as
m
en
tal
illn
ess
in
a
f
am
ily
m
em
b
e
r
'
s
h
ea
lth
,
u
s
u
ally
r
esu
lts
in
p
s
y
ch
o
lo
g
i
ca
l
an
d
em
o
tio
n
al
d
is
tu
r
b
an
ce
s
f
o
r
th
e
wh
o
le
f
a
m
ily
.
C
ar
eg
iv
er
s
in
th
is
s
tu
d
y
r
e
p
o
r
ted
f
ee
lin
g
m
o
r
e
b
u
r
d
e
n
ed
wh
en
th
e
y
s
aid
t
h
ey
d
id
n
o
t
h
a
v
e
en
o
u
g
h
h
elp
with
ca
r
in
g
r
esp
o
n
s
ib
ilit
ies
an
d
em
o
tio
n
al
s
u
p
p
o
r
t.
Ma
n
y
n
eg
ati
v
e
im
p
licatio
n
s
o
f
ca
r
in
g
,
s
u
ch
as
a
h
ig
h
er
d
eg
r
ee
o
f
ca
r
eg
iv
er
b
u
r
d
en
,
h
av
e
b
ee
n
i
d
en
tifie
d
b
ec
au
s
e
ca
r
er
s
r
ec
eiv
e
d
in
ad
eq
u
ate
ass
is
tan
ce
.
Ho
wev
er
,
in
s
tr
u
m
en
tal
an
d
e
m
o
tio
n
al
s
tr
ess
as
s
is
tan
ce
d
o
n
o
t
s
u
f
f
icien
tly
r
ed
u
ce
ca
r
er
s
'
d
if
f
icu
lties
.
Fu
r
th
er
r
esear
ch
is
n
ee
d
e
d
to
d
eter
m
i
n
e
th
e
le
v
el
o
f
h
elp
th
at
ca
r
e
r
s
n
ee
d
b
ased
o
n
th
e
d
is
cr
ep
an
c
ies
in
f
in
d
in
g
s
.
T
h
e
f
in
d
in
g
s
f
r
o
m
q
u
alitativ
e
d
ata
in
th
is
s
tu
d
y
s
u
g
g
ested
th
at
m
o
s
t
o
f
th
e
ca
r
e
g
iv
er
s
h
ad
a
k
n
o
wled
g
e
d
ef
icit
in
ca
r
in
g
f
o
r
in
d
iv
id
u
als
with
s
ev
er
e
an
d
p
e
r
s
is
ten
t
m
en
tal
illn
ess
.
As
m
o
s
t
ca
r
eg
iv
er
s
n
ee
d
t
o
p
r
e
p
ar
e
to
ac
ce
p
t
th
e
r
esp
o
n
s
ib
ilit
ies,
co
m
p
r
eh
e
n
s
iv
e
n
u
r
s
in
g
e
d
u
ca
tio
n
s
h
o
u
l
d
b
e
im
p
lem
e
n
ted
f
o
r
th
e
ca
r
e
g
iv
er
s
.
I
n
o
r
d
er
to
d
ea
l
with
p
atien
ts
’
u
n
ex
p
ec
ted
b
e
h
av
io
u
r
s
,
s
ev
er
al
ca
r
eg
iv
er
s
s
aid
th
e
y
wer
e
alwa
y
s
in
‘
s
tan
d
-
b
y
’
m
o
d
e
w
h
en
ca
r
in
g
f
o
r
p
er
s
o
n
s
with
s
ev
er
e
m
en
tal
illn
ess
.
T
h
e
ca
r
eg
iv
er
s
s
o
m
etim
es
f
o
u
n
d
it
ch
allen
g
in
g
to
d
ea
l
with
ir
r
e
g
u
lar
d
is
r
u
p
tiv
e
b
eh
av
i
o
u
r
s
lik
e
d
is
tu
r
b
in
g
o
r
an
g
r
y
o
u
tb
u
r
s
ts
.
Fin
d
in
g
s
f
r
o
m
th
is
s
tu
d
y
s
h
o
w
th
at
ca
r
er
s
o
f
p
e
o
p
le
wh
o
h
av
e
s
ev
e
r
e
m
en
tal
illn
ess
ar
e
m
o
r
e
b
u
r
d
en
e
d
th
an
th
o
s
e
ca
r
in
g
f
o
r
p
eo
p
le
with
n
o
b
e
h
av
io
u
r
al
p
r
o
b
lem
s
,
s
u
ch
as
v
io
len
t
o
r
h
u
m
iliatin
g
b
e
h
av
io
u
r
.
R
esp
o
n
d
in
g
t
o
th
e
o
p
en
-
en
d
ed
q
u
esti
o
n
,
th
e
ca
r
eg
i
v
er
s
r
ep
o
r
ted
th
at
p
atien
ts
’
u
n
ex
p
ec
ted
an
d
d
is
r
u
p
ted
b
eh
a
v
io
u
r
s
co
n
tr
ib
u
te
d
to
th
e
b
u
r
d
e
n
o
f
ca
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ca
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lif
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[
3
2
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.
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'
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ter
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tics
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r
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tr
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s
,
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esil
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c
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all
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o
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wh
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o
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