Unmasking Caregiver Heterogeneity: Latent Class Analysis of Abuse Tendency Subtypes for Alzheimer’s Disease Caregivers in China

Unmasking Caregiver Heterogeneity: Latent Class Analysis of Abuse Tendency Subtypes for Alzheimer’s Disease Caregivers in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unmasking Caregiver Heterogeneity: Latent Class Analysis of Abuse Tendency Subtypes for Alzheimer’s Disease Caregivers in China Yao Zheng, Meiqian Wu, Jin Xiao, Bin Shang, Feifei Li, Biyan Jiang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6624940/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Alzheimer's disease patients face higher risks of caregiver abuse and caregiver burden than healthy older adults,. However, the association between abuse tendency by AD caregivers and their burden remains understudied. This study aimed to investigate the association between caregivers' abusive tendencies and burden levels in Alzheimer's disease through latent class analysis. Methods: A total of 541 Alzheimer's disease caregivers from long-term care facilities in Zhejiang Province, China, were included in this cross-sectional study. Demographic characteristics、abusive tendencies and caregiver burden were assessed using scale. Heterogeneous subtypes of abusive tendencies were identified through latent class analysis, and their associations with caregiver burden were examined using multivariate regression models. Rseults: The prevalence of caregiver abuse tendency toward Alzheimer's patients in Zhejiang long-term care facilities was 39.4%, categorized into three latent classes: Class 1 ("high abuse tendency-low coping deficiency"), Class 2 ("overall low abuse tendency"), Class 3 ("high coping deficiency-low abuse tendency"). Significant differences (P<0.05) emerged among classes in marital status, chronic conditions, daily care duration, caregiving training, and patient neuropsychiatric symptoms. Compared with Class 2, caregivers in Class 1 had significantly higher odds of providing more than 12 hours of daily care (OR=0.252, P<0.001), whereas those in Class 3 had lower odds of having received Alzheimer's caregiving training (OR=0.435, P=0.002). Caregiver burden scores also differed significantly across classes (F=12.086, P<0.001). Conclusions: Caregivers for Alzheimer's patients exhibit distinct abuse tendency categories with caregiving burdens. Healthcare providers should implement targeted training programs to alleviate these burdens, reduce the incidence of abuse tendency. Alzheimer's disease latent class analysis caregivers abuse tendency caregiver burden Figures Figure 1 BACKGROUND Elder abuse poses a significant global public health threat, elevating risks of depression and mortality in older adults. 1 Alzheimer's disease (AD) has been recognized as a key risk factor for such abuse. 2 Patients with AD experience progressive deterioration in daily functioning and neuropsychiatric impairments,rendering them more vulnerable to caregiver-perpetrated abuse than non-AD populations. 3 Caregiver abuse tendency, defined as the intention to harm older adults' physical/mental well-being through actions or neglect, serves as a critical predictor of abusive behaviors. 4 Studies report 49.8%-78.4% prevalence of abuse tendency among AD caregivers in long-term care facilities, 5 – 8 with positive correlations to caregiver burden. 9 , 10 The burden on caregivers is further intensified by their limited ability to cope with behavioural and psychological symptoms associated with dementia (BPSD). 11 Existing research predominantly examines total scale scores of abuse tendency and caregiver burden through correlational analyses. However, variations in caregiver burden across distinct abuse tendency subtypes remain unexplored. Latent class analysis (LCA), a method widely applied in psychology and education to identify latent subgroups through response patterns, 12 offers a novel approach to address this gap. The objective of this study was to employ LCA to investigate the prevalence of abusive tendencies among AD caregivers, classify them into distinct categories based on their behavioral profiles, and examine how these categories differ in terms of caregiver burden. The findings aim to inform targeted interventions for mitigating abusive behaviors and alleviating caregiver burden. METHODS Study population and design A convenience sampling method was employed to select 541 caregivers of individuals with AD from 11 four-star long-term care facilities in Zhejiang Province, China, between April and December 2022. The inclusion criteria were as follows: (1) caregivers who provided paid care for AD patients in the long-term care facilities; (2) care recipients aged ≥ 60 years and meeting at least one criterion of the 2011 National Institute on Aging-Alzheimer’s Association diagnostic criteria for AD; 13 (3) caregivers who had been continuously caring for a specific elderly individual for ≥ 1 month; (4) caregivers aged ≥ 18 years; (5) caregivers with clear consciousness and normal language expression and communication abilities. The exclusion criterion was family members, friends, or social workers who were not hired caregivers. This cross-sectional survey was conducted based on the sample size estimation method for multiple logistic regression. According to the literature, the incidence rate of abuse tendency was 49.8%. 8 Considering potential invalid assessments, a 30% invalid sample rate was assumed. The required sample size was calculated as 13×10×(1 + 0.3)÷0.49.8 = 339 cases. In this study, 11 long-term care facilities were selected, and a total of 541 samples were included, which is sufficient for latent class analysis. This study was approved by the hospital ethics committee (approval number: 2022 Lin shen No. (61K)-X1).The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained before recruitment from all participants. Survey Tools Abuse Tendency Assessment The Caregiver Abuse Screen for the Elderly (CASE) was developed by Reis and Nahmiash. 14 It was validated through a survey of 139 caregivers, using self-reported data to assess internal consistency, criterion validity, and construct validity. The final version of the CASE includes two dimensions with eight items and one open-ended question, all of which are non-malicious and non-coercive in nature. Most existing abuse assessment tools are derived from foreign sources, insufficient cultural adaptation and validation in chinese. 15 The CASE scale was translated and validated into Chinese by Feng Ruixin, 16 and it is currently the most widely used scale in China for screening caregiver abuse tendency. 17 The Chinese version of the CASE has a Cronbach's α of 0.77, which is higher than the original scale's reliability coefficient of 0.71. This scale can assess whether caregivers have tendencies towards physical abuse, psychological abuse, financial abuse, or neglect. It is answered by caregivers and is applicable to all caregivers of elderly individuals as a tool to determine the presence of abuse tendency. Scoring method: 1 = yes, 0 = no. The total score is 8 points. A score of ≥ 3 indicates the presence of abuse tendency, with higher scores representing a higher degree of abuse tendency. In the pre-survey of this study, the Cronbach's α coefficient of the Chinese version of the CASE was 0.779. Caregiver Burden Assessment The Zarit Burden Interview (ZBI) is a widely used tool for assessing caregiver burden. 18 The Chinese version of the ZBI, which has been translated and validated for use in Chinese populations, consists of 22 items, including 12 items related to personal strain, 6 items related to role strain, and 4 items related to other strain. The scale employs a 5-point Likert scoring method, ranging from 0 (never) to 4 (always), with higher scores indicating a greater burden. The burden levels are categorized as follows: 0–19 points indicate no or very mild burden; 20–39 points indicate mild burden; 40–59 points indicate moderate burden; and 60 points or above indicate severe burden. The Chinese version of the ZBI has demonstrated good reliability, with a total Cronbach's α coefficient of 0.87. Sociodemographic Factors To investigate the sociodemographic characteristics of the study participants, the research team identified 13 potential predictors through a systematic literature review and expert panel consultations 7 , 11 ,19–22 . This questionnaire were included demographic information of the caregivers (age, sex, geographic location, marital status, educational attainment, comorbidity count, and frequency of routine medical examinations) and caregiving experiences related to AD (caregiving duration; daily caregiving time commitment; number of AD patients assisted; patient's functional independence level; caregiver training status; presence of BPSD in the care recipient). Statistical Analysis LCA was conducted using Mplus 8.0. Data from the abuse tendency scale(CASE) were dichotomized into 0 and 1, with scores ≥ 3 indicating the presence of abuse tendency (coded as 1) and scores < 3 indicating no abuse tendency (coded as 0). The analysis began with a single-class model and progressively evaluated models with 1 to 5 latent classes to determine the optimal model. Model fit was assessed using the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and sample-size adjusted BIC (aBIC), with lower values indicating better model fit. Entropy was used to evaluate the precision of classification, with values ranging from 0 to 1; values closer to 1 indicate higher classification accuracy, with values around 0.8 suggesting over 90% accuracy. Likelihood ratio tests included the Lo-Mendell-Rubin adjusted likelihood ratio test (LMRT) and the bootstrap likelihood ratio test (BLRT) to compare the fit of different latent class models, with P < 0.05 indicating that a k-class model fits better than a k − 1-class model. 23 Statistical analyses were performed using SPSS 26.0. Continuous variables are presented as mean ± standard deviation, and categorical variables are presented as frequencies and proportions. Comparisons of categorical variables across multiple groups were conducted using the chi-square test. Multivariate logistic regression analysis was used to identify factors influencing different categories of abuse tendency among AD caregivers, A p-value of less than 0.05 was considered statistically significant. RESULTS Scores of abuse tendency and caregiver burden in AD caregivers The study identified abuse tendency in 213 caregivers (39.4% incidence rate), with a mean total caregiver burden score of (40.42 ± 10.18). Burden severity distribution revealed: no/very mild (16.40 ± 2.03; 2.96%), mild (32.47 ± 5.47; 42.33%), moderate (47.53 ± 5.28; 53.79%), and severe (64.80 ± 4.38; 0.92%), see Table 1 . Table 1 Scores of Abuse Tendency and Caregiver Burden in AD Caregivers(n = 541) Variable Score Range Items Mean Score (Points) Number of Cases (Cases) percentage CASE ≥ 3分 2.05 ± 1.11 213 39.4% ZBI No/Very Mild 0–19分 16.40 ± 2.03 16 2.96% Mild 20–39分 32.47 ± 5.47 229 42.33% Moderate 40–59分 47.53 ± 5.28 291 53.79% Severe ≥ 60分 64.80 ± 4.38 5 0.92% Total Score 88分 40.42 ± 10.18 / / CASE: Caregiver Abuse Screen for the Elderly scale,measring caregiver abuse tendency; ZBI:Zarit Burden Interview scale, measuring caregiver burden; Latent class analysis A total of 541 AD caregivers were included in this study. LCA was performed using the item scores of the Chinese version of the CASE as observed variables to fit the model for the characteristics of abuse tendency among AD caregivers. The analysis began with a one-class model and progressively increased the number of classes to determine the optimal model. As the number of classes increased, the values of AIC, BIC, and aBIC gradually decreased. The decrease in these indices became slightly more gradual when the number of classes reached three, indicating that the improvement in model fit diminished with additional classes. The BLRT P-values for models with 1 to 5 classes were all < 0.001. However, the BIC value was minimized at three classes, and the entropy value was maximized (0.849) at five classes, indicating the highest classification accuracy. Considering model fit, classification effectiveness, interpretability, and parsimony, the three-class model was selected as the optimal model for abuse tendency among AD caregivers. The average probabilities of caregivers being classified into each of the three classes were 85.9%, 92.8%, and 91.4%, respectively, indicating reliable classification results (see Table 2 ). The CASE scale revealed distinct categories of caregivers associated with abuse tendency. As illustrated in Fig. 1 , three distinct caregiver profiles emerged based on their conditional probabilities across the eight items. Class 1 (n = 80) demonstrated pronounced elevations on abuse tendency indicators (items 2/4/6) coupled with minimal coping deficiencies (scores ≤ 0.2 on items 1/3/5/7), warranting the designation "High Abuse Tendency-Low Coping Deficiency". Class 2, the largest subgroup (n = 371) exhibited uniformly low probabilities ( p < 0.5) across all items, classified as "Overall Low Abuse Tendency". Class 3 (n = 90) presented a divergent categories characterized by prominent coping deficiencies (items 1/3) alongside negligible abuse tendency (items 2/4/6/8), thus labeled "High Coping Deficiency-Low Abuse Tendency". Table 2 Fit indices of latent class analysis models for potential categories of AD caregivers' abuse tendency(n = 541) Model AIC BIC aBIC Entropy LMR(P) BLRT(P) class probability 1 4680.644 4714.991 4689.596 - - - 1 2 4586.797 4659.785 4605.821 0.700 0.047 <0.001 0.762/0.238 3 4534.727 4646.355 4563.822 0.817 0.424 <0.001 0.148/0.686/0.166 4 4519.843 4670.113 4559.010 0.740 0.552 <0.001 0.268/0.157/0.405/0.170 5 4487.446 4676.356 4536.684 0.849 0.002 <0.001 0.137/0.128/0.115/0.488/0.133 6 4466.510 4694.061 4525.820 0.798 0.055 <0.001 0.122/0.072/0.268/0.231/0.174/0.133 AIC:akaike information criterio; BIC:bayesian information criterion; aBIC:adjusted bayesian information criterion; Entropy:Average information content index; LMR:lo-mendell-rubin likelihood; BLRT:bootstrapped likelihood ratio test. Differences in abusive tendencies among AD caregivers across latent classes Univariate analysis results showed that the age, sex, geographic location, educational attainment, frequency of routine medical examinations, caregiving duration, number of AD patients assisted, and AD Patient's functional independence level did not significantly differ among AD caregivers with different abusive tendencies ( p > 0.05). In contrast, marital status, comorbidity count, daily caregiving time commitment, caregiver training status, and presence of BPSD in the care recipient were significantly associated with abuse tendency (p < 0.05). Detailed results are presented in Table 3 . Table 3 Distribution of demographic variables of abuse tendency of AD caregivers in different categories (e.g. %) item Class 1( n = 80) Class 2( n = 371) Class 3( n = 90) H/X 2 P Age (years)/M(P25, P75) 50(48,52) 50(46,53) 50(48,56) 4.10 0.129 Sex (e.g. /%) male 10(12.5) 56(15.1) 18(20) 1.99 0.371 Female 70(87.5) 315(84.9) 72(80) Geographic location (e.g. /%) urban 16(20) 121(32.6) 23(25.6) 5.87 0.053 rural 64(80) 250(67.4) 67(74.4) Marital status (e.g. /%) single 0 2(0.5) 4(4.4) 17.21 0.012 married 73(91.3) 339(91.4) 80(88.9) divorce 7(8.8) 13(3.5) 6(6.7) remarry 0 10(2.7) 0 Widowed 0 7(1.9) 0 Education attainment (e.g. /%) Primary and below 29(36.3) 135(36.4) 32(35.6) 3.37 0.906 junior high school 25(31.3) 124(33.4) 33(36.7) High school or technical secondary school 20(25) 94(25.3) 21(23.3) junior college 6(7.5) 14(3.8) 4(4.4) Bachelor degree or above 0 4(1.1) 0 Comorbidity count 0(0,1) 1(0,1) 1(0,1) 21.92 <0.001 Frequency of routine medical examination (e.g. /%) half a year 12(15) 38(10.2) 11(12.2) 11.18 0.178 1 year 55(68.8) 247(66.6) 52(57.8) 2 years 8(10) 54(14.6) 15(16.7) 3 years and above 0 14(3.8) 7(7.8) nonparticipator 5(6.3) 18(4.9) 5(5.6) Caregiving duration (month) /M (P25, P75) 17(9.75,29.5) 16(10,24) 24(12,24) 5.27 0.072 Daily caregiving time commitment(hours) 0 ~ 8 1(1.25) 18(4.85) 3(3.33) 18.41 0.001 8 ~ 12 21(26.25) 174(46.90) 31(34.44) >12 58(72.5) 179(48.25) 56(62.22) Number of AD patients assisted 4(3,5) 4(3,5) 4(4,5) 0.12 0.942 AD patient's functional independence level (example /%) Complete self-care 3(3.8) 20(5.4) 7(7.8) 1.75 0.786 Partial self-care 61(76.3) 286(77.1) 66(73.3) Completely unable to take care of oneself 16(20) 65(17.5)༉ 17(18.9) Caregiver training status (example /%) Trained 37(46.3) 188(50.7) 26(28.9) 13.82 0.001 Untrained 43(53.8) 183(49.3) 64(71.1) Presence of BPSD in the care recipient (example /%) Yes 35(43.8) 299(80.6) 59(65.6) 47.68 <0.001 No 45(56.3) 72(19.4) 31(34.4) Class 1 = High Abuse Tendency–Low Coping Deficiency;Class 2 = Overall Low Abuse Tendency༛Class 3 = High Coping Deficiency–Low Abuse Tendency. Logistic regression analysis of abuse tendency categories among AD caregivers A multinomial logistic regression analysis was conducted with the latent classes of abusive tendencies among AD caregivers as the dependent variable, using the Class 2 as the reference group. The independent variables and their coding methods are detailed in Table 4 . Variables with p < 0.05 in the univariate analysis were included in the multivariate logistic regression model. The comorbidity count is based on “0”; the daily caregiving duration is based on “0–8 hours”. Results showed that caregivers who provided care for more than 12 hours per day were more likely to be classified into the Class 1. Caregivers who had not received AD care training were more likely to be classified into the Class 3. Complete statistical outcomes, including odds ratios and confidence intervals, are systematically presented in Table 5 . Table 4 Assignment of argument variables variable assignment Marital status Single/divorced/widowed = 0, Married/remarry = 1 Comorbidity count 1 = 0, 2 = 1 Daily caregiving time commitment (hours) 8 ~ 12 = 0, 12 ~ 24 = 1 Caregiver training status untrained = 0, trained = 1 Presence of BPSD in the care recipient If no = 0, if yes = 1 Table 5 Multivariable Analysis of Abuse Tendeny Categories in AD Caregivers item Class 1 Class 3 B P OR 95%CI B P OR 95%CI Marital status Single/divorced/Widowed -0.309 0.513 0.734 0.291ཞ1.854 -0.085 0.831 0.918 0.420ཞ2.007 Comorbidity count 1kind 0.327 0.553 1.387 0.470ཞ4.094 -0.663 0.192 0.516 0.191ཞ1.394 2 kinds -0.278 0.615 0.758 0.257 ~ 2.236 -0.158 0.748 1.171 0.448 ~ 3.060 Daily caregiving time commitment (hours) 8 ~ 12 -1.919 0.069 0.291 0.029ཞ2.939 0.686 0.294 0.504 0.140ཞ1.813 >12 -1.380 <0.001 0.252 0.142ཞ0.446 0.360 0.899 0.965 0.553 ~ 1.682 Caregiver training status untrained 0.157 0.575 1.170 0.677ཞ2.022 0.833 0.002 0.435 0.256ཞ0.739 Presence of BPSD in the care recipient No -0.399 0.227 0.671 0.352 ~ 1.281 0.470 0.114 0.625 0.349ཞ1.120 Class 1 constant term P = 0.376; Class 2 constant term P = 0.049. Class 1 = High Abuse Tendency–Low Coping Deficiency;Class 2 = Overall Low Abuse Tendency༛Class 3 = High Coping Deficiency–Low Abuse Tendency. Comparison of caregiver burden among AD caregivers with different abusive tendencies The three latent classes of abusive tendencies identified through latent class analysis had the following caregiver burden scores: Class 1 (42.31 ± 10.05), Class 2 (39.05 ± 9.90), and Class 3 (44.49 ± 10.23). Analysis of variance (ANOVA) was used to compare the scores among the different classes. Results showed that there were significant differences in the total caregiver burden scores among the different abuse tendency classes ( F = 12.086, p < 0.001). Further pairwise comparisons using the least significant difference (LSD) method revealed that significant differences existed in the total burden scores, personal strain dimension, and other strain dimension among the three classes ( p < 0.005). However, no significant differences were found in the role burden dimension among the three classes ( F = 1.485, p = 0.227). Detailed results are presented in Table 6 . Table 6 Comparative analysis of carebiver burden across distinct abuse tendency in AD caregivers( \(\:\stackrel{-}{x}\pm\:\) s) Potential Category Number of cases Personal Strain Role Strain Other Strain Total points Class 1 80 21.61 ± 5.08 13.34 ± 4.06 7.36 ± 2.01 42.31 ± 10.5 Class 2 371 20.02 ± 5.47 13.04 ± 3.87 7.26 ± 2.09 39.05 ± 9.90 Class 3 90 22.69 ± 5.78 13.80 ± 3.55 7.90 ± 2.09 44.39 ± 10.23 F - 9.91 1.485 3.474 12.086 P - <0.001 0.227 0.032 <0.001 Pairwise comparison (PC2 C1 = C2 = C3 C2C2 Class 1 = High Abuse Tendency–Low Coping Deficiency;Class 2 = Overall Low Abuse Tendency༛Class 3 = High Coping Deficiency–Low Abuse Tendency. DISCUSSION This study employed LCA to systematically identify three distinct subtypes of abuse tendency among AD caregivers in China. These subtypes were characterized as: Class1: high abuse tendency-low coping deficiency (14.8% of caregivers), indicating individuals with adequate coping skills but elevated risks of abuse tendency, necessitating targeted psychological interventions by institutional administrators; Clsaa 2: Overall low abuse tendency (68.6% of caregivers), suggesting a majority subgroup with lesser abuse risks; Class 3: High Coping Deficiency–Low Abuse Tendency(16.6% of caregivers), reflecting caregivers lacking standardized AD symptoms coping strategies, Institutional administrators should focus on professional skills training to reduce the incidence of abusive tendencies. The overall prevalence of abuse tendency in this study was 39.4%, which is lower than the rates reported by Chen et al. 19 , 24 – 26 This disparity may be attributed to nationwide caregiver support policies implemented between 2018 and 2022, China introduced various measures to enhance the training and professionalization of eldercare workers through pre-service and in-service continuing education programs, competency certification systems, and strengthened regulatory oversight in long-term care facilities 27 – 30 , which collectively improved AD care specialization and reduced abuse susceptibility. A pivotal finding of this study was that demographic characteristics (including age, sex, geographic location, educational attainment) and caregiving-related variables (Daily caregiving time commitment, number of AD patients assisted, frequency of routine medical examinations, AD patient's functional independence level) showed no statistically significant differences across caregiver subgroups with heterogeneous abuse tendency (all p > 0.05). This finding contrasts with prior studies by Zeng et al. 7 , 20 , 21 which identified demographic factors as predictors of abuse risk. Our results indicate that traditional demographic indicators may lack sensitivity in predicting abuse tendency. Notably, this study identified multiple significant predictors of abusive tendencies, including caregivers' marital status, comorbidity count, daily caregiving time commitment, caregiver training status, and presence of BPSD in care recipient (all p < 0.05). These findings corroborate prior evidence indicating that BPSD significantly exacerbates caregiver burden, 18 , 19 ,22 which in turn adversely impacts caregivers' physical and psychological well-being. Such bidirectional influences suggest a potential "fatigue-irritability" pathway, 31 wherein prolonged caregiving burden may amplify abusive tendencies in AD caregivers. To mitigate these risks, Institutional administrators should implement dynamic biopsychosocial evaluations for AD caregivers and develop targeted stress reduction interventions, such as mindfulness-based stress reduction. 32 These measures could facilitate timely regulation of caregivers' psychophysiological homeostasis and affective states, thereby interrupting this detrimental cycle. Another key finding was that caregivers with adequate professional skills but excessive workloads (> 12 hours/day) exhibited significantly elevated abuse risks (OR = 0.252). The greater the caregiver fatigue in long-term care facilities, the more pronounced the abuse tendency. 33 Caregivers in this group have strong coping abilities for disease symptoms, but when caregiving exceeds 12 hours per day, they have little opportunity to rest or engage in social activities, restricting their personal development and increasing the risk of abuse. 34 While international models like Sweden’s "Time Bank" and the Dutch "Dementia Village" smart scheduling system have reduced burnout through structural reforms, 35 respite care services although still in the early stages in China. Research shows that reducing caregiving time is the most immediate and cost-effective way to benefit caregivers. 36 Institutional administrators should focus on caregivers' time load and adopt flexible schedules to keep working hours under 12 hours to alleviate caregiving burden. Our findings provide the first empirical evidence to advocate for policy innovations, such as mandatory shift rotations and government-subsidized respite insurance programs. The "High Coping Deficiency–Low Abuse Tendency" primarily manifests as unintentional neglect stemming from caregivers' coping deficits, such as improper physical restraint techniques or ineffective communication strategies. These behaviors often evade detection by conventional monitoring systems. Untrained caregivers exhibited unintentional neglect due to skill gaps, consistent with global findings. Our results extend Yan et al. 37 Caregivers in this category may not have abusive thoughts, but when the AD symptoms appear, they fail to respond appropriately, which can lead to unintended abuse. Existing training programs primarily focus on practical care but often overlook the emotional and cultural needs of elderly individuals. 38 Caregivers without adequate education or training lack the ability to identify and report abuse or neglect, leading to a higher likelihood of inadvertent abusive behaviors. Many caregivers have not kept up with new knowledge and skills required for the increasing needs of elderly individuals, compounded by long working hours and short breaks. 39 This suggests a need for standardized specialized training for caregivers, something that is currently lacking in China. 40 – 42 This underscores the urgency to establish a dual-track training system integrating technical competency and ethical awareness. The study revealed that 98.02% of caregivers experienced mild-to-moderate burden levels, with the lowest total burden scores observed in the low abuse tendency subgroup. Significant differences emerged in overall caregiver burden and personal strain dimensions across the three caregiver categories ( p < 0.05). Long-term caregiving burden can lead to a weakened immune system, increased physiological issues, and the development of negative emotions like anxiety and depression. 43 This can result in neglecting the needs of AD patients and increase abuse tendency. Notably, the personal strain dimension, which includes physical and emotional problems of caregivers, is crucial in alleviating abuse tendencies. Previous studies have shown that addressing emotional and personal issues ensures caregivers remain positive in their roles. 44 Positive coping strategies help reduce caregiving burdens and mitigate abusive tendencies. 45 To reduce caregiver burden and prevent abuse, interventions should focus on coping strategies, emphasizing the importance of specialized caregiving. Training caregivers to have a certain level of medical knowledge is vital. Government and institutional collaboration could establish unified training centers, cooperating with vocational colleges to provide regular training to enhance caregivers' overall competence and caregiving skills. Conclusion This study revealed moderate-to-low abuse tendency levels among Chinese AD caregivers. Through LCA, we identified distinct abuse tendency categories, challenging the prior assumption of caregiver homogeneity in abuse tendency by revealing its heterogeneity, the critical need for healthcare providers and institutional administrators to implement subgroup-specific interventions tailored to different abuse tendency profiles. Notably, this investigation represents the first application of LCA to classify abuse tendency categories among AD caregivers in China. However, several limitations warrant consideration. The convenience sampling method restricted participant selection to long-term care facilities in Zhejiang Province, potentially compromising sample representativeness. Future investigations should expand sampling to include family caregivers and diverse geographic regions, particularly considering China's substantial urban-rural disparities in aging populations. Multicenter studies encompassing caregivers from mountainous and island areas' grassroots facilities are recommended. Abbreviations AD Alzheimer's disease BPSD psychological symptoms associated with dementia LCA Latent class analysis CASE Caregiver Abuse Screen for the Elderly ZBI Zarit Burden Interview AIC Akaike Information Criterion BIC Bayesian Information Criterion aBIC sample-size adjusted BIC LMRT Lo-Mendell-Rubin adjusted likelihood ratio test BLRT bootstrap likelihood ratio test ANOVA Analysis of variance LSD least significant difference Declarations Ethics approval and consent to participate This study was approved by the Medical ethics committee of Zhejiang Hospital ethics committee (approval number: 2022 Lin shen No. (61K)-X1).The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained before recruitment from all participants. Consent for publication Not Applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Zhejiang Provincial basic and public welfare research program (LGF22H250002) . Author Contribution Y.Z. contributed to data curation, investigation, methodology, and original draft writing; M.W., J.X., and L.L. performed data curation, investigation, and methodology; B.S. supervised the study, curated data, and participated in manuscript review/editing; F.L. and B.J. conducted data curation and supervision; C.L. provided supervision and manuscript review/editing; X.X. contributed resources, software, and manuscript review/editing. Acknowledgement We sincerely thank all the long-term care facilities that provided support for this research. Special gratitude is extended to the Hangzhou Social Welfare Center, Zhejiang Province, and its Director, Mr. Xiaodong Sun, for their invaluable assistance throughout the study. 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A qualitative study on the initial work experience of re-employed elderly care nurses. J Nurs Res. 2022;37(17):90–3. National Health Commission of the People's Republic of China. Transcript of routine press conference [EB/OL]. May 2018 [2018-05-18]. Available from: http://www.nhc.gov.cn/wjw/xwdt/201805/886a77eeacc741ecb69c76b97375f089.shtml2018510 The General Office of the State Council. Opinions on Promoting the Development of Elderly Care Services. 2019 Apr 23 [2019-04-23]. http://www.nhc.gov.cn/wjw/mtbd/201904/0378496f543049dd958a83f4deb1b3ee.shtml2019423 The General Office of the State Council. Report on the Progress of Strengthening and Promoting Aging Work. 2022 Sep 03 [2022-09-03]. http://www.nhc.gov.cn/wjw/mtbd/202209/2ca97b572ee34a38819cceaf5207dd1a.shtml Chen WC, Zeng LJ, Chen Y, et al. The relationship between fatigue and abuse tendency of caregivers for demented elderly in long-term care institutions and its influencing factors. Chongqing Med J. 2019;03:460–5. Zheng Y, Zhong YL, Liu CX, et al. Correlation between abusive tendencies, caregiving competence, and social support among caregivers of elderly with dementia in long-term care facilities. Zhonghua Lao Nian Bing Yanjiu Dianzi Zazhi. 2024;11(1):45–50. Pan JB, Tang ZX, Zhu YZ, et al. The role of coping styles and psychological resilience of caregivers for Alzheimer’s disease patients in the relationship between caregiving burden and abuse tendency. Chin J Mod Doctor. 2023;14:102–5. Griffith D. Respite care. Br Med J. 1993;306(6871):160. Chen F, Xu X. Visualization analysis of domestic and international respite care research hotspots and trends based on CiteSpace. Evid Based Nurs. 2023;17:3131–7. Jia CL, Xu HY, Pan XF. Research on the intervention of respite care + social work practice strategy into the care burden of cancer patients’ family caregivers. Healthc Res Pract:146–52. Yan E. Elder Abuse and help-seeking behavior in elderly Chinese. J interpers Violence. 2015;30(15):2683–708. Li HY. Science, emotion and experience: the multiple care logics of medical institutions for the elderly. Social Sci Res. 2023;06:137–46. Shinan-Aktman S, Cohen M. Nursing aide’s attitudes to elder abuse in long-term care facilities: the effect of work stressors and burnout. Gerontologist. 2009;49(5):674–84. Zhang H, Sun H. Knowledge, attitude and self-efficacy of elderly caregivers in Chinese long-term care facilities: a cross-sectional study in Liaoning Province. BMJ Open. 2019;9(11):29869. Bressington D, Badnapurkar A, Inoue S, et al. Physical Health Care for People with Severe Mental Illness: the Attitudes, Practices, and Training demand of Nurses in Three Asian Countries. Int J Environ Res Public Health. 2018;15(2):343. Chen R, Dai F, Yang H, et al. Caring behaviours perceived by elderly residents and their associated factors in long-term care facilities in Zhengzhou City of China: A qualitative study. Health Soc Care Community. 2021;29(5):126–34. Wang P. A qualitative study on the care experience of family caregivers for Alzheimer’s disease patients. Nurs Rehabilitation. 2017;16(12):1248–51. Liu Z, Sun W, Chen H, et al. Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study. BMJ Open. 2022;12(5):e057817. Vatter S, Leroi I. Resilience in people with lewy body disorders and their care partners: association with mental health, relationship satisfaction, and care burden. Brain Sci. 2022;12(2):148. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Meiqian","middleName":"","lastName":"Wu","suffix":""},{"id":521858839,"identity":"86ee521a-6e69-47e4-bfea-244e2f29cf58","order_by":2,"name":"Jin Xiao","email":"","orcid":"","institution":"Zhejiang Chinese Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Xiao","suffix":""},{"id":521858840,"identity":"32dee9c5-f44f-48d6-b871-2bb944fd0447","order_by":3,"name":"Bin Shang","email":"","orcid":"","institution":"The First People's Hospital of Lianyungang","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Shang","suffix":""},{"id":521858841,"identity":"02600312-2fc3-4069-b4eb-c89595ec3563","order_by":4,"name":"Feifei Li","email":"","orcid":"","institution":"Zhejiang 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07:19:26","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135853,"visible":true,"origin":"","legend":"","description":"","filename":"e814ea377dc744b6af26fbc88a5446951enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/733c1b5dcdd03e3a82338438.xml"},{"id":92476020,"identity":"21a28d5d-b81a-4de1-8190-5cf8a8627802","added_by":"auto","created_at":"2025-09-30 07:19:26","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131336,"visible":true,"origin":"","legend":"","description":"","filename":"e814ea377dc744b6af26fbc88a5446951structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/b8b89538574e0748de091018.xml"},{"id":92476021,"identity":"3cdc5f1f-e045-405d-8dd4-5e4372f1baec","added_by":"auto","created_at":"2025-09-30 07:19:26","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":143640,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/d7525f682ae2b3df8b800a3b.html"},{"id":92476014,"identity":"11e04c4f-a517-4b38-a819-a2dbbbb9ffe7","added_by":"auto","created_at":"2025-09-30 07:19:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":90123,"visible":true,"origin":"","legend":"\u003cp\u003eConditional probability distribution of three potential categories of AD caregiver abuse tendeny\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/99f17bb03d19f1ace4ef8dc8.png"},{"id":92480777,"identity":"ba87d1bc-2bf9-429f-b2b4-05118794c27f","added_by":"auto","created_at":"2025-09-30 07:43:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1205296,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/4178443d-b982-4d4c-a676-c155c25cdd48.pdf"},{"id":92476015,"identity":"464a4d80-c0ff-4439-ac5b-f766e3032376","added_by":"auto","created_at":"2025-09-30 07:19:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14340,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile.docx","url":"https://assets-eu.researchsquare.com/files/rs-6624940/v1/0b36ce0df23e942b16dda6fe.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unmasking Caregiver Heterogeneity: Latent Class Analysis of Abuse Tendency Subtypes for Alzheimer’s Disease Caregivers in China","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eElder abuse poses a significant global public health threat, elevating risks of depression and mortality in older adults.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Alzheimer's disease (AD) has been recognized as a key risk factor for such abuse.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Patients with AD experience progressive deterioration in daily functioning and neuropsychiatric impairments,rendering them more vulnerable to caregiver-perpetrated abuse than non-AD populations. \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Caregiver abuse tendency, defined as the intention to harm older adults' physical/mental well-being through actions or neglect, serves as a critical predictor of abusive behaviors.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Studies report 49.8%-78.4% prevalence of abuse tendency among AD caregivers in long-term care facilities,\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e with positive correlations to caregiver burden.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The burden on caregivers is further intensified by their limited ability to cope with behavioural and psychological symptoms associated with dementia (BPSD). \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Existing research predominantly examines total scale scores of abuse tendency and caregiver burden through correlational analyses. However, variations in caregiver burden across distinct abuse tendency subtypes remain unexplored. Latent class analysis (LCA), a method widely applied in psychology and education to identify latent subgroups through response patterns,\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e offers a novel approach to address this gap.\u003c/p\u003e\u003cp\u003eThe objective of this study was to employ LCA to investigate the prevalence of abusive tendencies among AD caregivers, classify them into distinct categories based on their behavioral profiles, and examine how these categories differ in terms of caregiver burden. The findings aim to inform targeted interventions for mitigating abusive behaviors and alleviating caregiver burden.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and design\u003c/h2\u003e\u003cp\u003eA convenience sampling method was employed to select 541 caregivers of individuals with AD from 11 four-star long-term care facilities in Zhejiang Province, China, between April and December 2022. The inclusion criteria were as follows: (1) caregivers who provided paid care for AD patients in the long-term care facilities; (2) care recipients aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years and meeting at least one criterion of the 2011 National Institute on Aging-Alzheimer\u0026rsquo;s Association diagnostic criteria for AD;\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e (3) caregivers who had been continuously caring for a specific elderly individual for \u0026ge;\u0026thinsp;1 month; (4) caregivers aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (5) caregivers with clear consciousness and normal language expression and communication abilities. The exclusion criterion was family members, friends, or social workers who were not hired caregivers.\u003c/p\u003e\u003cp\u003eThis cross-sectional survey was conducted based on the sample size estimation method for multiple logistic regression. According to the literature, the incidence rate of abuse tendency was 49.8%.\u003csup\u003e8\u003c/sup\u003e Considering potential invalid assessments, a 30% invalid sample rate was assumed. The required sample size was calculated as 13\u0026times;10\u0026times;(1\u0026thinsp;+\u0026thinsp;0.3)\u0026divide;0.49.8\u0026thinsp;=\u0026thinsp;339 cases. In this study, 11 long-term care facilities were selected, and a total of 541 samples were included, which is sufficient for latent class analysis.\u003c/p\u003e\u003cp\u003eThis study was approved by the hospital ethics committee (approval number: 2022 Lin shen No. (61K)-X1).The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained before recruitment from all participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurvey Tools\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eAbuse Tendency Assessment\u003c/h2\u003e\u003cp\u003eThe Caregiver Abuse Screen for the Elderly (CASE) was developed by Reis and Nahmiash.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e It was validated through a survey of 139 caregivers, using self-reported data to assess internal consistency, criterion validity, and construct validity. The final version of the CASE includes two dimensions with eight items and one open-ended question, all of which are non-malicious and non-coercive in nature.\u003c/p\u003e\u003cp\u003eMost existing abuse assessment tools are derived from foreign sources, insufficient cultural adaptation and validation in chinese.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The CASE scale was translated and validated into Chinese by Feng Ruixin,\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e and it is currently the most widely used scale in China for screening caregiver abuse tendency.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The Chinese version of the CASE has a Cronbach's α of 0.77, which is higher than the original scale's reliability coefficient of 0.71. This scale can assess whether caregivers have tendencies towards physical abuse, psychological abuse, financial abuse, or neglect. It is answered by caregivers and is applicable to all caregivers of elderly individuals as a tool to determine the presence of abuse tendency. Scoring method: 1\u0026thinsp;=\u0026thinsp;yes, 0\u0026thinsp;=\u0026thinsp;no. The total score is 8 points. A score of \u0026ge;\u0026thinsp;3 indicates the presence of abuse tendency, with higher scores representing a higher degree of abuse tendency. In the pre-survey of this study, the Cronbach's α coefficient of the Chinese version of the CASE was 0.779.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCaregiver Burden Assessment\u003c/h3\u003e\n\u003cp\u003eThe Zarit Burden Interview (ZBI) is a widely used tool for assessing caregiver burden.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The Chinese version of the ZBI, which has been translated and validated for use in Chinese populations, consists of 22 items, including 12 items related to personal strain, 6 items related to role strain, and 4 items related to other strain. The scale employs a 5-point Likert scoring method, ranging from 0 (never) to 4 (always), with higher scores indicating a greater burden. The burden levels are categorized as follows: 0\u0026ndash;19 points indicate no or very mild burden; 20\u0026ndash;39 points indicate mild burden; 40\u0026ndash;59 points indicate moderate burden; and 60 points or above indicate severe burden. The Chinese version of the ZBI has demonstrated good reliability, with a total Cronbach's α coefficient of 0.87.\u003c/p\u003e\n\u003ch3\u003eSociodemographic Factors\u003c/h3\u003e\n\u003cp\u003eTo investigate the sociodemographic characteristics of the study participants, the research team identified 13 potential predictors through a systematic literature review and expert panel consultations\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,19\u0026ndash;22\u003c/sup\u003e. This questionnaire were included demographic information of the caregivers (age, sex, geographic location, marital status, educational attainment, comorbidity count, and frequency of routine medical examinations) and caregiving experiences related to AD (caregiving duration; daily caregiving time commitment; number of AD patients assisted; patient's functional independence level; caregiver training status; presence of BPSD in the care recipient).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eLCA was conducted using Mplus 8.0. Data from the abuse tendency scale(CASE) were dichotomized into 0 and 1, with scores\u0026thinsp;\u0026ge;\u0026thinsp;3 indicating the presence of abuse tendency (coded as 1) and scores\u0026thinsp;\u0026lt;\u0026thinsp;3 indicating no abuse tendency (coded as 0). The analysis began with a single-class model and progressively evaluated models with 1 to 5 latent classes to determine the optimal model. Model fit was assessed using the Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and sample-size adjusted BIC (aBIC), with lower values indicating better model fit. Entropy was used to evaluate the precision of classification, with values ranging from 0 to 1; values closer to 1 indicate higher classification accuracy, with values around 0.8 suggesting over 90% accuracy. Likelihood ratio tests included the Lo-Mendell-Rubin adjusted likelihood ratio test (LMRT) and the bootstrap likelihood ratio test (BLRT) to compare the fit of different latent class models, with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating that a k-class model fits better than a k\u0026thinsp;\u0026minus;\u0026thinsp;1-class model.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Statistical analyses were performed using SPSS 26.0. Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and categorical variables are presented as frequencies and proportions. Comparisons of categorical variables across multiple groups were conducted using the chi-square test. Multivariate logistic regression analysis was used to identify factors influencing different categories of abuse tendency among AD caregivers, A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eScores of abuse tendency and caregiver burden in AD caregivers\u003c/h2\u003e\u003cp\u003eThe study identified abuse tendency in 213 caregivers (39.4% incidence rate), with a mean total caregiver burden score of (40.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18). Burden severity distribution revealed: no/very mild (16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03; 2.96%), mild (32.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47; 42.33%), moderate (47.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28; 53.79%), and severe (64.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38; 0.92%), see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScores of Abuse Tendency and Caregiver Burden in AD Caregivers(n\u0026thinsp;=\u0026thinsp;541)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScore Range\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eItems Mean Score (Points)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumber of Cases (Cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003epercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCASE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39.4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eZBI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo/Very Mild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u0026ndash;19分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.96%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u0026ndash;39分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40\u0026ndash;59分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.79%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;60分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.92%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88分\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eCASE: Caregiver Abuse Screen for the Elderly scale,measring caregiver abuse tendency; ZBI:Zarit Burden Interview scale, measuring caregiver burden;\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLatent class analysis\u003c/h2\u003e\u003cp\u003eA total of 541 AD caregivers were included in this study. LCA was performed using the item scores of the Chinese version of the CASE as observed variables to fit the model for the characteristics of abuse tendency among AD caregivers. The analysis began with a one-class model and progressively increased the number of classes to determine the optimal model. As the number of classes increased, the values of AIC, BIC, and aBIC gradually decreased. The decrease in these indices became slightly more gradual when the number of classes reached three, indicating that the improvement in model fit diminished with additional classes. The BLRT P-values for models with 1 to 5 classes were all \u0026lt;\u0026thinsp;0.001. However, the BIC value was minimized at three classes, and the entropy value was maximized (0.849) at five classes, indicating the highest classification accuracy. Considering model fit, classification effectiveness, interpretability, and parsimony, the three-class model was selected as the optimal model for abuse tendency among AD caregivers. The average probabilities of caregivers being classified into each of the three classes were 85.9%, 92.8%, and 91.4%, respectively, indicating reliable classification results (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The CASE scale revealed distinct categories of caregivers associated with abuse tendency. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, three distinct caregiver profiles emerged based on their conditional probabilities across the eight items. Class 1 (n\u0026thinsp;=\u0026thinsp;80) demonstrated pronounced elevations on abuse tendency indicators (items 2/4/6) coupled with minimal coping deficiencies (scores\u0026thinsp;\u0026le;\u0026thinsp;0.2 on items 1/3/5/7), warranting the designation \"High Abuse Tendency-Low Coping Deficiency\". Class 2, the largest subgroup (n\u0026thinsp;=\u0026thinsp;371) exhibited uniformly low probabilities (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.5) across all items, classified as \"Overall Low Abuse Tendency\". Class 3 (n\u0026thinsp;=\u0026thinsp;90) presented a divergent categories characterized by prominent coping deficiencies (items 1/3) alongside negligible abuse tendency (items 2/4/6/8), thus labeled \"High Coping Deficiency-Low Abuse Tendency\".\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFit indices of latent class analysis models for potential categories of AD caregivers' abuse tendency(n\u0026thinsp;=\u0026thinsp;541)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaBIC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEntropy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLMR(P)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eBLRT(P)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eclass probability\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4680.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4714.991\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4689.596\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4586.797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4659.785\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4605.821\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.700\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.762/0.238\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4534.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4646.355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4563.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.148/0.686/0.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4519.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4670.113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4559.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.740\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.552\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.268/0.157/0.405/0.170\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4487.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4676.356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4536.684\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.137/0.128/0.115/0.488/0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4466.510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4694.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4525.820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.122/0.072/0.268/0.231/0.174/0.133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAIC:akaike information criterio; BIC:bayesian information criterion; aBIC:adjusted bayesian information criterion; Entropy:Average information content index; LMR:lo-mendell-rubin likelihood; BLRT:bootstrapped likelihood ratio test.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDifferences in abusive tendencies among AD caregivers across latent classes\u003c/h2\u003e\u003cp\u003eUnivariate analysis results showed that the age, sex, geographic location, educational attainment, frequency of routine medical examinations, caregiving duration, number of AD patients assisted, and AD Patient's functional independence level did not significantly differ among AD caregivers with different abusive tendencies (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In contrast, marital status, comorbidity count, daily caregiving time commitment, caregiver training status, and presence of BPSD in the care recipient were significantly associated with abuse tendency (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of demographic variables of abuse tendency of AD caregivers in different categories (e.g. %)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eitem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClass 1(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClass 2(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;371)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eClass 3(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eH/X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)/M(P25, P75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(48,52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50(46,53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e50(48,56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex (e.g. /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56(15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70(87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e315(84.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e72(80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGeographic location (e.g. /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eurban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23(25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003erural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250(67.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e67(74.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eMarital status (e.g. /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003esingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e17.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73(91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e339(91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80(88.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003edivorce\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(6.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eremarry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eEducation attainment (e.g. /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135(36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32(35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ejunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124(33.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33(36.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school or technical secondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94(25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21(23.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ejunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor degree or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidity count\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(0,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(0,1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eFrequency of routine medical examination (e.g. /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ehalf a year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(10.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e11.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55(68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e247(66.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(57.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54(14.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15(16.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7(7.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003enonparticipator\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiving duration (month) /M (P25, P75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(9.75,29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(10,24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24(12,24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.072\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDaily caregiving time commitment(hours)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026thinsp;~\u0026thinsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(4.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(3.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e18.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026thinsp;~\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(26.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e174(46.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31(34.44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(72.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e179(48.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56(62.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of AD patients assisted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(3,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(3,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4,5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAD patient's functional independence level (example /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eComplete self-care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7(7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.786\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartial self-care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61(76.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286(77.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66(73.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompletely unable to take care of oneself\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65(17.5)༉\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17(18.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCaregiver training status (example /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e188(50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26(28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e13.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUntrained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43(53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e183(49.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64(71.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of BPSD in the care recipient (example /%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(43.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e299(80.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59(65.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e47.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(56.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31(34.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eClass 1\u0026thinsp;=\u0026thinsp;High Abuse Tendency\u0026ndash;Low Coping Deficiency;Class 2\u0026thinsp;=\u0026thinsp;Overall Low Abuse Tendency༛Class 3\u0026thinsp;=\u0026thinsp;High Coping Deficiency\u0026ndash;Low Abuse Tendency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLogistic regression analysis of abuse tendency categories among AD caregivers\u003c/h2\u003e\u003cp\u003e A multinomial logistic regression analysis was conducted with the latent classes of abusive tendencies among AD caregivers as the dependent variable, using the Class 2 as the reference group. The independent variables and their coding methods are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Variables with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis were included in the multivariate logistic regression model. The comorbidity count is based on \u0026ldquo;0\u0026rdquo;; the daily caregiving duration is based on \u0026ldquo;0\u0026ndash;8 hours\u0026rdquo;.\u003c/p\u003e\u003cp\u003eResults showed that caregivers who provided care for more than 12 hours per day were more likely to be classified into the Class 1. Caregivers who had not received AD care training were more likely to be classified into the Class 3. Complete statistical outcomes, including odds ratios and confidence intervals, are systematically presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssignment of argument variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eassignment\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle/divorced/widowed\u0026thinsp;=\u0026thinsp;0, Married/remarry\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidity count\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026thinsp;=\u0026thinsp;0, 2\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaily caregiving time commitment (hours)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026thinsp;~\u0026thinsp;12\u0026thinsp;=\u0026thinsp;0, 12\u0026thinsp;~\u0026thinsp;24\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver training status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003euntrained\u0026thinsp;=\u0026thinsp;0, trained\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresence of BPSD in the care recipient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIf no\u0026thinsp;=\u0026thinsp;0, if yes\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable Analysis of Abuse Tendeny Categories in AD Caregivers\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eitem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eClass 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003eClass 3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle/divorced/Widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.734\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.291ཞ1.854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.918\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.420ཞ2.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eComorbidity count\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1kind\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.470ཞ4.094\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.191ཞ1.394\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 kinds\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.758\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.257\u0026thinsp;~\u0026thinsp;2.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e-0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e1.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.448\u0026thinsp;~\u0026thinsp;3.060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDaily caregiving time commitment (hours)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026thinsp;~\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-1.919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.029ཞ2.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.686\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.140ཞ1.813\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-1.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.142ཞ0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.553\u0026thinsp;~\u0026thinsp;1.682\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver training status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003euntrained\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.677ཞ2.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.833\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.256ཞ0.739\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresence of BPSD in the care recipient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.352\u0026thinsp;~\u0026thinsp;1.281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.470\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.349ཞ1.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eClass 1 constant term P\u0026thinsp;=\u0026thinsp;0.376; Class 2 constant term P\u0026thinsp;=\u0026thinsp;0.049.\u003c/p\u003e\u003cp\u003eClass 1\u0026thinsp;=\u0026thinsp;High Abuse Tendency\u0026ndash;Low Coping Deficiency;Class 2\u0026thinsp;=\u0026thinsp;Overall Low Abuse Tendency༛Class 3\u0026thinsp;=\u0026thinsp;High Coping Deficiency\u0026ndash;Low Abuse Tendency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eComparison of caregiver burden among AD caregivers with different abusive tendencies\u003c/h2\u003e\u003cp\u003eThe three latent classes of abusive tendencies identified through latent class analysis had the following caregiver burden scores: Class 1 (42.31\u0026thinsp;\u0026plusmn;\u0026thinsp;10.05), Class 2 (39.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90), and Class 3 (44.49\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23). Analysis of variance (ANOVA) was used to compare the scores among the different classes. Results showed that there were significant differences in the total caregiver burden scores among the different abuse tendency classes (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.086, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Further pairwise comparisons using the least significant difference (LSD) method revealed that significant differences existed in the total burden scores, personal strain dimension, and other strain dimension among the three classes (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.005). However, no significant differences were found in the role burden dimension among the three classes (\u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.485, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.227). Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative analysis of carebiver burden across distinct abuse tendency in AD caregivers(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\stackrel{-}{x}\\pm\\:\\)\u003c/span\u003e\u003c/span\u003es)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotential Category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePersonal Strain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRole Strain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOther Strain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal points\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.31\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e371\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39.05\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClass 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e44.39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.086\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePairwise comparison\u003c/p\u003e\u003cp\u003e(P\u0026lt;0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC1\u0026thinsp;=\u0026thinsp;C3\u0026gt;C2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eC1\u0026thinsp;=\u0026thinsp;C2\u0026thinsp;=\u0026thinsp;C3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC2\u0026lt;C3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eC1\u0026thinsp;=\u0026thinsp;C3\u0026gt;C2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eClass 1\u0026thinsp;=\u0026thinsp;High Abuse Tendency\u0026ndash;Low Coping Deficiency;Class 2\u0026thinsp;=\u0026thinsp;Overall Low Abuse Tendency༛Class 3\u0026thinsp;=\u0026thinsp;High Coping Deficiency\u0026ndash;Low Abuse Tendency.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study employed LCA to systematically identify three distinct subtypes of abuse tendency among AD caregivers in China. These subtypes were characterized as: Class1: high abuse tendency-low coping deficiency (14.8% of caregivers), indicating individuals with adequate coping skills but elevated risks of abuse tendency, necessitating targeted psychological interventions by institutional administrators; Clsaa 2: Overall low abuse tendency (68.6% of caregivers), suggesting a majority subgroup with lesser abuse risks; Class 3: High Coping Deficiency\u0026ndash;Low Abuse Tendency(16.6% of caregivers), reflecting caregivers lacking standardized AD symptoms coping strategies, Institutional administrators should focus on professional skills training to reduce the incidence of abusive tendencies.\u003c/p\u003e\u003cp\u003eThe overall prevalence of abuse tendency in this study was 39.4%, which is lower than the rates reported by Chen et al.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This disparity may be attributed to nationwide caregiver support policies implemented between 2018 and 2022, China introduced various measures to enhance the training and professionalization of eldercare workers through pre-service and in-service continuing education programs, competency certification systems, and strengthened regulatory oversight in long-term care facilities\u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, which collectively improved AD care specialization and reduced abuse susceptibility.\u003c/p\u003e\u003cp\u003eA pivotal finding of this study was that demographic characteristics (including age, sex, geographic location, educational attainment) and caregiving-related variables (Daily caregiving time commitment, number of AD patients assisted, frequency of routine medical examinations, AD patient's functional independence level) showed no statistically significant differences across caregiver subgroups with heterogeneous abuse tendency (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This finding contrasts with prior studies by Zeng et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e which identified demographic factors as predictors of abuse risk. Our results indicate that traditional demographic indicators may lack sensitivity in predicting abuse tendency. Notably, this study identified multiple significant predictors of abusive tendencies, including caregivers' marital status, comorbidity count, daily caregiving time commitment, caregiver training status, and presence of BPSD in care recipient (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings corroborate prior evidence indicating that BPSD significantly exacerbates caregiver burden,\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,22\u003c/sup\u003e which in turn adversely impacts caregivers' physical and psychological well-being. Such bidirectional influences suggest a potential \"fatigue-irritability\" pathway,\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e wherein prolonged caregiving burden may amplify abusive tendencies in AD caregivers. To mitigate these risks, Institutional administrators should implement dynamic biopsychosocial evaluations for AD caregivers and develop targeted stress reduction interventions, such as mindfulness-based stress reduction.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e These measures could facilitate timely regulation of caregivers' psychophysiological homeostasis and affective states, thereby interrupting this detrimental cycle.\u003c/p\u003e\u003cp\u003eAnother key finding was that caregivers with adequate professional skills but excessive workloads (\u0026gt;\u0026thinsp;12 hours/day) exhibited significantly elevated abuse risks (OR\u0026thinsp;=\u0026thinsp;0.252). The greater the caregiver fatigue in long-term care facilities, the more pronounced the abuse tendency.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Caregivers in this group have strong coping abilities for disease symptoms, but when caregiving exceeds 12 hours per day, they have little opportunity to rest or engage in social activities, restricting their personal development and increasing the risk of abuse.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e While international models like Sweden\u0026rsquo;s \"Time Bank\" and the Dutch \"Dementia Village\" smart scheduling system have reduced burnout through structural reforms,\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e respite care services although still in the early stages in China. Research shows that reducing caregiving time is the most immediate and cost-effective way to benefit caregivers.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Institutional administrators should focus on caregivers' time load and adopt flexible schedules to keep working hours under 12 hours to alleviate caregiving burden. Our findings provide the first empirical evidence to advocate for policy innovations, such as mandatory shift rotations and government-subsidized respite insurance programs.\u003c/p\u003e\u003cp\u003eThe \"High Coping Deficiency\u0026ndash;Low Abuse Tendency\" primarily manifests as unintentional neglect stemming from caregivers' coping deficits, such as improper physical restraint techniques or ineffective communication strategies. These behaviors often evade detection by conventional monitoring systems. Untrained caregivers exhibited unintentional neglect due to skill gaps, consistent with global findings. Our results extend Yan et al.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e Caregivers in this category may not have abusive thoughts, but when the AD symptoms appear, they fail to respond appropriately, which can lead to unintended abuse. Existing training programs primarily focus on practical care but often overlook the emotional and cultural needs of elderly individuals.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e Caregivers without adequate education or training lack the ability to identify and report abuse or neglect, leading to a higher likelihood of inadvertent abusive behaviors. Many caregivers have not kept up with new knowledge and skills required for the increasing needs of elderly individuals, compounded by long working hours and short breaks.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e This suggests a need for standardized specialized training for caregivers, something that is currently lacking in China.\u003csup\u003e\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e This underscores the urgency to establish a dual-track training system integrating technical competency and ethical awareness.\u003c/p\u003e\u003cp\u003eThe study revealed that 98.02% of caregivers experienced mild-to-moderate burden levels, with the lowest total burden scores observed in the low abuse tendency subgroup. Significant differences emerged in overall caregiver burden and personal strain dimensions across the three caregiver categories (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Long-term caregiving burden can lead to a weakened immune system, increased physiological issues, and the development of negative emotions like anxiety and depression.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e This can result in neglecting the needs of AD patients and increase abuse tendency. Notably, the personal strain dimension, which includes physical and emotional problems of caregivers, is crucial in alleviating abuse tendencies. Previous studies have shown that addressing emotional and personal issues ensures caregivers remain positive in their roles.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Positive coping strategies help reduce caregiving burdens and mitigate abusive tendencies.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e To reduce caregiver burden and prevent abuse, interventions should focus on coping strategies, emphasizing the importance of specialized caregiving. Training caregivers to have a certain level of medical knowledge is vital. Government and institutional collaboration could establish unified training centers, cooperating with vocational colleges to provide regular training to enhance caregivers' overall competence and caregiving skills.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed moderate-to-low abuse tendency levels among Chinese AD caregivers. Through LCA, we identified distinct abuse tendency categories, challenging the prior assumption of caregiver homogeneity in abuse tendency by revealing its heterogeneity, the critical need for healthcare providers and institutional administrators to implement subgroup-specific interventions tailored to different abuse tendency profiles. Notably, this investigation represents the first application of LCA to classify abuse tendency categories among AD caregivers in China. However, several limitations warrant consideration. The convenience sampling method restricted participant selection to long-term care facilities in Zhejiang Province, potentially compromising sample representativeness. Future investigations should expand sampling to include family caregivers and diverse geographic regions, particularly considering China's substantial urban-rural disparities in aging populations. Multicenter studies encompassing caregivers from mountainous and island areas' grassroots facilities are recommended.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlzheimer's disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBPSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epsychological symptoms associated with dementia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLatent class analysis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCASE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCaregiver Abuse Screen for the Elderly\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eZBI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eZarit Burden Interview\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAkaike Information Criterion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBayesian Information Criterion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eaBIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esample-size adjusted BIC\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLo-Mendell-Rubin adjusted likelihood ratio test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBLRT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ebootstrap likelihood ratio test\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAnalysis of variance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eleast significant difference\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was approved by the Medical ethics committee of Zhejiang Hospital ethics committee (approval number: 2022 Lin shen No. (61K)-X1).The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained before recruitment from all participants.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot Applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by the Zhejiang Provincial basic and public welfare research program (LGF22H250002) .\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.Z. contributed to data curation, investigation, methodology, and original draft writing; M.W., J.X., and L.L. performed data curation, investigation, and methodology; B.S. supervised the study, curated data, and participated in manuscript review/editing; F.L. and B.J. conducted data curation and supervision; C.L. provided supervision and manuscript review/editing; X.X. contributed resources, software, and manuscript review/editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely thank all the long-term care facilities that provided support for this research. Special gratitude is extended to the Hangzhou Social Welfare Center, Zhejiang Province, and its Director, Mr. Xiaodong Sun, for their invaluable assistance throughout the study. Additionally, we would like to acknowledge the AI language model developed by Kimi (heeps://kimi.moonshot.cn), which was used for the language refinement of this manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYunus R, Hairi N, Choo WY. Consequences of Elder Abuse and Neglect: A Systematic Review of Observational Studies. Trauma Violence Abus. 2019;20:197\u0026ndash;213.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogers MM, Storey JE, Galloway S. Elder Mistreatment and Dementia: A Comparison of People with and without Dementia across the Prevalence of Abuse. 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Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study. BMJ Open. 2022;12(5):e057817.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVatter S, Leroi I. Resilience in people with lewy body disorders and their care partners: association with mental health, relationship satisfaction, and care burden. Brain Sci. 2022;12(2):148.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alzheimer's disease, latent class analysis, caregivers, abuse tendency, caregiver burden","lastPublishedDoi":"10.21203/rs.3.rs-6624940/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6624940/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAlzheimer's disease patients face higher risks of caregiver abuse and caregiver burden than healthy older adults,. However, the association between abuse tendency by AD caregivers and their burden remains understudied. This study aimed to investigate the association between caregivers' abusive tendencies and burden levels in Alzheimer's disease through latent class analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 541 Alzheimer's disease caregivers from long-term care facilities in Zhejiang Province, China, were included in this cross-sectional study. Demographic characteristics、abusive tendencies and caregiver burden were assessed using scale. Heterogeneous subtypes of abusive tendencies were identified through latent class analysis, and their associations with caregiver burden were examined using multivariate regression models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRseults: \u003c/strong\u003eThe prevalence of caregiver abuse tendency toward Alzheimer's patients in Zhejiang long-term care facilities was 39.4%, categorized into three latent classes: Class 1 (\"high abuse tendency-low coping deficiency\"), Class 2 (\"overall low abuse tendency\"), Class 3 (\"high coping deficiency-low abuse tendency\"). Significant differences (P\u0026lt;0.05) emerged among classes in marital status, chronic conditions, daily care duration, caregiving training, and patient neuropsychiatric symptoms. Compared with Class 2, caregivers in Class 1 had significantly higher odds of providing more than 12 hours of daily care (OR=0.252, P\u0026lt;0.001), whereas those in Class 3 had lower odds of having received Alzheimer's caregiving training (OR=0.435, P=0.002). Caregiver burden scores also differed significantly across classes (F=12.086, P\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eCaregivers for Alzheimer's patients exhibit distinct abuse tendency categories with caregiving burdens. Healthcare providers should implement targeted training programs to alleviate these burdens, reduce the incidence of abuse tendency.\u003c/p\u003e","manuscriptTitle":"Unmasking Caregiver Heterogeneity: Latent Class Analysis of Abuse Tendency Subtypes for Alzheimer’s Disease Caregivers in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:19:21","doi":"10.21203/rs.3.rs-6624940/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-18T02:13:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T03:22:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332589815704961932035436337986603538192","date":"2026-05-11T08:07:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323343878670485003932363469826695794917","date":"2026-05-06T03:26:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T09:37:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261621616522279971235581854763358501484","date":"2025-09-25T07:52:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114015777236660365439712042278623321368","date":"2025-09-23T09:18:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77827802682603046856192423046321943264","date":"2025-09-18T16:37:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T08:52:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T07:13:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T07:19:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-12T12:24:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-05-12T12:23:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a9f3c5b-83b7-4637-b505-66b913c61e8c","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-18T02:13:07+00:00","index":113,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-16T03:22:58+00:00","index":112,"fulltext":""},{"type":"reviewerAgreed","content":"332589815704961932035436337986603538192","date":"2026-05-11T08:07:07+00:00","index":111,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T07:19:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:19:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6624940","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6624940","identity":"rs-6624940","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}