The length of the caregiving to elders with dementia is usually very long and characterized with changes due to the nature of the Alzheimer’s disease. The phases of family caregiving process might be related but not necessary the same as the progress of the illness. There is a lack of specific interventions developed for different phases of caregiving to elders with dementia in Taiwan. The understanding of the longitudinal changes of the caregiving process specifically the interactions between caregiver and care receiver needs to be developed to provide guidelines for clinical practices. However, most of the studies on the family caregiving processes for frail elders, specifically elders with dementia, have been conducted in the United States and might not be able to reflect the caregiving phenomena in Taiwan.

     A conceptual framework of “role tuning” was developed by the investigator to explain the dynamic changes of caregiving process during discharge transition for families of physically impaired elders in Taiwan. This process describes how caregiver and care receiver engaged in caregiving relationship, negotiated with each other and finally settled into a stable pattern of caregiving. This model is able to explain the caregiving phenomena in transition for families of physically impaired elders and might be further developed to explain the longitudinal changes in family caregiving to elders with dementia. Thus, the purpose of this study was to expand the role-tuning model to develop a substantive theory for explaining the longitudinal changes in caregiving process of families of elders with dementia in Taiwan. 

     Grounded theory method is selected over other methods due to the reason that grounded theory method is particularly established to serve the purpose of developing/extending an empirically grounded conceptual framework. Face-to-face interviews with participant observations will be used to collect the data. All the interviews will be tape recorded and then transcribed verbatim. Based on the concepts developed previously in the role tuning model, the initial theoretical sampling will include families who are in the beginning of providing caregiving, who are experiencing intense conflict and stress and who have stable caregiving relationship and regular caregiving schedule. At least four families from each sites including the clinics, support groups and psychiatric wards will be recruited and followed every 3 months for one year in order to maximize the variability and to catch the longitudinal changes of the phenomena. Actual sampling strategies and number of interviews will be decided according to the emerged theory and the saturation of the concepts. Constant comparative strategy will be used to analyze the data. Audit trails, peer debriefing, triangulation, prolonged engagement, thick data with theoretical sampling, and member checks will help to increase the overall trustworthiness of the study. This study will be able to develop a culturally relevant conceptual framework to explain the processes of family caregiving to elders with dementia and provide guidelines for clinical practices in Taiwan.