Implementation of eMental health technologies for informal caregivers: A multiple case study

Introduction

Informal caregivers offer continuous unpaid support to loved ones who are unable to live independently. Providing care can be a very burdensome commitment, that heavily impacts informal caregivers' mental health. eMental health is a possible, yet challenging, solution to improve caregivers' mental health and their overall experience of caregiving. In fact, eMental health technologies often face challenges of implementation. The present work gathers knowledge on how to best deal with these challenges by collecting testimonies of implementation experts of eight eMental health technologies for informal caregivers with the aim of comparing them and extracting lessons learned.

Methods

For this multiple case study, technologies were selected (through informal suggestions and independent search) according to the following inclusion criteria: they were intended for informal caregivers as main user group, were aimed at improving informal caregivers' mental wellbeing and caregiving experience and were available and running in real life settings in Europe. Ten interviews were conducted (two pilots and eight included cases). The interviewees were asked to provide a description of the technology and its aims and their implementation approach, method and frameworks used. Finally, determinants of implementation, the influence of the Covid-19 pandemic on implementation processes and lessons learned were investigated.

Results

The results highlight key differences between technologies developed within academia and the industry regarding efficacy testing and use and use and choice of frameworks. Also, similarities in terms of recognized barriers such as financing are illustrated.

Discussion

Possible ways to overcome main barriers and examples of best practices, such as structuring a business model and discussing tool maintenance and long-term hosting in advance, are discussed.

Mindfulness and Care Experience in Family Caregivers of Persons Living with Dementia

Background

Greater mindfulness, the practice of awareness and living in the moment without judgement, has been linked to positive caregiving outcomes in dementia caregivers and its impact attributed to greater decentering and emotion regulation abilities. Whether the impact of these mindfulness-based processes varies across caregiver subgroups is unclear.

Objective

Analyze cross-sectional associations between mindfulness and caregiver psychosocial outcomes, considering different caregiver and patient characteristics.

Methods

A total of 128 family caregivers of persons living with Alzheimer's disease and related disorders were assessed on several mindfulness measures (i.e., global; decentering, positive emotion regulation, negative emotion regulation) and provided self-reported appraisals of caregiving experience; care preparedness; confidence, burden, and depression/anxiety. Bivariate relationships between mindfulness and caregiver outcomes were assessed with Pearson's correlations and stratified by caregiver (women versus men; spouse versus adult child) and patient (mild cognitive impairment (MCI) versus Dementia; AD versus dementia with Lewy bodies; low versus high symptom severity) characteristics.

Results

Greater mindfulness was associated with positive outcomes and inversely associated with negative outcomes. Stratification identified specific patterns of associations across caregiver groups. Significant correlations were found between all mindfulness measures and caregiving outcomes in male and MCI caregivers while the individual mindfulness component of positive emotion regulation was significantly correlated to outcomes in most caregiver groups.

Conclusion

Our findings support a link between caregiver mindfulness and improved caregiving outcomes and suggest directions of inquiry into whether the effectiveness of dementia caregiver-support interventions may be improved by targeting specific mindfulness processes or offering a more inclusive all-scope approach depending on individual caregiver or patient characteristics.

Policies to Sustain Employment Among Family Caregivers: The Family Caregiver Perspective

The work of caregiving can make it difficult to sustain employment. This study aimed to clarify what family caregivers themselves think is important in remaining employed, as part of work mandated under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018. Data came from a Request for Information promulgated by the Administration for Community Living, resulting in 1147 family caregiver responses, and 12 focus groups. Findings support many goals identified by caregiver-advocates, such as expanding the Family and Medical Leave Act, and access to paid time off and sick leave; caregivers also value flexible work arrangements. However, the study further revealed a need for supportive work environments that protect caregivers against workplace discrimination and negative attitudes held by both managers and colleagues, and thus for employer education about the caregiving experience as well as caregivers' needs for workplace supports and benefits, and possibly anti-discrimination legislation.

Impact and Perceived Value of iGeriCare e-Learning Among Dementia Care Partners and Others: Pilot Evaluation Using the IAM4all Questionnaire

BACKGROUND

Care partners of people living with dementia may benefit from web-based education. We developed iGeriCare, an award-winning internet-based platform with 12 multimedia e-learning lessons about dementia.

OBJECTIVE

Our objective was to evaluate users' perceptions of impact.

METHODS

From March 17, 2021 to May 16, 2022, data were collected upon lesson completion. We used the content-validated Information Assessment Method for all (IAM4all) for patients and the public adapted for dementia care partners. The IAM4all questionnaire assesses outcomes of web-based consumer health information. Responses were collected using SurveyMonkey, and data were analyzed using IBM SPSS Statistics (version 28).

RESULTS

A total of 409 responses were collected, with 389 (95.1%) survey respondents completing the survey. Of 409 respondents, 179 (43.8%) identified as a family or friend care partner, 84 (20.5%) identified as an individual concerned they may have mild cognitive impairment or dementia, 380 (92.9%) identified the lesson as relevant or very relevant, and 403 (98.5%) understood the lesson well or very well. Over half of respondents felt they were motivated to learn more, they were taught something new, or they felt validated in what they do, while some felt reassured or felt that the lesson refreshed their memory. Of 409 respondents, 401 (98%) said they would use the information, in particular, to better understand something, discuss the information with someone else, do things differently, or do something.

CONCLUSIONS

Users identified iGeriCare as relevant and beneficial and said that they would use the information. To our knowledge, this is the first time the IAM4all questionnaire has been used to assess patient and caregiver feedback on internet-based dementia education resources. A randomized controlled trial to study feasibility and impact on caregiver knowledge, self-efficacy, and burden is in progress.

Informal care in Huntington's disease: Assessment of objective-subjective burden and its associated risk and protective factors

BACKGROUND

Because of the genetic transmission of Huntington's disease (HD), informal caregivers (ICs, i.e., non-professional caregivers) might experience consecutive and/or concurrent caregiving roles to support several symptomatic relatives with HD over their life. Additionally, some ICs might be HD carriers. However, whether family burden of care is associated with specific factors in HD remains poorly studied.

OBJECTIVE

To provide a quantitative view of the IC burden and identify associated factors.

METHODS

This was a cross-sectional assessment of home-dwelling symptomatic HD individuals (from REGISTRY and Bio-HD studies) and their primary adult ICs, including the HD individual's motor, cognitive, behavioral, functional Unified Huntington's Disease Rating Scale score; IC objective burden (quantification of IC time in activities of daily living, instrumental activities of daily living and supervision, using the Resource Utilization in Dementia instrument), IC subjective burden (Zarit Burden Inventory), and ICs' social economic functioning and use of professional home care.

RESULTS

We included 80 ICs (mean [SD] age 57 [12.9] years, 60% women) in charge of 80 individuals with early to advanced stage HD (mean age 56 [12.6] years, 51% men). The mean hours of informal care time was high: 7.3 (7.9) h/day (range 0-24); the mean professional home care was 2.8 (2.8) h/day (range 0.1-12.3). This objective burden increased with higher functional loss of the HD individual and with more severe cognitive-behavioral disorders. The mean subjective burden (35.4 [17.8], range 4-73) showed a high level since the earliest stage of HD; it was associated with HD duration (mean 9.2 [4.7] years) and with aggressive symptoms in individuals (44% of cases). The burden was partially related to the multiplex caregiving status (19%). Protective factors lowering the IC burden included the absence of financial hardship (57%), a strong social network (16%) and keeping active on the job market outside home (46%).

CONCLUSIONS

The objective-subjective burden of ICs related to changing patterns of neuro-psychiatric symptoms and mitigating environmental characteristics around the HD individual-caregiver dyads.

Formal and Informal Costs of Care for People With Dementia Who Experience a Transition to Hospital at the End of Life: A Secondary Data Analysis

OBJECTIVES

To explore formal and informal care costs in the last 3 months of life for people with dementia, and to evaluate the association between transitions to hospital and usual place of care with costs.

DESIGN

Cross-sectional study using pooled data from 3 mortality follow-back surveys.

SETTING AND PARTICIPANTS

People who died with dementia.

METHODS

The Client Service Receipt Inventory survey was used to derive formal (health, social) and informal care costs in the last 3 months of life. Generalized linear models were used to explore the association between transitions to hospital and usual place of care with formal and informal care costs.

RESULTS

A total of 146 people who died with dementia were included. The mean age was 88.1 years (SD 6.0), and 98 (67.1%) were female. The usual place of care was care home for 85 (58.2%). Sixty-five individuals (44.5%) died in a care home, and 85 (58.2%) experienced a transition to hospital in the last 3 months. The mean total costs of care in the last 3 months of life were £31,224.7 (SD 23,536.6). People with a transition to hospital had higher total costs (£33,239.2, 95% CI 28,301.8-39,037.8) than people without transition (£21,522.0, 95% CI 17,784.0-26,045.8), mainly explained by hospital costs. People whose usual place of care was care homes had lower total costs (£23,801.3, 95% CI 20,172.0-28,083.6) compared to home (£34,331.4, 95% CI 27,824.7-42,359.5), mainly explained by lower informal care costs.

CONCLUSIONS AND IMPLICATIONS

Total care costs are high among people dying with dementia, and informal care costs represent an important component of end-of-life care costs. Transitions to hospital have a large impact on total costs; preventing these transitions might reduce costs from the health care perspective, but not from patients' and families' perspectives. Access to care homes could help reduce transitions to hospital as well as reduce formal and informal care costs.

Labor supply and informal care responses to health shocks within couples: Evidence from the UK

Shocks to health have been shown to reduce labor supply for the individual affected. Less is known about household self-insurance through a partner's response. Previous studies have presented inconclusive empirical evidence on the existence of a health-related Added Worker Effect, and results limited to labor and income responses. We use UK longitudinal data to investigate within households both the labor supply and informal care responses of an individual to the event of an acute health shock to their partner. Relying on the unanticipated timing of shocks, we combine Coarsened Exact Matching and Entropy Balancing algorithms with parametric analysis and exploit lagged outcomes to remove bias from observed confounders and time-invariant unobservables. We find no evidence of a health-related Added Worker Effect but a significant and sizable Informal Carer Effect. This holds irrespective of spousal labor market position or household financial status and ability to purchase formal care provision, suggesting that partners' substitute informal care provision for time devoted to leisure activities.

Compassion Fatigue in Informal Caregivers of Children with Cancer; a Section from Turkey

Compassion fatigue is the natural stress caused by the strong desire to help a valued person and alleviate the pain he/she suffers after he/she undergoes a traumatizing event. That caregiver who witnesses the physical suffering of the patient, who makes intense effort during the process deprived of the social, psychological, or economic support they need is among the reasons causing compassion fatigue. In this study, the aim was to test and describe the effects of compassion fatigue on informal caregivers of children with cancer. The study is phenomenological, a form of a qualitative study. The participants were the relatives of children with cancer. The data were obtained through in-depth interviews. The audio-recorded interviews were analyzed through the inductive thematic analysis to obtain answers to the questions. The findings were categorized under four headings which compassion fatigue was addressed: Empathy ability, compassion stress, problems experienced by the participants as components of compassion fatigue. The results of this study demonstrated that mothers were at risk of compassion fatigue. Those who give care to their relatives are faced with problems more than professionals. It is recommended that the implementation of multidisciplinary interventions that will improve caregivers' well-being, and preventive social work interventions, will prevent them from compassion fatigue.

Caregiving Situation as a Predictor of Subjective Caregiver Burden: Informal Caregivers of Older Adults during the COVID-19 Pandemic

The COVID-19 pandemic has created and exacerbated emotional, financial, and technical challenges for informal caregivers of older people. The aim of this study was to explore the caregiving situation and subjective burden of informal caregivers of older family members during COVID-19, and to investigate how a caregiving situation's characteristics predict the subjective burden of care in times of COVID-19. The study was conducted in April and May 2021 via an online access panel. The sample (n = 612) was determined using a screening test that enabled us to focus on a Slovenian population of informal caregivers aged 40+ caring for a person aged 65+ for at least four hours/week on average. Our findings reveal that the subjective burden of care was high among informal caregivers during COVID-19. Multiple regression analysis showed that the provision of activities of daily living, care duration, average hours of care per week, formal care status, and recipients' health problems related to dementia or other memory problems significantly predicted the subjective burden of caregivers. These findings call for better recognition of the role of informal caregivers. The time and effort devoted to informal care should be supported by legislation and social security.

Relational, community-based and practical: Support systems used by Canadian spousal caregivers living seasonally in the United States

Every year tens of thousands of older Canadians travel to the southern United States (US) to live there seasonally during the winter months to enjoy a warmer climate-a practice known as international retirement migration. Several factors facilitate participation in this transnational mobility, including having the financial resources needed to live abroad. For those managing chronic or acute health conditions, traveling with a caregiver (typically a spouse) is another important facilitator. In this qualitative analysis, we explore the transnational systems of support that Canadian international retirement migrant spousal caregivers draw upon to enable them to provide care while in the US. We report on the findings of ten semi-structured dyad interviews (n = 20 participants) conducted with Canadian international retirement migrants living seasonally in Yuma, Arizona. The dyads consisted of spouses, one of whom had defined care needs and the other of whom provided informal care. Through thematic analysis of these interviews, we identified three types of transnational support systems that spousal caregivers draw on: relational, community-based and practical. While aspects of these support systems have been documented in other informal care-giving studies, this analysis demonstrates their copresence in the transnational care-giving context associated with international retirement migration. Overall, this analysis highlights the benefits of close social relations enjoyed by international retirement migrants providing informal care to mitigate the lack of access to their established support networks at home.

Informal care in times of a public health crisis: Objective burden, subjective burden and quality of life of caregivers in the Netherlands during the COVID-19 pandemic

In the Netherlands, about one-third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID-19 pandemic, and what characteristics were related to these changes. We use self-reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care-related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0-10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long-term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers.

Exploring the association between grandparental care and child development: Evidence from China

Grandparental care has become an involuntary choice in life for many families, mainly due to parents' unavailability to provide care and the lack of public or affordable private childcare. This phenomenon has raised concerns regarding the effects of grandparental care along the dimensions of child development. This study aims to test the association between grandparental care and child development in three dimensions: subjective wellbeing, behavioural traits and study performance. It used data from the 2018 China Family Panel Studies survey. First, the study outlines the data and the applied method with defined variables, on the basis of which an overview on the current stage of grandparental care is presented. It then examines the association of the impact of grandparental care in different dimensions using the general linear model, along with the other influencing factors. Finally, a cross-age group comparison is employed. The results of the study illustrate the difficulty of examining an overall picture of grandparental childcare, with its negative or positive associations. However, when evaluated using the features of different age groups of children's development, significant associations between grandparental care and child development are mainly found in the 6-11 age group, but the significant associations weaken or disappear in the 12-16 age group. Attachment theory and peer group theory are used to explain the difference between the two age groups.

Informal caregiving from the perspectives of older people living alone in India

BACKGROUND

The cultural and social norms in India stipulate that family and preferably children of the older person, provide the support and care that is needed. In recent years, we have witnessed an overall upsurge in interest in informal care from all countries in the developed world considering their ageing populations. The older people living alone group is, especially interesting in this matter, since it seems to deviate from the expectations of extended family living.

OBJECTIVE

The aim was to describe older persons' experiences of informal care when living alone in India.

METHODS

The study has a hermeneutic design, analysing interviews of older persons living alone in India.

RESULTS

Findings revealed informal care as the thematic patterns: Informal care as a fundamental human responsibility, an obligation and thereby a way to act in 'common sense'. It was a way of 'paying-back' care that they had received from others in their life history, motivated by governmental care was not presented as an option. Informal care also created safety by the provision of alert and actionable care by loved ones, including spatial safety. Most of the informants experienced themselves as informal caregivers assisting others in need even if they themselves were old and fragile. Providing self care was also seen as a part of informal care conducted by capable and worthy persons. They also pointed out their own obligation to seek informal care and even to listen to the suggestions of younger generations regarding the type and scope of care.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Informal care in India is not only dependent on having children who ensure that you receive the care you need. Extended family, neighbours and friends feel a basic human obligation to care for the older people in their environment. This responsibility is deeply rooted even within the older people who become fragile in old age.

Caring for the caregiver: Why policy must shift from addressing needs to enabling caregivers to flourish

Policies supporting caregivers ("caregiver policies") are limited in the extent to which they meet the needs of those who care for others. Where policies do exist, they focus on relieving the burdens associated with caring or the needs of the person they care for, rather than consider the holistic needs of the caregiver that would enable them to flourish. We argue that the established approach to caregiver policies reflects a policy failure, requiring a reassessment of current practice related to caregiver support. Often, caregiver policies target the care recipient rather than the caregiver's needs. Through a consultative exercise, we identified five areas of need that existing caregiver policies touch upon. Yet current approaches remain piecemeal and inadequate in a global context. Caregiver policies should not just relieve burden to the extent that caregivers can continue in the role, but they should support caregivers to flourish, and future work may benefit from drawing on related frameworks from positive psychology, such as the PERMA™ model; this is important for both policymakers and researchers.

The Experiences of Informal Carers during the COVID-19 Pandemic: A Qualitative Systematic Review

OBJECTIVES

To identify, critically appraise and synthesise the qualitative literature on the experiences of informal carers of people with long-term conditions during the COVID-19 pandemic.

DESIGN

A qualitative systematic literature review.

DATA SOURCES

Eight electronic databases were systematically searched (Medline, Embase, CINAHL, PubMed, PsychINFO, Web of Science, Nursing and Allied Health and ASSIA) along with Google Scholar and handsearching via secondary sources.

STUDY SELECTION

Eligible studies had to include the experiences of informal carers (adults who are 65 or older), use a qualitative methodology and had to be written in English.

DATA EXTRACTION AND SYNTHESIS

Retrieved papers were quality assessed using the Critical Appraisal Skills Programme qualitative checklist and ranked for quality. Thematic analysis was used to synthesise the findings.

RESULTS

Fourteen studies were included, all from medical or nursing journals (n = 5 specifically gerontology). Four main themes were identified: (i) fear, (ii) uncertainty, (iii) burden and (iv) staying connected. Caregiving demands have increased for carers during the pandemic, as well as negative emotions such as fear and uncertainty. At the same time, less social support has been available, leading to concerns about carers' wellbeing and ability to cope.

CONCLUSION

Carers' needs have been exacerbated by the COVID-19 pandemic. Greater practical and emotional support is needed for carers from both formal services and community sources that considers their changing needs and offers educational and emotional support for long-term wellbeing. Strengths and Limitations: (1) This is the first systematic review to explore in depth the experiences of informal carers caring for people with a range of long-term conditions and from an international context. (2) The review includes an analysis of the quality of the studies, as well as a study of their relative contributions. (3) Further research is needed to explore the physical, emotional and financial impact of the pandemic for bereaved carers which is not captured in this review due to the lack of empirical data available at the time of review.

An Examination of Positive and Negative Dementia Caregiving Experiences

OBJECTIVES

We examined associations among three measures of caregiver experiences (i.e., positive aspects of caring [PAC], caregiver burden, and mutuality) in 228 dyads involving persons with dementia (PWD) and their informal caregivers. The associations between predisposing, enabling, and need factors and each of these three measures of caregiver experiences were also examined.

METHODS

We used baseline data from a randomized controlled trial of a psychosocial intervention aimed at preventing aggression in PWD. Associations among PAC, caregiver burden, and mutuality were examined. The Behavioral Model of Health Services Utilization guided the selection of predisposing, enabling, and need components.

RESULTS

Enabling characteristics (e.g., race/ethnicity, caregiver education and employment and PWD education) and most predisposing characteristics (e.g., caregiver age, PWD age, relationship type) were not associated with any caregiving experience measures. Need characteristics (e.g., levels of memory and functional impairment, behavioral problems, depression, pleasant events) were associated with the caregiving experience.

CONCLUSIONS

Bivariate correlations between PAC, caregiver burden, and mutuality were between -0.20 and -0.58. Predisposing, enabling, and need factors were differentially associated with outcomes, with need characteristics being most frequently associated with various aspects of caregiving.

CLINICAL IMPLICATIONS

Assessment of both positive and negative aspects of caregiving is important. Particular attention to depression and interventions that improve depressive symptoms may increase PAC and mutuality and reduce caregiver burden.

Caregiving burden of family caregivers of substance-addicted people in Turkey

PURPOSE

The purpose of this exploratory study was to examine the caregiving burden (CB) and the determinants of burden among family members of substance-addicted people.

DESIGN AND METHODS

The sample of this cross-sectional research was 128 informal family caregivers of substance-addicted people. We collected data by using the Zarit Burden Interview (ZBI) assessing subjective burden.

FINDINGS

Mean ZBI score was 52.2. The regression analysis showed that ZBI mean score was higher in female caregivers and caregivers with lower education, poor economic status, and longer caregiving duration. There was an inverse relationship between the addict's age and the CB.

PRACTICE IMPLICATIONS

The predictors of CB may assist in setting caregivers at greater risk of CB as targets for the intervention.

Impact of Sociodemographic Factors on Use of Formal Social Services in an Older Swedish Population

BACKGROUND

In Sweden, societal support for older people is the responsibility of the municipalities. However, due to Sweden's current aging-in-place policy for older people, there is a need to assess how the use of such services varies based on sociodemographic factors. The aim of this study was to describe the use of different forms of social services and institutional long-term care (ILTC) in an older population and to evaluate the impact of sociodemographic factors.

METHODS

This was a cross-sectional register-based study, including all individuals aged 65 years and older in two Swedish municipalities in 2010, 2015, and 2019. The study analyzed the use of social services and ILTC in relation to sex, place of birth, cohabitation status, and type of housing.

RESULTS

Women, those born in Sweden, and those living in an apartment were more likely to receive assistance than men, those born abroad, or living in single family houses, respectively. People living alone were consistently more likely to have assistance, as well as ILTC.

CONCLUSIONS

There may be a discrepancy between the individual's need and the assistance provided from the municipality in certain sociodemographic groups in the older population in Sweden.

The care types choice in filial culture: A cross-sectional study of disabled elderly in China

For the past few decades, studies of care types choice have been restricted to the scope of individual characteristics and health status. Meanwhile, the historiography of the research largely ignores the role of filial culture within China. This study sets out to examine the influence of the factors in the cultural context of filial piety on the choice of care types for older people with disability in China. According to the characteristics of filial culture, the factors influencing the choice of care type for the older people in China are summarized as family endowment and support. The study concludes that gender, residence, living alone or not, family income, real estate, pension and community service have momentous effects on the choice of care type of older people with disability; informal care has a substitutive effect on formal care. The research was based on cross-sectional data of CLHLS 2018 and utilized binary logistic regression analysis to compare the factors influencing the choice of old disabled people between formal and informal care. The study implies that in the context of filial culture, the older people's choice of care types is affected by family endowment and community service supply for the older people in China. In the background of filial culture, the government should give informal care official support such as cash and services, so as to change its attribute of private domain of it and enhance the quality of long-term care.

Relationships first: Formal and informal home care of older adults in Sweden

To a great extent, older people in Sweden, often with extensive care needs, are cared for in their own home. Support is often needed from both family and professional caregivers. This study aimed to describe and analyse different aspects of health, functioning and social networks, and how they relate to formal and informal care in the home among older adults. Analyses were performed utilising data from the OCTO-2 study, with a sample of 317 people living in Jönköping County, aged 75, 80, 85 or 90 years, living in their own homes. Data were collected with in-person-testing. Based on receipt of care, the participants were divided into three groups: no care, informal care only, and formal care with or without informal care. Descriptive statistics and multinomial regression analysis were performed to explore the associations between received care and different aspects of health (such as multimorbidity, polypharmacy), social networks (such as loneliness, number of confidants) and functioning (such as managing daily life). The findings demonstrate that the majority of the participants received no care at home (61%). Multimorbidity and polypharmacy were more common among those receiving some kind of care in comparison to those who received no care; moreover, those receiving some kind of care also had difficulties managing daily life and less satisfaction with their social networks. The multinomial logistic regression analyses demonstrated that age, functioning in daily life, perceived general health and satisfaction with the number of confidants were related to receipt of care, but the associations among these factors differed depending on the type of care that was received. The results show the importance of a holistic perspective that includes the older person's experiences when planning home care. The results also highlight the importance of considering social perspectives and relationships in home care rather than focusing only on health factors.

Do oldest old individuals perceive receipt of informal care as a restriction or support of their autonomy?

OBJECTIVES

Autonomy (defined as self-governance; not equivalent to independence) is relevant to well-being and psychological functioning. However, there is a lack of research on individuals aged >85 years and their perception of autonomy when receiving informal care. This study aims to answer the question if and how the receipt of informal care is associated with perceived autonomy of individuals aged over 85 years.

METHOD

A cross-sectional study was conducted with data from follow-up 9 of the AgeQualiDe study (2015/2016), which is a multi-centric prospective cohort study in Germany. The analytical sample included 570 participants aged >85 years and with a score of ≥ 19 on the Mini-Mental-State-Examination. Perceived autonomy was assessed with the Perceived Autonomy in Old Age Scale. Receipt of care was assessed as performance of at least one care task (help with basic and instrumental activities of daily living, and supervision) by relatives or friends. Sociodemographic information, mental health, functional level and receipt of professional ambulatory care were controlled for.

RESULTS

Unadjusted and adjusted linear regression analyses indicated a significant negative association between receipt of informal care and perceived autonomy. The results remained stable in sensitivity analyses; no significant interaction effect was found for gender or education.

CONCLUSION

Findings indicate that informal care recipients aged >85 years perceive lower autonomy compared to those not receiving care. Additional or other forms of support, and improving the care relationship and communication might be considered to support autonomy of care recipients aged >85 years.

Value assessment of new interventions for Alzheimer's disease dementia in Japan based on literature review and group interview

INTRODUCTION

With an increase in the number of patients with Alzheimer's disease dementia (ADD), new health technologies have been developed to address the problem. We propose an optimal way to assess the disease burden and treatment value of ADD in Japan by considering the characteristics of the disease.

AREAS COVERED

We performed literature searches and a group interview with professional care workers to obtain information on the items that would facilitate the assessment of the value of ADD intervention. We determined the items as patient quality of life (QOL), medical costs, caregiver QOL, public long-term care costs, and informal care costs.

EXPERT OPINION

There are several limitations to how QOL is measured, particularly for patients with ADD. Public long-term care costs represent a substantial proportion of total costs and should be included in the assessment and decision-making of ADD, even from the payer's perspective. Following that, a process is required to take informal care costs into account in decision-making, regardless of whether they are included or not in a base-case analysis. The importance of other elements of care burden that cannot be quantitatively measured should also be recognized and reflected in decision-making.

Impact of informal care with multiple medical devices on caregiver burden: A cross-sectional national survey in Japan

Family caregivers provide long-term, home-based, informal medical care to patients with special healthcare needs. We examined whether informal care involving medical device use is associated with caregiver burden, considering potential risk variables as moderators. Data were collected from March to May 2019 through a Japanese public visiting care system. This system is offered to patients with severe chronic or intractable disease or impairment. After contacting government-certified offices that provide visiting care systems, the offices that agreed to participate invited dyads of patients and caregivers to complete our questionnaire. To focus on new parameters other than the caregiver factor that had been clarified previously, we aimed to analyse the data from patient-caregiver dyads. Using a questionnaire-based cross-sectional design, we asked participants about caregiver and patient characteristics, care types, and caregiver burden using the Zarit Caregiver Burden Interview. Logistic regression analyses were conducted to test the association between caregiver burden and informal medical care. Data from 371 complete patient-caregiver dyads were analysed; 49.3% showed high caregiver burden, and 40.4% were administering at least one informal medical care procedure. Univariate analyses indicated a relationship between high caregiver burden among caregivers who slept less, provided care for longer periods daily, performed medical care procedures and cohabited with patients. Importantly, logistic regression analyses indicated a significant relationship between high caregiver burden and care involving multiple medical procedures (i.e. 4-6 procedures with medical devices; adjusted odds ratio (AOR) = 2.03, 95% confidence intervals (95% CI) = [1.01, 4.09]). In propensity-matched participants (n = 314), results continued to show that multiple medical care procedures were significantly related to high caregiver burden (AOR = 2.19, 95% CI [1.14-4.22]). The effects of non-medical informal care on caregiver burden were moderate. This result suggests that more intensive interventions are required for patients with multiple medical care needs to reduce caregiver burden.

How does long-term care impact the psychological wellbeing of older adults in different care policy contexts in the Netherlands?: A comparison of 1998, 2008 and 2018: A comparison of 1998, 2008 and 2018

Receipt of long-term care (LTC) is generally associated with worse psychological wellbeing for community-dwelling older adults. In addition to objective features of care use (e.g. formal vs. informal care), the subjective evaluation of care provision in terms of perceived sufficiency might be particularly predictive of one's wellbeing but is seldomly considered in the literature. Substantial changes in the availability of long-term care in past decades raise the question to what extent these effects, if present, are consistent over historic time. The present study, therefore, aims at better understanding the associations between types of LTC use and perceived care sufficiency on psychological wellbeing in a changing LTC context in the Netherlands. Data from the Longitudinal Aging Study Amsterdam (LASA) were used from three points in time: 1998 (N = 582), 2008 (N = 459) and 2018 (N = 415). At each wave, participants were between 75 and 85 years of age and living independently. The results show that after adjusting for age, gender, education and health, using formal LTC had a negative effect on depressive symptoms only in 2018, but that this effect was not significantly worse compared to previous cohorts. Perceived care sufficiency was consistently negatively associated with depressive symptoms in all three points in time. This suggests that despite a less generous Dutch LTC system, psychological wellbeing among LTC users remains stable. Perceiving care provision as sufficient, however, can help older adults maintain psychological wellbeing and should be considered by researchers and policymakers that aim to improve care recipients' wellbeing.