Validity and Responsiveness of Preference-Based Quality-of-Life Measures in Informal Carers: A Comparison of 5 Measures Across 4 Conditions

OBJECTIVES

Carer quality-of-life (QoL) effects are recommended for inclusion in economic evaluations, but little is known about the relative performance of different types of QoL measures with carers. This study evaluated the validity and responsiveness of 3 care-related QoL measures (the Carer Experience Scale [CES], CarerQoL-7D, and ASCOT-Carer), 1 health-related QoL measure (the EQ-5D-5L), and 1 generic QoL measure (the ICECAP-A).

METHODS

Validity and responsiveness were assessed in a UK sample of informal carers of adults with dementia, stroke, mental illness, or rheumatoid arthritis. A questionnaire containing the 5 QoL measures was posted to carers identified through the Family Resources Survey (N = 1004). Hypotheses regarding the anticipated associations between constructs related to the QoL of carers were tested to investigate construct validity and responsiveness.

RESULTS

Each measure exhibited some level of construct validity. In general, larger effect sizes and stronger associations were detected for the ASCOT-Carer and ICECAP-A measures in the pooled sample and across all conditions. The 5 measures did not exhibit clear responsiveness to changes over a 12-month period in care recipient health status or hours of care provided per week.

CONCLUSION

The results of this study provide initial evidence of the validity of care-related, health-related, and generic QoL (capability) measures in informal carers of adults with 4 highly prevalent conditions. Care-related measures were not always more sensitive to constructs associated with QoL of carers compared with generic measures. The performance of the ICECAP-A was comparable with that of the best-performing care-related measure, the ASCOT-Carer.

The care receivers perspective: How care-dependent people struggle with accepting help from family members, friends and neighbours

In many countries in north-western Europe, the welfare state is changing, and governments expect a great deal of informal care. In the Netherlands, citizens are also increasingly expected to rely on informal instead of professional care. In this study, we aim to determine to what extent Dutch care-dependent people want to rely on social network members and what reasons they raise for accepting or refusing informal care. To answer this question, we observed 65 so-called 'kitchen table talks', in which social workers assess citizens' care needs and examine to what extent relatives, friends and/or neighbours can provide help and care. We also interviewed 50 professionals and 30 people in need of care. Our findings show that a great deal of informal care is already given (in 46 out of 65 cases), especially between people who have a close emotional bond. For this reason, people in need of care often find it difficult to ask their family members, friends or neighbours for extra assistance. People are afraid to overburden their family members, friends or neighbours. Another reason people in need of care raise against informal care is that they feel ashamed of becoming dependent. Although the government wants to change the meaning of autonomy by emphasising that people are autonomous when they rely on social network members, people who grew up in the heyday of the welfare state feel embarrassed and ashamed when they are not able to reciprocate. Our findings imply that policymakers and social professionals need to reconsider the idea that resources of informal care are inexhaustible and that citizens can look after each other much more than they already do. It is important that social policymakers approach the codes and norms underlying social relations more cautiously because pressure on these relations can have negative effects.

Impact of Formal Care Use on Informal Care from Children after the Launch of Long-Term Care Insurance in Shanghai, China

The impact of formal care (co-paid by long term care (LTC) insurance) on informal care is critical to the improvement and promotion of public policy. We conducted an interview-based survey to examine how the use of formal care impacts the use of informal care in Shanghai, which was one of China's first long-term insurance pilots in 2016. In addition to total informal care time, the following four types of informal care were considered: (1) household activities of daily living (HDL) tasks, (2) activities of daily living (ADL) tasks, (3) instrumental activities of daily living (IADL) tasks, and (4) supervision tasks. Of the 407 families, an average of 12.36 h (SD = 6.70) of informal care was crowded out each week. Among them, ADL tasks, HDL tasks, and supervision tasks were reduced an average of 4.60 (SD = 3.59), 5.50 (SD = 3.38), and 2.10 h (SD = 3.06) per week, respectively. Each additional hour of formal care reduced 0.473 h of informal care. Care recipients' gender and health status were also determined to be associated with crowding out hours of informal care. These findings can be utilized as empirical evidence for decision-makers to consider the scope of funding for formal care, and this study provides comparable results to developing countries and regions.

Experiences of Older Spousal Caregivers for Caring a Person with a Memory Disorder

Memory disorders have become a major public, social, and health concern among the aging population, and many of those who are affected are cared for at home by their spouse. The aim of this qualitative study was to describe the individual experiences of 10 older caregivers who were looking after a spouse with a memory disorder in 2016. Data were collected from volunteers who were recruited from a memory clinic at a Finnish health center using the thematic interview method and processed using inductive content analysis. The participants were six female and four male caregivers who had been married for over 10 years. The results indicated that caring for a spouse with a memory disorder involved a number of factors. These included the impact of social networks and changes in their everyday life, collaboration with service providers, and the caregivers’ well-being. However, our study showed that caregivers felt that the formal multiprofessional services they received were fragmented, which means that they were less likely to provide a holistic approach to caregivers’ situations. Better multiprofessional cooperation is needed in the community, including services such as memory clinics, home care and practical services, day centers, and short-term respite in care homes.

The Double-Burden Effect: Does the Combination of Informal Care and Work Cause Adverse Health Outcomes Among Females in China?

Objective: This study investigates the impact of informal care and work stress on women's health and further disentangles this effect through intensity and channel analysis. Method: This research uses the 2000-2015 China Health and Nutrition Survey and employs the propensity score matching model with fixed effects. Results: The care and work burden significantly increases the probability of women suffering from chronic diseases, being underweight or overweight, and self-reporting poor health by 0.63%, 1.69%, and 2.35%, respectively. This double-burden effect is exacerbated as the care and work hours increase. Women who care for more than 20 hr and work for more than 50 hr per week experience the most serious health decline. We further find that the double burden leads to health deterioration through channels of reduced exercise and increased psychological stress. Discussion: This study provides a reliable decision-making basis for policy makers to formulate strategies for informal caregivers in China.

Volunteers and Informal Caregivers' Contributions and Collaboration with Formal Caregivers in Norwegian Long-term Care

The article illuminates and discusses the realism of policy-makers' goals to increase involvement of volunteers and informal caregivers in long-term care services in Norway. Drawing on multiple data sources, the article investigates how commonplace volunteering and informal care are in long-term care, and it explores challenges experienced in collaboration between formal caregivers and volunteers and informal caregivers. The results show that only 4.4 percent of the Norwegian population carry out unpaid, voluntary work in long-term care. Twenty percent regularly provide informal care to someone with special care needs. Knowledge/information gaps and lacking coordination are common collaboration challenges between formal caregivers and volunteers/informal caregivers. The limitations identified in the current collaboration environment should be used actively by both policy makers and the practice field to critically assess goals and strategies for involvement and improving collaboration practices.

Economic burden of stroke across Europe: A population-based cost analysis

INTRODUCTION

In 2017, 1.5 million people were diagnosed with stroke, 9 million were living with stroke and 0.4 million died because of stroke in 32 European countries. We estimate the economic burden of stroke across these countries in 2017.

PATIENTS AND METHODS

In a population-based cost analysis, we evaluated the cost of stroke. We estimated overall health and social care costs from expenditure on care in the primary, outpatient, emergency, inpatient and nursing/residential care settings, and pharmaceuticals. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients, lost earnings due to premature death and costs associated with individuals who temporarily or permanently left employment because of illness.

RESULTS

In 2017 stroke cost the 32 European countries under analysis €60 billion, with health care accounting for €27 billion (45%), representing 1.7% of health expenditure. Adding the costs of social care (€5 billion), annual stroke-related care costs were equivalent to €59 per citizen, varying from €11 in Bulgaria to €140 in Finland. Productivity losses cost €12 billion, equally split between early death and lost working days. A total of €1.3 billion hours of informal care were provided to stroke survivors, costing Europe €16 billion.

CONCLUSION

Our study provides a snapshot of the economic consequences posed by stroke to 32 European countries in 2017. It also strengthens and updates the evidence we have gathered over the last 15 years, indicating that the costs of stroke are rising, partly due to an ageing population.

Reciprocity, Autonomy, and Vulnerability in Men's Experiences of Informal Cancer Care

Men are increasingly participating, and acknowledging their roles, as informal carers. Yet, there has been comparatively little exploration of their experiences therein, especially within the context of cancer care. Here, drawing on semi-structured qualitative interviews with 16 Australian male carers for a relative with cancer, and using constructivist grounded theory, we explore their experiences of informal caring. Our analysis highlights a series of tensions, including the following: the meanings and practicalities of care provision including notions of reciprocity, duty, autonomy, and interdependence; the discomforts of dependency and vulnerability; and the complicated moralities that inflect "caring well." Given the shifting dynamics around informal care, we argue for increased attention to the affective tensions that arise at the nexus of moralities and masculinities in informal caring relations, especially as they are articulated in the context of illness, affliction, and dependency.

Health Insurance and Long-Term Care Services for the Disabled Elderly in China: Based on CHARLS Data

Purpose

This paper aimed to explore the relationship between the different factors, especially health insurance, and the availability of long-term care (LTC) services, among the disabled elderly.

Methods

Based on the data of China Health and Retirement Longitudinal Study (CHARLS), the logistic regression model was utilized to evaluate the influence of the different factors, especially health insurance, on the availability of long-term care services.

Results

Our findings show some interesting results. Firstly, the findings suggest that informal long-term care (LTC) services for elderly persons with disabilities heavily depend on a family member from different health insurance groups. About 80.733% of the disabled elderly depend on a family member as their primary caregivers. Secondly, other influence factors such as income and area of residence were also significantly related to the availability of long-term rental services. Thirdly, Health insurance is a very important factor influencing the availability of Long-term care services both in urban and rural areas (p<0.001) but Income is the most interesting variable.

Conclusion

Based on our results, the growth and integration of formal long-term care (LTC) services should be facilitated. Firstly, policymakers can encourage formal long-term care (LTC) services from a variety of sources to work together to increase overall supply capability. Secondly, the long-term living security needs of people who do not have health insurance should be regulated through subsidies according to the economic status.

Factors associated with long-term impact on informal caregivers during Alzheimer's disease dementia progression: 36-month results from GERAS

OBJECTIVE

To identify, in caregivers of patients with Alzheimer's disease (AD) dementia, factors associated with subjective (personal, physical, emotional, and social) and objective (informal caregiver time and costs) caregiver burden.

DESIGN

Prospective longitudinal European observational study: post-hoc analysis.

SETTING

Clinic.

PARTICIPANTS

Community-dwelling patients in France and Germany aged ≥ 55 years (n = 969) with probable AD and their informal caregivers.

MEASUREMENTS

Mini-Mental State Examination (MMSE), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), 12-item Neuropsychiatric Inventory (NPI-12), Zarit Burden Interview (ZBI), informal caregiver basic and instrumental ADL hours (Resource Utilization in Dementia instrument), and informal caregiver costs. Mixed-effect models of repeated measures (MMRM) were run, including baseline and time-dependent covariates (change from baseline [CFB] to 18 months in MMSE, ADCS-ADL, and NPI-12 scores) associated with CFB in ZBI score/informal caregiver time over 36 months (analyzed using linear regression models) and informal caregiver costs over 36 months (analyzed using generalized linear models).

RESULTS

Greater decline in patient function (ADCS-ADL) over 18 months was associated with increased subjective caregiver burden (ZBI), hours, and costs over 36 months. Increased behavioral problems (NPI-12) over 18 months also negatively impacted ZBI. Cognitive decline (MMSE) over 18 months did not affect change in caregiver burden.

CONCLUSIONS

Long-term informal caregiver burden was driven by worsening functional abilities and behavioral symptoms but not cognitive decline, over 18 months in community-dwelling patients with AD dementia. Identifying the drivers of caregiver burden could highlight areas in which interventions may benefit both caregivers and patients.

Elder Care in Iran: A Case with a Unique Demographic Profile

Iran will encounter rapid population aging, resulting from increased life expectancy and fluctuating fertility rates during its eight-year war with Iraq (1980-1988). The need for long-term care in Iran is expected to increase dramatically. The purpose of this paper is to examine Iran's health care system and informal care upon discussing its demographic profile. Scant attention of policymakers on the country's demographic transformation has resulted in limited resources for quality elder care as well as budget constraints for relevant research. In this demographic and political context, the costs of formal care, the shortage of health workforce and infrastructures (i.e., long-term care facilities), and the continuation of traditional cultural values are the most significant reasons for heavy reliance on informal elder care. In addition to inadequate systemic support, the prevalence of domestic violence, abuse, and infantalization are largely attributable to insufficient knowledge among informal elder carers.

Cancer caregivers' experiences of prognosis in Australia: a qualitative interview study

OBJECTIVES

Forecasting survival in cancer is a particularly challenging facet of oncological work and can involve complex interactions with patients and their families. While there is considerable research on patient experiences of being provided with, or becoming aware of, their prognosis, there has been much less emphasis placed on the experiences of caregivers. The aim of this paper was to examine caregivers' experiences of prognosis.

DESIGN

This study used semistructured interviews; transcripts were analysed thematically using the framework approach. These data are part of a larger research project focused on experiences of cancer survivorship.

SETTING

Recruitment was from two metropolitan hospitals in Queensland, Australia.

PARTICIPANTS

50 caregivers of patients living with cancer and receiving treatment at two metropolitan hospitals (32% male, 68% female) participated in this study.

RESULTS

Four main themes were identified: (1) caregivers' uncertainty around the meaning and implications of prognosis, (2) caregivers' sense of exclusion in prognostic conversations, (3) the practice of situating prognosis within a context of hope and (4) the precarious balance between realism, optimism and strategic 'ignorance'.

CONCLUSIONS

Caregivers are in many respects the unseen third party of prognostic communication. Developing a better understanding of caregivers' perceptions of prognosis, including how this may be challenged, accepted or otherwise, is important in engaging caregivers in the process of communicating prognostic information. Facilitating greater participation by caregivers in prognostic conversations could potentially address evident complexities and even improve the experiences of all stakeholders in cancer care settings.

The kids are alright - labour market effects of unexpected parental hospitalisations in the Netherlands

Unexpected negative health shocks of a parent may reduce adult children's labour supply via informal caregiving and stress-induced mental health problems. We link administrative data on labour market outcomes, hospitalisations and family relations for the full Dutch working age population for the years 1999-2008 to evaluate the effect of an unexpected parental hospitalisation on the probability of employment and on conditional earnings. Using an event study difference-in-differences model combined with coarsened exact matching and individual fixed effects, we find no effect of an unexpected parental hospitalisation on either employment or earnings for Dutch men and women, and neither for the full population nor for the subpopulations most likely to become caregivers. These findings suggest that the extensive public coverage of formal long-term care in the Netherlands combined with widespread acceptance of part-time work provides sufficient opportunities to deal with adverse health events of family members without having to compromise one's labour supply.

Carer Social Care-Related Quality of Life Outcomes: Estimating English Preference Weights for the Adult Social Care Outcomes Toolkit for Carers

BACKGROUND

There is increasing interest in assessing the effects of interventions on older people, people with long-term conditions and their informal carers for use in economic evaluation. The Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) is a measure that specifically assesses the impact of social care services on informal carers. To date, the ASCOT-Carer has not been preference-weighted.

OBJECTIVES

To estimate preference-based index values for the English version of the ASCOT-Carer from the general population in England.

METHODS

The ASCOT-Carer consists of 7 domains, each reflecting aspects of social care-related quality of life in informal carers. Preferences for the ASCOT-Carer social care-related quality of life states were estimated using a best-worst scaling exercise in an online survey. The survey was administered to a sample of the general adult population in England (n = 1000). Participants were asked to put themselves into the hypothetical state of being an informal carer and indicate which attribute they thought was the best (first and second) and worst (first and second) from a profile list of 7 attributes reflecting the 7 domains, each ranging at a different level (1-4). Multinomial logit regression was used to analyze the data and estimate preference weights for the ASCOT-Carer measure.

RESULTS

The most valued aspect by English participants was the 'occupation' attribute at its highest level. Results further showed participants rated having no control over their daily life as the lowest attribute-level of all those presented. The position of the 7 attributes influenced participants' best and worst choices, and there was evidence of both scale and taste heterogeneity on preferences.

CONCLUSION

This study has established a set of preference-based index values for the ASCOT-Carer in England derived from the best-worst scaling exercise that can be used for economic evaluation of interventions on older individuals and their informal carers.

Informal caregivers' judgements on sharing care with home care professionals from an intersectional perspective: the influence of personal and situational characteristics

The European policy emphasis on providing informal care at home causes caregivers and home care professionals having more contact with each other, which makes it important for them to find satisfying ways to share care. Findings from the literature show that sharing care between caregivers and professionals can be improved. This study therefore examines to what degree and why caregivers' judgements on sharing care with home care professionals vary. To improve our understanding of social inequities in caregiving experiences, the study adopts an intersectional perspective. We investigate how personal and situational characteristics attached to care judgements are interwoven. Using data of the Netherlands Institute for Social Research, we conducted bivariate and multivariate linear regression analysis (N = 292). We combined four survey questions into a 1-4 scale on 'caregiver judgement' (α = 0.69) and used caregivers' personal (such as gender and health status) and situational characteristics (such as the care recipient's impairment and type of care) as determinants to discern whether these are related to the caregivers' judgement. Using a multiplicative approach, we also examined the relationship between mutually constituting factors of the caregivers' judgement. Adjusted for all characteristics, caregivers who provide care to a parent or child with a mental impairment and those aged between 45 and 64 years or with a paid job providing care to someone with a mental impairment are likely to judge sharing care more negatively. Also, men providing care with help from other caregivers and caregivers providing care because they like to do so who provide domestic help seem more likely to be less satisfied about sharing care. This knowledge is vital for professionals providing home care, because it clarifies differences in caregivers' experiences and hence induce knowledge how to pay special attention to those who may experience less satisfaction while sharing care.

The Sustainable Development Agenda Needs to Include Long-term Care

The rapid ageing of populations around the world and the associated shift in the burden of disease from infectious to chronic conditions are creating complex challenges for national governments. Addressing the needs of these older populations in a sustainable and equitable way, will be a fundamental pillar of socioeconomic development in the 21^st Century. The World Health Organization (WHO) Global strategy and action plan on ageing and health, which was adopted by all the Organization's 194 Member states in 2016, provides a clear framework for global action. One critical priority is to establish sustainable and equitable long-term care systems in every country. WHO defines long-term care as "the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity". These activities include both social care and health care, as well as contributions from other sectors, such as education or transport. And these activities need to be effectively coordinated if they are to efficiently, equitably and sustainably meet the needs of older people. This requires the stewardship of governments to ensure that: care is accessible and affordable; the rights of older people to lives of meaning and dignity are upheld regardless of their physical or mental capacity; services are oriented around the individual's specific needs; caregivers are supported; the workforce (both paid and unpaid) are treated fairly; and older people's intrinsic capacity is maintained for as long as possible. WHO has proposed three inter-related strategies to establish and sustain long-term care systems. System infrastructure needs to be developed and continually improved. The capacity of the workforce needs to be strengthened and families and communities must be supported. And the care and support provided needs to be more person-centred and integrated, underpinned by minimum standards and accreditation for care providers. This paper outlines some of the critical issues confronting governments in countries at all levels of development if this ambitious vision is to be achieved.

Home care for terminally ill patients: the experiences of family caregivers with and without paid work

OBJECTIVES

To facilitate care at the end of life at home, support from family caregivers is crucial. A substantial number of these family caregivers also work. Work in relation to care for terminally ill patients has received limited attention. To better understand the context in which these family caregivers provide care, we provide a detailed overview of the situation and experiences of family caregivers of terminally ill patients at home, with and without paid work.

METHODS

We used a pooled cross-section of data from the Dutch Informal Care Study, collected in 2014 and 2016. All working and non-working family caregivers of terminally ill patients at home were included (n=292).

RESULTS

Working family caregivers reported more care tasks, and shared care tasks with others more often than non-working caregivers. No differences between working and non-working caregivers were found in negative and positive experiences. Non-working caregivers provided care more often because the care recipient wanted to be helped by them or because there was no one else available than working caregivers. About 70% of the working caregivers were able to combine work and family caregiving successfully.

CONCLUSIONS

Working and non-working family caregivers of terminally ill patients at home have similar burden and positive experiences. Working family caregivers vary in their ability to combine work and care. Although the majority of working family caregivers successfully combine work and care, a substantial number struggle and need more support with care tasks at home or responsibilities at work.

Determinants of Burden and Satisfaction in Informal Caregivers: Two Sides of the Same Coin? The CUIDAR-SE Study

The aim of this study conducted in Spain was to analyze and compare burden, severe burden, and satisfaction among informal caregivers in relation to health-related quality of life (HRQoL), type and duration of caregiving, perceived social support, and use of social and health care services. We performed multivariate analyses to identify variables associated with caregiver burden, severe burden, and satisfaction with caregiving, stratified by gender. The results showed that secondary or third-level education, performance of ungratifying tasks, negative coping with caregiving, and more years providing care were associated with greater burden. Variables with protective effect were better perceived health of the person being cared for, better caregiver HRQoL, and high perceived social support. Women were 75% more likely to experience severe burden compared with male caregivers. Burden was reduced by high perceived social support in the case of women and by high caregiver HRQoL in the case of men. The main determinant of caregiving satisfaction for both men and women was perceived social support (OR = 3.11 and OR = 6.64). This study shows the need for interventions that promote gender equality and social support as a means of relieving burden and severe burden and improving satisfaction in both male and female caregivers.

Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)-study

AIM

The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study.

BACKGROUND

The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy, and promoting practice improvement.

DESIGN

The Living Arrangements for people with Dementia -study monitors changes in - quality of - care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centred care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach.

METHODS

The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers, and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323,088 and partly funded by the participating care homes.

DISCUSSION

Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia.

IMPACT

Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention.

TRIAL REGISTRATION

Not applicable. This article does not report the results of a healthcare intervention on human participants.

Senior Co-Housing in the Netherlands: Benefits and Drawbacks for Its Residents

Senior co-housing communities offer an in-between solution for older people who do not want to live in an institutional setting but prefer the company of their age peers. Residents of co-housing communities live in their own apartments but undertake activities together and support one another. This paper adds to the literature by scrutinizing the benefits and drawbacks of senior co-housing, with special focus on the forms and limits of social support and the implications for the experience of loneliness. Qualitative fieldwork was conducted in eight co-housing communities in the Netherlands, consisting of document analysis, interviews, focus groups, and observations. The research shows that co-housing communities offer social contacts, social control, and instrumental and emotional support. Residents set boundaries regarding the frequency and intensity of support. The provided support partly relieves residents’ adult children from caregiving duties but does not substitute formal and informal care. Due to their access to contacts and support, few residents experience social loneliness. Co-housing communities can potentially also alleviate emotional loneliness, but currently, this happens to a limited degree. The paper concludes with practical recommendations for enhancing the benefits and reducing the drawbacks of senior co-housing.

Effectiveness of an in-home respite care program to support informal dementia caregivers: A comparative study

OBJECTIVES

Dementia is a major public health problem with important physical, psychosocial, emotional, and financial consequences for patients, their caregivers, and society. Since patients prefer to be managed at home, extensive research has been conducted into effectiveness of psychosocial interventions to support informal caregivers. The aim of this study was to assess the effectiveness of an in-home respite care program.

METHODS

In a prospective quasi-experimental study, 99 dyads who received an in-home respite care program were compared at 6 months post-baseline, with 99 matched dyads receiving standard dementia care. Additionally, the short-term effect of the program was evaluated 14 to 15 days post-intervention. The primary outcome was caregiver burden. The secondary outcomes were: desire to institutionalize the patient, caregiver quality of life, and frequency and impact of behavioral problems. Mixed model analyses were performed to evaluate the impact of the intervention.

RESULTS

After 6 months, no significant difference on caregiver burden was observed, but intervention group caregivers had a significant lower desire to institutionalize the patient compared with control group caregivers (adj.diff = -0.51; p = .02). Shortly after the program, intervention group caregivers also had a significant lower role strain (adj.diff = 0.75; p = .05), and a lower burden on social and family life (adj.diff = 0.55; p = .05) compared with baseline.

CONCLUSIONS

This study was the first comparative study to investigate effectiveness of an in-home respite care program to support informal caregivers of persons with dementia. The results partly confirm earlier positive findings from explorative studies.

Optimizing access to and use of formal dementia care: Qualitative findings from the European Actifcare study

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi-structured in-depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross-national analysis. Overall, analysis of the in-depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease-related factors and system-related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care-giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision-making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.

Caring hours and possible need for employment support among primary carers for adults with mental illness: Results from an Australian household survey

Intensive unpaid caring is associated with greater likelihood of not being employed, but impacts for mental health carers specifically remain unknown. This study aimed to: (a) examine the association between caring intensity and not being employed for primary mental health carers, (b) ascertain whether this relationship differs from that for other disability carers, (c) enumerate Australian primary mental health carers with a possible need for employment support and (d) describe these carers' unmet support needs and barriers to employment. Co-resident, working age primary mental health (n = 137) and other disability carers (n = 821) were identified in the Survey of Disability, Ageing and Carers (collected July-December 2015). Multiple logistic regression analyses examined associations between levels of caring intensity (1-9, 10-19, 20-39, 40+ hr/week) and not being employed. A 'possible need for employment support' indicator was derived from information about current employment status, caring hours, past impact of caring on employment and desire for more work or workplace accommodations. After controlling for demographic and caring role factors, mental health carers providing 40+ hr of care weekly had greater odds of not being employed compared to carers providing <10 hr (AOR 13.38, 95% CI: 2.17-82.39). For other disability carers, the odds of not being employed were also higher among those providing 20-39 hr of care (AOR 3.21, 95% CI: 2.18-4.73). An estimated 54.1% (95% CI: 43.1-64.8) of carers had a possible need for employment support, with the proportion increasing as level of caring intensity increased. Of carers who were not employed, 42.2% (95% CI: 30.3-55.0) reported a desire to work, and the main reported barrier was no alternative care arrangements or disruption to the person supported. Findings suggest that improving employment participation for mental health carers requires a greater balance between unpaid care and access to formal services for people with mental illness.

Informal Carers Training: In-group Social Learning as an Effective Method for Quality Care Empowerment

In this article, a method of in-group social learning used for informal carers training is presented. This method was developed by Jože Ramovš and his team at the Anton Trstenjak Institute of Gerontology and Intergenerational Relations primary for the fields of holistic health prevention and aging; later on, special attention has been given to its development for training of informal carers as the latter often carry the most significant part of the long-term care burden. In the first part of the article, the need for such a method is discussed through a review of current international demographic and long-term care situations. In the second part, a novel method for the training of informal carers is introduced. Finally, the results of the evaluation analysis of 453 persons who participated in the training are presented and compared with the results of the nationally-representative study. The results show that the method of in-group social learning has a great potential for quality care empowerment of informal carers as well as for holistic development of intergenerational solidarity in the modern age. Furthermore, they open new possibilities for research and present directions for further development and implementation of the described method within this important field.

Burden of caring for people with dementia - comparing family caregivers and professional caregivers. A descriptive study

Purpose

Caring for people with dementia is known to be accompanied by burden for the caregiver. This study aims at describing family caregivers’ and professional caregivers’ burden immediately after hospitalization of the person with dementia.

Materials and methods

Twenty-five family caregivers and twenty-five professional caregivers of the locked gerontopsychiatric ward of a hospital in Northern Germany completed a questionnaire (BIZA-D-PV), which was evaluated in matched samples. The distribution of frequencies, differences in mean values and correlations were determined. Furthermore, family caregivers were categorized into risk groups.

Results

Family caregivers perceived a higher burden due to cognitive impairment as well as aggressive and disoriented behavior of the person with dementia compared to professional caregivers. Differences with regard to care tasks were not detected. Female family caregivers rated a higher burden compared to male family caregivers, whereas in the sample of professional caregivers males perceived a higher burden. Correlations between several dimensions of burden and caregivers’ age, severity of dementia as well as physical symptoms were described. Categorizing family caregivers into risk groups showed high risks for depression of the caregiver, violence against the person with dementia and institutionalization of the person with dementia within the next months in 44–72% of cases.

Conclusion

Our findings emphasize the importance of acquiring knowledge about caregivers’ burden in the course of time in order to develop targeting interventions to decrease caregivers’ burden and to prevent hospital admissions of people with dementia due to a crisis of home caring.