Determinants of informal care time, distress, depression, and quality of life in care partners along the trajectory of Alzheimer's disease

The impact of caregiver burden on sense of coherence in Chinese family caregivers of people with dementia: the mediating effect of family resilience

OBJECTIVES

The caregiver burden frequently experienced by family members tending to people with dementia significantly impacts their psychological well-being and family quality of life. Thus, the objective of this study is to examine the link between caregiver burden and sense of coherence (SOC) among Chinese caregivers of people with dementia, as well as to explore the mediating effect of family resilience on this relationship.

METHODS

This cross-sectional research took place from November 2023 to June 2024 across two public tertiary hospitals and a community setting in Hangzhou Province, China. In total, 326 family caregivers who cared for members with dementia were recruited. Data were collected using the Zarit Burden Interview (ZBI), the Family Resilience Rating Scale (FRAS), and the Sense of Coherence Scale (SOC- 13). The relationships between caregiver burden, family resilience, and sense of coherence (SOC) were analyzed using Pearson correlation techniques. Furthermore, the mediating effect of family resilience on the relationship between caregiver burden and SOC was assessed utilizing Amos 27.0.

RESULTS

In this study, the total scores of caregiver burden, family resilience, and SOC were 45.64 ± 17.04, 175.30 ± 34.38, and 52.29 ± 15.91 among family caregivers of people with dementia. Caregiver burden, family resilience, and SOC of family caregivers were at a moderate to high level. Caregiver burden was negatively correlated with family resilience and SOC (p < 0.05). The mediating effect of family resilience on the relationship between caregiver burden and SOC was found to be significant (p < 0.05), accounting for 45.9%.

CONCLUSIONS

In this research, caregiver burden and family resilience emerged as critical factors influencing SOC. Additionally, the family resilience served as an important mediator in the connection between caregiver burden and SOC. Healthcare professionals should pay attention to the family dynamics of people with dementia and adopt intervention programs that focus on reducing caregiver burden and improving family resilience to improve the SOC of family caregivers of people with dementia.

The influential factors of depression among caregivers of children with Cleft Lip and/or Palate: a path analysis based on diathesis-stress theoretical model

BACKGROUND

Depression is the most common psychological phenomenon among caregivers of children with Cleft Lip and/or Palate and affects the quality of life, treatment satisfaction, children's self-esteem and parent-child relationship. However, Existing studies have limited explanations for the mechanisms that lead to depression in caregivers of children with Cleft Lip and/or Palate. The present study aimed to identify factors influencing depression among caregivers of children with Cleft Lip and/or Palate and to provide a reference point and new ideas for future research.

METHODS

This cross-sectional study investigated 248 caregivers at two Cleft Lip and/or Palate treatment centers in China, spanning from April 2019 to July 2020. The diathesis-stress model was used to construct the model, and data analysis was conducted using SPSS 26.0 and AMOS 25.0. Path analysis was employed to test the hypothetical model, and the fit of the model was evaluated using Chi-Square/degree of freedom, Goodness-of-Fit Index, Normed Fit Index, Relative Fit Index, Incremental Fit Index, Tacker-Lewis Index, Comparative Fit Index and Root Mean Square Error of Approximation.

RESULTS

The study found that the average level of depression among caregivers of children with Cleft Lip and/or Palate was 4.83 (4.79). Additionally, 43.5% of caregivers exhibited depressive symptoms. The fit of the modified path model was found to be satisfactory, with the following indices: Chi-Square/degree of freedom = 1.881, Goodness-of-Fit Index = 0.986, Normed Fit Index = 0.973, Relative Fit Index = 0.919, Incremental Fit Index = 0.987, Tucker-Lewis Index = 0.960, Comparative Fit Index = 0.987, and Root Mean Square Error of Approximation (RMSEA) = 0.060. The results indicated that parenting stress had the greatest direct impact on depression, followed by hope. Indirect effects on depression were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.

CONCLUSIONS

This study suggests that depression in caregivers of children with Cleft Lip and/or Palate was leadingly influenced by parenting stress and hope. Strategies aimed at the key factors are expected to decrease depression.

Neuropsychiatric Symptoms in Dementia

OBJECTIVE

This article discusses the prevalence, pathophysiology, assessment, and management of neuropsychiatric symptoms in patients with dementia.

LATEST DEVELOPMENTS

There is a growing body of evidence localizing neuropsychiatric symptoms in dementia to frontal circuits in the brain, as well as relating them to pathologic changes seen in different dementias. Although very few medications have been approved by the US Food and Drug Administration (FDA) for the treatment of neuropsychiatric symptoms in dementia, there are more clinical trials showing the benefit of antidepressants, stimulants, and antipsychotics. In line with that trend, in 2023, the FDA approved the use of brexpiprazole, an atypical antipsychotic, for the treatment of agitation in Alzheimer disease dementia.

ESSENTIAL POINTS

Neuropsychiatric symptoms are a core feature of all dementias and often emerge before cognitive symptoms manifest. They are highly clinically significant symptoms that disrupt the lives of patients and care partners and greatly influence the decision to place patients in long-term care facilities. The first line of treatment for neuropsychiatric symptoms in dementia is nonpharmacologic behavioral modification, but clinicians often must supplement this intervention with medications using an empiric approach.

The influential factors of anxiety among caregivers of children with CL/P: a path analysis based on diathesis-stress theoretical model

BACKGROUND

This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P).

METHODS

A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects.

RESULTS

The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.

CONCLUSION

In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.

Burden and quality of life of family caregivers of Alzheimer's disease patients: the role of forgiveness as a coping strategy

OBJECTIVES

This study aimed to evaluate the variables that  were associated, contributed and moderated quality of life (QoL) and burden in family caregivers.

METHODS

A total of 130 participants were evaluated using the following instruments: Depression, Anxiety and Distress Scale; Index of Family Relations; Heartland Forgiveness Scale; Burden Interview Scale; Short Form Health Survey.

RESULTS

Being a younger caregiver, less distress, better family relationships and greater use of forgiveness were associated with more QoL. Also, family caregivers who chosethe caregiving role, less distress, better family relationships and greater use of forgiveness showed lower levels of burden. Age, distress and forgiveness contributed to QoL. In turn, the choice to become a family caregiver, distress, and forgiveness contributed to burden. Forgiveness played a moderating role in the relationship between family relationships and burden.

CONCLUSION

Based on the results, there is a need to intervene in older family caregivers, particularly those who did not choose to become a caregiver, who report greater distress, have worse family relationships, and display less use of forgiveness, in order to decrease their burden and promote QoL.

Psychosocial factors affected by burden in family caregivers of people with Alzheimer's disease

The world's population is experiencing an aging process, which is resulting in an increase in diseases such as Alzheimer's disease. Consequently, more and more people need care, which can lead to overload and harm to their family's quality of life.

Objective

Identify the psychosocial factors affected by the burden on family caregivers of people with Alzheimer's disease.

Methods

Forty-nine family caregivers of people with Alzheimer's disease, from a city in Minas Gerais, Brazil, participated in the study. They filled out a form of sociodemographic variables, and answered the Burden Interview Scale (BI-Zarit), Quality of Life in Alzheimer's Disease Caregiver version (CQoL-AD), the Depression, Anxiety and Stress Scale (DASS-21), the Mindfulness and Awareness Scale (MAAS) and the Clinical Dementia Rating Scale (CDR).

Results

All participants were female with an average age of 54.26 (±8.99). Daughters comprised 77.55% of the sample, and 34.69% were sole caregivers. The Bi-Zarit scale positively and significantly correlated with DASS-21 Depression (r=0.440; p=0.002), DASS-21 Anxiety (r=0.415; p=0.003), DAAS-21 Stress (r=0.583; p<0.001). On the other hand, it showed a negative correlation with MAAS (r=-0.429; p=0.002) and CQoL-AD (r=-0.533; p<0.001).

Conclusion

This study demonstrates that family caregivers of people with Alzheimer's disease may be overloaded, and that the heavier the burden, the lower level of attention, the worse quality of life and the greater the possibility for the caretaker to present symptoms of depression, anxiety, and stress.