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Trucco AP, Khondoker M, Kishita N, Backhouse T, Copsey H, Mioshi E. Factors affecting anticipatory grief of family carers supporting people living with Motor Neurone disease: the impact of disease symptomatology. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-9. [PMID: 38813983 DOI: 10.1080/21678421.2024.2359559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To investigate the effect of carer- and disease-related factors on anticipatory grief (AG) in family carers supporting people living with Motor Neurone Disease. METHODS Seventy-five carers from the UK and USA participated in this cross-sectional study, between July 2021 and February 2023. Participants completed assessments on: anticipatory grief (MMCGI-SF, comprising three sub-scales: Personal Sacrifice Burden, Heartfelt Sadness and Longing, Worry and Felt Isolation); person with MND (pwMND) behavioral changes (MiND-B) and disease severity (ALSFRS-R); carer-pwMND emotional bond (Relationship Closeness Scale), familism levels (Familism Scale), and reported hours of care provided. Multiple linear regression analyses were conducted to explore factors impacting carer AG. RESULTS AG total scores showed that 50.7% of carers were experiencing common grieving reactions, 22.6% presented intense grieving emotions, and 26.7% presented low grieving responses.Disease severity (regression coefficient, β = -0.31, p = 0.01, 95%CI -0.91 to -0.13) and behavioral changes (β = -0.34, p = 0.002, 95%CI -1.45 to -0.33) predicted AG total scores (proportion of explained variation, R2=0.38, p < 0.001).Regarding AG subscales, Personal Sacrifice Burden (R2=0.43, p < 0.001) was predicted by disease severity (β = -0.39, p < 0.001, 95%CI -0.42 to -0.11). Behavioral changes predicted Heartfelt Sadness and Longing (β = -0.27, p = 0.03, 95%CI -0.49 to -0.03; R2 = 0.21, p = 0.01) and Worry and Felt Isolation (β = -0.42, p < 0.001, 95%CI -0.63 to -0.20; R2=0.33, p < 0.001). CONCLUSION This study suggests that disease-related factors may be the strongest predictors of carer AG. Interventions addressing carers' understanding and management of MND symptoms seem crucial to support their experiences of loss and their acceptance of MND. Evidence-based support for carers in MND services is required.
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Affiliation(s)
- Ana Paula Trucco
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Helen Copsey
- Norfolk and Norwich University Hospital Foundation Trust, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
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2
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Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. DEATH STUDIES 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
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Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Ashouri A, Yousefi S, Prigerson HG. Psychometric properties of the PG-13-R scale to assess prolonged grief disorder among bereaved Iranian adults. Palliat Support Care 2024; 22:174-181. [PMID: 37052287 DOI: 10.1017/s1478951523000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES The PG-13-Revised (PG-13-R) is a self-report measure to assess prolonged grief disorder (PGD) in terms of Diagnostic and Statistical Manual of Mental Disorders, fifth revision, Text Revision. This measure has been shown to yield good psychometric properties in Western samples. This study aimed to evaluate the psychometric properties of the Persian PG-13-R. METHODS Three hundred forty-seven individuals (209 women and 138 men) fully completed the scales. The participants were recruited using convenience sampling. The confirmatory factor analysis (CFA), convergent and divergent validity, and reliability of the Persian version of the PG-13-R were evaluated. RESULTS CFA results of a unidimensional model support the construct validity of this version of the PG-13-R. The results of this study demonstrated that this version of the PG-13-R has internal consistency reliability (omega coefficient of 0.93), and the test-retest reliability with an interval of 6 weeks was 0.89. The convergent and divergent validity was shown with significant correlations between the PG-13-R and measures of depression, PTSD, functional impairment, and hope. SIGNIFICANCE OF RESULTS Overall, the Persian version of the PG-13-R showed good psychometric properties in the Iranian population.
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Affiliation(s)
- Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Yousefi
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Live Care, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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4
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Crawley S, Sampson EL, Moore KJ, Kupeli N, West E. Grief in family carers of people living with dementia: A systematic review. Int Psychogeriatr 2023; 35:477-508. [PMID: 35086600 DOI: 10.1017/s1041610221002787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief. DESIGN (Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized. PARTICIPANTS Family non-paid carers of somebody with any dementia type. MEASUREMENTS Validated measures of pre-death and/or post-death grief. RESULTS We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported. CONCLUSION Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.
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Affiliation(s)
- Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | | | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Nuriye Kupeli
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | - Emily West
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
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Bermejo Gómez I, Gallego-Alberto L, Losada Baltar A, Mérida Herrera L, García Batalloso I, Márquez-González M. [Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review]. Rev Esp Geriatr Gerontol 2023; 58:101374. [PMID: 37246011 DOI: 10.1016/j.regg.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. OBJECTIVES The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. METHOD A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013-2023). RESULTS A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers' physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. CONCLUSIONS Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population.
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Affiliation(s)
- Isabel Bermejo Gómez
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España.
| | - Laura Gallego-Alberto
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Andrés Losada Baltar
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
| | - Laura Mérida Herrera
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - Inés García Batalloso
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
| | - María Márquez-González
- Departamento de Psicología Biológica y de la Salud, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, España
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Manevich A, Rubin SS, Katz M, Ben-Hayun R, Aharon-Peretz J. Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline. Gerontol Geriatr Med 2023; 9:23337214231171264. [PMID: 37342766 PMCID: PMC10278413 DOI: 10.1177/23337214231171264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/15/2023] [Accepted: 04/05/2023] [Indexed: 06/23/2023] Open
Abstract
Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner's behavioral disorders; caregiver's burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.
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Affiliation(s)
- Alexander Manevich
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Tzemach, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Yezreel Valley College, Israel
| | - Michael Katz
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Rachel Ben-Hayun
- Cognitive Neurology Institute, Rambam Health Care Campus, Haifa, Israel
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Dehpour T, Koffman J. Assessment of anticipatory grief in informal caregivers of dependants with dementia: a systematic review. Aging Ment Health 2023; 27:110-123. [PMID: 35168426 DOI: 10.1080/13607863.2022.2032599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Informal caregivers of dependants with dementia commence their bereavement experience long before the physical death of their dependant, a process referred to as "anticipatory grief". This represents an ambiguous state that has been acknowledged as a measurable variable among informal caregivers. The use of assessment tools for the identification of anticipatory grief is important for timely intervention to promote well-being and positive bereavement experiences. The aim of this systematic review is to identify and examine existing tools for assessing anticipatory grief among caregivers of dependants with dementia. METHODS MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science were searched to July 2021. Studies focusing on the development/evaluation of instruments for measuring anticipatory grief in dementia caregivers were eligible. The quality of each measurement was graded as positive, fair, poor or no information based on defined criteria. RESULTS 100 studies were identified. 33 papers were selected for full-text assessment and 12 papers met the eligibility criteria. Seven assessment tools were identified for measurement of pre-death grief caregivers - the Anticipatory Grief Scale (AGS), Marwit-Meuser Caregiver Grief Inventory (MM-CGI), MM-CGI-short-form (MM-CGI-SF), MM-CGI-brief (MM-CGI-BF), Prolonged Grief Scale (PG-12), Caregiver Grief Scale (CGS) and Caregiver Grief Questionnaire (CGQ). Based on content/construct validity, internal consistency and test-retest reliability the MM-CGI/MM-CGI-SF scored highest for quality followed by the CGS. CONCLUSION Anticipatory grief in dementia has multiple facets that can be measured using self-scoring questionnaires. Our findings provide support for different measures of anticipatory grief. Further research is needed for the evaluation of the responsiveness and interpretability of these instruments.
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Affiliation(s)
- Tara Dehpour
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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8
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Putri YSE, Putra IGNE, Falahaini A, Wardani IY. Factors Associated with Caregiver Burden in Caregivers of Older Patients with Dementia in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12437. [PMID: 36231732 PMCID: PMC9566301 DOI: 10.3390/ijerph191912437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This cross-sectional study aimed to identify caregiver burden and its determinants in the informal caregivers of older patients with dementia (PWDs) aged ≥ 60 years in Java, Indonesia. Data were collected from 207 caregivers of older PWDs using self-administered questionnaires. The dependent variable was caregiver subjective burden, assessed using the Zarit Burden Interview (ZBI). The independent variables included the socio-demographic characteristics of PWDs and caregivers, the caregiver's perceived social support, and the behavioural and psychological symptoms of dementia (BPSD). Linear regression with a stepwise elimination method was used to identify the factors associated with caregiver burden. This study found that four factors were associated with the caregiver burden, such as the gender of PWDs, the educational level of caregivers, social support, and BPSD (R-squared = 27.78%). Higher burden was reported among the caregivers of female PWDs (β = 5.58; 95%CI = 2.16; 8.99) and PWDs with higher scores of BPSD (β = 0.34; 95%CI = 0.25; 0.43). Meanwhile, the caregivers with higher perceived social support (β = -0.26; 95%CI = -0.42; -0.10) and who completed high school education and above (β = -6.41; 95%CI = -10.07; -2.74) tended to have lower scores of subjective burden. These findings suggest that BPSD management and maintaining the resources of support may provide an opportunity to minimise caregiver burden and improve the quality of life of caregivers and PWDs.
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Affiliation(s)
- Yossie Susanti Eka Putri
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia
| | | | | | - Ice Yulia Wardani
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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Luo M, Pan S, Xie J, Li Y. A correlation study between nursing staff's knowledge level of hospice care and the psychology, emotion and attitude towards deaths. Am J Transl Res 2021; 13:10751-10757. [PMID: 34650751 PMCID: PMC8507026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We investigated the relationship between nursing staff's knowledge of hospice care and psychological states, including grief and attitude towards death. METHODS From October 2018 to December 2018, a total of 1900 professional nursing staff of secondary and tertiary levels in Qinghai Province were chosen as the research subjects. Professional questionnaires were used to evaluate their knowledge level of Hospice Care (HC), psychological states, grief and attitude towards death, while the correlation between HC knowledge level and the latter three were analyzed. RESULTS In Qinghai Province, the nursing staff had the highest scores in terms of knowledge levels of HC symptom control with a score of 4.48±1.65, and the lowest score of 1.79±1.12 in terms of knowledge levels of death education. In the Death Attitude Profile-Revised (DAP-R) scale, there was a negative correlation between fear of death, death avoidance, escape acceptance, and HC knowledge total score (P<0.05), while there was a positive correlation between natural acceptance and HC knowledge score (P<0.05). There was no statistical correlation between the total score of approach acceptance and HC knowledge (P>0.05). In the Grief Experience Questionnaire (GEQ) questionnaire, there were negative correlations between the total score of HC knowledge and body reaction, general grief response, seeking to explain and respond to special death forms (P<0.05). Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were negatively correlated with HC knowledge scores (P<0.05). CONCLUSION There is a correlation between nursing staff's knowledge level of hospice care and the psychological state, partial grief and attitudes towards death. The improvement of levels of nursing staff's HC knowledge plays a positive role in maintaining their healthy psychological state, alleviating their grief and helping them to actively face death.
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Affiliation(s)
- Mingqin Luo
- Nursing Department, Qinghai Provincial People’s HospitalQinghai, China
| | - Shiqin Pan
- ICU, Qinghai Provincial People’s HospitalQinghai, China
| | - Jianzhi Xie
- Department of Rehabilitation, Qinghai Provincial People’s HospitalQinghai, China
| | - Yuemei Li
- Nursing Department, Qinghai Provincial People’s HospitalQinghai, China
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11
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Liew TM. Neuropsychiatric symptoms in early stage of Alzheimer's and non-Alzheimer's dementia, and the risk of progression to severe dementia. Age Ageing 2021; 50:1709-1718. [PMID: 33770167 DOI: 10.1093/ageing/afab044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs. METHOD This cohort study included 7,594 participants who were ≥65 years and had early dementia (global Clinical Dementia Rating [CDR] = 1). Participants completed Neuropsychiatric-Inventory-Questionnaire at baseline and were followed-up almost annually for progression to severe dementia (global CDR = 3) (median follow-up = 3.5 years; interquartile range = 2.1-5.9 years). Cox regression was used to examine progression risk, stratified by AD and non-AD. RESULTS The presence of NPSs was associated with risk of progression to severe dementia, but primarily in AD (HR 1.4, 95% confidence interval [CI]: 1.1-1.6) and not in non-AD (HR 0.9, 95% CI: 0.5-1.5). When comparing across various NPSs, seven NPSs in AD were associated with disease progression, and they were depression, anxiety, apathy, delusions, hallucinations, irritability and motor disturbance (HR 1.2-1.6). In contrast, only hallucinations and delusions were associated with disease progression in non-AD (HR 1.7-1.9). CONCLUSIONS NPSs in early dementia-especially among individuals with AD-can be useful prognostic markers of disease progression. They may inform discussion on advanced care planning and prompt clinical review to incorporate evidence-based interventions that may address disease progression.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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12
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Park J, Galvin JE. Pre-Loss Grief in Caregivers of Older Adults with Dementia with Lewy Bodies. J Alzheimers Dis 2021; 82:1847-1859. [PMID: 34219734 DOI: 10.3233/jad-210616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-loss grief increases as dementia advances. Caregivers who experience pre-loss grief face risks to their own physical and psychological health. OBJECTIVE The study examined factors associated with pre-loss grief in caregivers of older adults with dementia with Lewy bodies (DLB) to determine whether overall caregiver experiences differ based on the stages of DLB in care recipients. The study also compared pre-loss grief in caregivers of DLB patients with that in caregivers of patients with Alzheimer's disease (AD) and other dementias. METHOD Using a cross-sectional design, 714 caregivers of older adults with dementia (488 DLB, 81 AD, 145 other dementias) completed an online survey on pre-loss grief. Multivariate linear regression identified risk factors associated with pre-loss grief and analysis of variance examined whether pre-loss grief in caregivers differed significantly based on type of dementia or stage of DLB. RESULTS Being the caregiver of a spouse, lower level of caregiver well-being, lower psychological well-being of the caregiver, and higher level of burden were associated (p < 0.005) with increased pre-loss grief in caregivers of older adults with DLB. There was no significant difference in caregiver burden, well-being, or depression according to the various stages of DLB (mild, moderate, severe, deceased) in the care recipients. There was no significant difference in pre-loss grief in caregivers of DLB care recipients compared to caregivers of patients with other dementias. CONCLUSION Assessment of DLB caregivers and appropriate interventions should be conducted to reduce their burden and emotional distress to decrease the incidence of pre-loss grief.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, The Florida Atlantic University, Boca Raton, FL, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Bravo-Benítez J, Cruz-Quintana F, Fernández-Alcántara M, Pérez-Marfil MN. Intervention Program to Improve Grief-Related Symptoms in Caregivers of Patients Diagnosed With Dementia. Front Psychol 2021; 12:628750. [PMID: 33643160 PMCID: PMC7905313 DOI: 10.3389/fpsyg.2021.628750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
The objectives of the present study were to adapt a grief intervention program to family caregivers of patients with dementia, and assess its effectiveness in improving the symptoms of grief and other health-related variables. The intervention was based on Shear and Bloom's grief intervention program, with the necessary adaptations for use in the grieving process for a family member's illness. A total of 52 family caregivers of individuals with dementia participated. They were evaluated using a battery of self-report measures assessing grief, overload, resilience, post-traumatic growth, experiential avoidance, health-related quality of life, and benefits of care. The results suggest that the program is effective in improving grief symptoms, caregiver burden, resilience, post-traumatic growth, and quality of life of family caregivers. It is necessary to create and implement interventions targeting caregivers' feelings and manifestations of ambiguous grief, because there is a lack of programs providing an efficient solution for the mental and physical health of caregivers, and because of the human and socioeconomic cost involved in neglecting this group.
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Affiliation(s)
- Jorge Bravo-Benítez
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain
| | - Francisco Cruz-Quintana
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
| | | | - María Nieves Pérez-Marfil
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
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Liew TM, Tai BC, Wee SL, Koh GCH, Yap P. The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study. J Am Geriatr Soc 2020; 68:2348-2353. [PMID: 32700328 DOI: 10.1111/jgs.16717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the PWD, with such caregiver grief postulated to affect the well-being of the PWD-caregiver dyads. However, the longitudinal effects of caregiver grief and the moderating effects of social services are not yet clear. OBJECTIVES We investigated the longitudinal effects of caregiver grief on caregiver depression, caregivers' quality of life (QoL), and caregivers' perceived positive aspects of caregiving (PAC); and examined potential effect modification of social service utilization (dementia care services, caregiver programs, and paid caregivers). DESIGN AND SETTING A prospective cohort study with three time points of assessments (at 0, 6, and 12 months). PARTICIPANTS Family caregivers of community-dwelling PWD (n = 178). MEASUREMENTS At time point 1 (baseline), participants completed questionnaires that captured caregiver grief, burden, and social service utilization. Outcomes that were captured over time were: depression (time points 1-3), QoL (time point 2), and PAC (time point 3). Caregiver grief as well as interaction terms with social service utilization were included in Tobit regression to examine the association with outcomes. RESULTS After accounting for the effect of caregiver burden, caregiver grief remained associated with depressive symptoms (P < .001) and poorer QoL (P < .001). However, compared with burden, grief contributed to larger magnitudes of the adverse effects. Grief, not burden, was associated with less PAC (P = .006 and P = .746, respectively). In contrast, burden, not grief, was associated with poorer physical health (P = .010 and P = .110, respectively). Dementia care services attenuated the effect of burden but not grief; caregiver programs did not affect burden but appeared to aggravate the effect of grief; and paid caregivers attenuated the effect of burden, and partially attenuated the effect of grief. CONCLUSION Caregiver grief has an impact on dementia caregivers, likely through a distinct mechanism from that of caregiver burden. However, prevailing social services may not be sufficient to address grief, highlighting the need to further train care workers in this respect. J Am Geriatr Soc 68:2348-2353, 2020.
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Affiliation(s)
- Tau Ming Liew
- Department of Psychiatry, Singapore General Hospital, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Department of Geriatric Psychiatry, Institute of Mental Health, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Philip Yap
- Geriatric Education and Research Institute, Singapore.,Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
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Chan I, Yap P, Wee SL, Liew TM. The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit-Meuser Caregiver Grief Inventory. Int J Geriatr Psychiatry 2020; 35:213-222. [PMID: 31736107 PMCID: PMC7004032 DOI: 10.1002/gps.5238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is one among the few scales that capture such experiences. In a recent study, MM-CGI was found to contain three subscales identifying dimensions of loss in caregivers-Personal-Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population. METHODS Family caregivers (n = 394) completed MM-CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test-retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM-CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship. RESULTS The three dimensions of MM-CGI exhibited adequate internal consistency, test-retest reliability, construct validity, and known-group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions. CONCLUSIONS The three dimensions of MM-CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief.
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Affiliation(s)
- Ivana Chan
- Geriatric Education and Research InstituteSingapore
| | - Philip Yap
- Geriatric Education and Research InstituteSingapore,Department of Geriatric Medicine, Khoo Teck Puat HospitalSingapore
| | - Shiou Liang Wee
- Geriatric Education and Research InstituteSingapore,Health and Social Sciences ClusterSingapore Institute of TechnologySingapore
| | - Tau Ming Liew
- Department of Geriatric PsychiatryInstitute of Mental HealthSingapore,Psychotherapy ServiceInstitute of Mental HealthSingapore,Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
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Liew TM, Tai BC, Yap P, Koh GCH. Development and validation of a simple screening tool for caregiver grief in dementia caregiving. BMC Geriatr 2019; 19:54. [PMID: 30813899 PMCID: PMC6391777 DOI: 10.1186/s12877-019-1070-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/15/2019] [Indexed: 03/05/2023] Open
Abstract
Background Loss and grief are experienced by caregivers of persons with dementia (PWD), relating to the ambiguous loss of PWD even when they are still alive and the anticipation of future loss related to their physical death. Such experience of caregiver grief is not easily recognized in clinical practice, despite its association with adverse effects such as caregiver burden, caregiver depression and caregivers’ desire to place the PWD in nursing homes. We constructed a simple screening tool – based on factors associated with caregiver grief – to identify caregivers with high grief. Methods Spouses or children of community-dwelling PWD (n = 403) completed self-administered questionnaires containing a well-established grief scale and information related to the caregiver and PWD. We split the study sample into two – the derivation sample (n = 300) was used to identify factors associated with grief (using logistic regression) and derive a simple tool based on the number of identified factors; the validation sample (n = 103) evaluated the performance of the tool using the receiver-operating-characteristic-curve-analysis (ROC). Results Four key factors were identified by the multivariable regression – more severe dementia (odds ratio, OR 6.9), behavioral problems in PWD (OR 5.0), spousal caregivers (OR 6.0) and daily caregiving (OR 3.0). The screening tool (based on the number of key factors) had an area under ROC of 0.77. At the optimal cut-off of ≥2 key factors, the tool had a sensitivity of 0.91 and a specificity of 0.42. Conclusions The identified factors are consistent with current understanding on caregiver grief. They can be easily integrated into the workflow of routine services to screen for caregivers who are more likely to benefit from further grief-related assessment. Electronic supplementary material The online version of this article (10.1186/s12877-019-1070-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. .,Psychotherapy Service, Institute of Mental Health, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Liew TM, Tai BC, Yap P, Koh GC. Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis. Int J Geriatr Psychiatry 2019; 34:258-264. [PMID: 30370698 PMCID: PMC6635735 DOI: 10.1002/gps.5014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the person. While such phenomenon of pre-death grief (PDG) has been increasingly described, we are uncertain how it can be distinct from the well-studied construct of caregiver burden. OBJECTIVE To determine whether there are differences in the risk factors of PDG and caregiver burden to aid in our understanding of the relationship between the two constructs. METHODS Spouses or children of community-dwelling PWD were consecutively sampled from two tertiary hospitals. They completed questionnaires containing a PDG scale, a caregiver burden scale, and information related to the caregiver and PWD. Risk factors of PDG and caregiver burden were identified using multivariate regression, within which PDG and caregiver burden scores were jointly included as two separate dependent variables. RESULTS We recruited 394 caregivers with a mean age of 53.0 years (SD 10.7), majority were Chinese (86.6%), children caregivers (86.3%), and primary caregivers (70.8%). In the regression analyses, we identified three risk factors which were shared by both PDG and caregiver burden (later stage of dementia, behavioral problems in PWD, and primary caregiving role) and three other risk factors which were unique to PDG alone (younger age of PWD, lower educational attainment of caregivers, and spousal caregiver). CONCLUSIONS The different risk factor profiles evidence a distinction between PDG and caregiver burden. They may possibly be distilled into a framework to direct our approach to PDG interventions, which may include using caregiver burden as an opportunity to initiate conversations on grief, exploring the various aspects of losses and encouraging adaptive coping.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric PsychiatryInstitute of Mental HealthSingapore,Psychotherapy ServiceInstitute of Mental HealthSingapore,Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Philip Yap
- Department of Geriatric MedicineKhoo Teck Puat HospitalSingapore,Geriatric Education and Research InstituteSingapore
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