Informal caregiving patterns in Korea and European countries: a cross-national comparison

The impact of an agro-healing program on family resilience, parental stress, and social skills of children with developmental disabilities

Developmental disabilities pose challenges for the entire family, making it crucial to enhance family resilience and promote a positive outlook for all members. This study aimed to investigate the impact of an agro-healing program based on horticultural activities using a family resilience framework among families with children with developmental disabilities in South Korea. A total of 15 participants, including children with developmental disabilities, from 6 families were recruited for the research. The program entailed conducting a 90-min agro-healing program based on horticultural activities for 8 weeks; a total of 8 sessions were delivered weekly. The Family Resilience Scale, Family Adaptability Scale, Korean Perceived Stress Scale, Social Skills Rating Scale, and Satisfaction Survey Questionnaire were utilized to evaluate the program's impact. The analysis of the agro-healing program's effects revealed that family resilience in families with children with developmental disabilities improved significantly. Additionally, the parents' stress levels decreased, and social skills of the children with developmental disabilities improved. The agro-healing program based on horticultural activities can serve as a social support measure to enhance psychological and social well-being and aid recovery in families with children with developmental disabilities.

Impact of the presence of a family member with dementia on the prevalence of depression: a comparison based on household income level

BACKGROUND

Families caring for patients with dementia are more vulnerable to depression. This cross-sectional study compared differences in socioeconomic status and gender related to depression among families of patients with dementia and identified associated factors.

METHODS

Inequality in depression according to household income level among families of patients with dementia was assessed using the Korean Community Health Survey, which included a sample of over 200,000 participants. Depression prevalence was assessed using the Patient Health Questionnaire-9 (PHQ-9) and each independent variable was calculated. Significant differences were analyzed using the chi-square test. Complex-sample multivariate logistic regression was performed to examine the association between the income levels of families of patients with dementia and depression. Additionally, an analysis of depression, stratified by income level and gender, was conducted.

RESULTS

The prevalence of depression among families of patients with dementia was 4.41%. The odds ratio (OR) for depression among families of patients with dementia compared to the population of families without patients with dementia was 1.49. Depression was significantly more likely in families with lower income levels (adjusted OR [aOR]: 2.17, 95% confidence interval [CI]: 2.16-2.18). The magnitude of the impact of having a family member with dementia on depression varied by income level, being highest in the lowest income group (aOR: 1.64, 95% CI: 1.63-1.66) and lowest in the highest income group (aOR: 1.26, 95% CI: 1.24-1.27). Stratification by gender showed that both men and women in families of patients with dementia were more likely to experience depression than those in families without patients with dementia. Women had a higher likelihood of depression across all income levels than men; however, the impact of having a family member with dementia was more pronounced among men, especially those from lower-income groups.

CONCLUSIONS

Our findings suggest the necessity for support policies tailored to low-income groups and women among families of patients with dementia. This is crucial given the higher prevalence of depression among families of patients with dementia than among families without patients with dementia.

Career Disruption and Employment Status of Korean Family Caregivers of Older Adults Using Home-Based Care

This study utilized nationally approved data from the 2022 Long-Term Care Survey of Korea to examine the factors associated with career disruptions and employment status among family caregivers of home-based care recipients. Descriptive statistics, chi-square tests, one-way ANOVA, and multinomial logistic regression analysis were employed to address the research questions. The results indicated that 19.39% of family caregivers of home-based care recipients experienced career disruptions due to informal caregiving. Demographic factors such as gender, age of family caregivers, and their relationship with care recipients predicted their employment status. Gender was a significant explanatory factor, as daughters/daughters-in-law were more likely to be in insecure employment positions than sons. Lower household income and older age were also associated with employment insecurity. Recommendations include coverage expansion, family support programs, and pension credit for family caregivers to meet the needs of care recipients and their families.

The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant's method

BACKGROUND

Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs.

METHODS AND MATERIAL

This was a concept analysis study. This concept analysis was conducted using Walker and Avant's eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented.

RESULTS

The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients' and families' greater care-related knowledge, improvement of nurses' care quality, patient autonomy, and self-efficacy.

CONCLUSION

The concept of CNC in OCCs can be defined as "a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients' and families' culture and background, fulfill patients' physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life."

Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series

BACKGROUND

The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers.

OBJECTIVE

This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it.

DESIGN

A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS.

PARTICIPANTS

The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS).

METHODS

We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset.

RESULTS

We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008).

CONCLUSIONS

This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services.

TWEETABLE ABSTRACT

Korean Comprehensive Nursing Service reduces private caregiving costs.

Evaluation of repositioning care provided by non-professionals using a caregiver-assistive device: an experimental study

As the population ages in Japan and worldwide, the number of informal caregivers, such as family members, providing nursing care to older individuals is increasing. Among caregiving tasks, repositioning care, which causes lower back pain, is frequent and burdensome for caregivers. Therefore, we developed a position-changing device that can adjust and support the care recipient's body in the lateral position. This was a feasibility study of the device-assisted care provided by non-professionals using the device we developed. Of the 40 healthy volunteers enrolled, 17 simulated caregivers and 17 simulated care recipients finally participated in the study. One caregiver and one care recipient were paired to engage in two types of care: device-assisted care and manual care. Furthermore, the care provided by the caregiver and received by the care recipient were evaluated. Non-professionals were able to use the device successfully and safely after a short period of practice, and both caregivers and care recipients rated the device-assisted care positively. The study results suggest that informal caregivers can also provide safe and comfortable care that is less burdensome than manual care by using a caregiver-assistive device.

Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale

The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75-0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments' construct validity and internal consistency.

Association between caregiver type and catastrophic health expenditure among households using inpatient medical services: using Korean health panel

BACKGROUND

Caregiving services often place a financial burden on individuals and households that use inpatient medical services. Consequently, this study aimed to examine the association between the type of caregiver and catastrophic health expenditure among households utilizing inpatient medical services.

METHODS

Data were extracted from the Korea Health Panel Survey conducted in 2019. This study included 1126 households that used inpatient medical and caregiver services. These households were classified into three groups: formal caregivers, comprehensive nursing services, and informal caregivers. Multiple logistic regression was used to analyze the association between caregiver type and catastrophic health expenditure (CHE).

RESULTS

Households receiving formal caregiving had an increased likelihood of CHE at threshold levels of 40% compared to those who received care from family (formal caregiver: OR 3.11; CI 1.63-5.92). Compared to those who received formal caregiving, households using comprehensive nursing services (CNS) had a decreased likelihood of CHE (CNS: OR, 0.35; CI 0.15-0.82). In addition, considering the economic value associated with informal care, there was no significant relationship between households received formal caregiving and informal caregiving.

CONCLUSION

This study found that the association with CHE differed based on the type of caregiving used by each household. Households using formal care had a risk of developing CHE. Households using CNSs were likely to have a decreased association with CHE, compared to households using informal and formal caregivers. These findings highlight the need to expand policies to mitigate the burden on caregivers for households forced to use formal caregivers.

A scoping review of dementia caregiving for Korean Americans and recommendations for future research

OBJECTIVES

This scoping review aims to examine the caregiving experiences of Korean American caregivers of persons with dementia.

METHODS

A comprehensive electronic search was conducted within 5 databases (PubMed, CINAHL, Web of Science, Embase, PsycINFO-ProQuest) for papers published from 01/01/00 -01/24/22. Seventeen articles met the inclusion criteria. Thematic analysis was used to summarize key findings from these papers.

RESULTS

Most Korean American dementia caregivers were immigrants and wives/daughters/daughters-in-law. Two themes emerged: 1) how Korean American caregivers perceived their caregiving experiences, and 2) how Korean American caregivers perceived their caregiving support services. Korean American caregivers often experience poor mental health and burden. Social support and familism were found to be two of the most important factors that determine their attitudes toward caregiving. Most reported barriers to utilizing public services. Challenges in finding culturally relevant resources were common.

CONCLUSIONS

Dementia caregiving is a significant public health problem facing Korean Americans. Recommendations for future research are provided.

Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis

BACKGROUND

In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults.

METHODS

We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group.

RESULTS

Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01).

CONCLUSION

Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.

Health behaviors and psychological burden of adolescents after parental cancer diagnosis

This study aims to investigate health behaviors and psychological burdens in adolescent children of cancer parents. We compared health behaviors and mental health outcomes between 266 adolescent children with a parent diagnosed with cancer and 3163 control adolescents aged 12-19 years using data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2018. Alcohol use of adolescents increased between 2 and 5 years after parental cancer diagnosis (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.01-2.94) but decreased after 5 years. Parental cancer was associated with increased vaccination uptake in adolescents within 1 year of diagnosis (aOR, 3.19; 95% CI, 1.55-6.54), but after 2 years, there was no difference from rates in their peers. Maternal cancer was associated with increased depression among adolescents (aOR, 1.73; 95% CI, 1.10 - 2.73). Although the risks of suicidal thoughts/plans/attempts increased within 1 year after parental cancer diagnosis (aOR, 2.96; 95% CI, 1.00 - 8.83), it reduced 2 years after diagnosis, leading to no significant difference from the frequency in peers. Within five years after the parent was diagnosed with cancer, support for their adolescent children's health behaviors and mental health is necessary in the community.

Does Receiving Informal Care Lead to Better Health Outcomes? Evidence From China Longitudinal Healthy Longevity Survey

Population aging has become a global challenge. Drawing data from Chinese Longitudinal Healthy Longevity Survey 2008, 2011, and 2014, this study examines the effect of informal care receipt on functional limitations and depressive symptoms among older people in China using lagged fixed effects model. Our findings suggest that receiving informal care is significantly associated with a slower functional decline. We also find that this effect varies across different income groups. The protective effect of informal care is more pronounced among older people with higher income compared to those with lower income. We do not observe any significant associations between receiving informal care and depressive symptoms of older people. This study highlights a pressing need for the Chinese government to establish a comprehensive long-term care system.

Psychosocial trajectories before and after spousal loss: Does gender matter?

RATIONALE

Prior studies have suggested that spousal loss can have negative impacts on widowed persons' lives. However, few studies have examined whether time since spousal loss is related to changes in psychosocial outcomes and there are gender differences in psychosocial trajectories in response to spousal loss.

OBJECTIVE

This study examines the psychosocial trajectories (depressive symptoms and social engagement) of widowed individuals before and after spousal death. This study also investigates whether psychosocial adjustment trajectories, among individuals who experienced spousal loss, are gendered.

METHODS

This study uses data from 685 middle- and older-aged adults over seven waves (4284 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. This study estimates fixed effects models to account for observed and unobserved individual-level heterogeneity. Gender-stratified fixed effects regression models are used to investigate whether psychosocial changes associated with spousal loss differ by gender.

RESULTS

Psychosocial adjustment to spousal loss is strikingly gendered. Among men, depressive symptoms began to increase within the first year following spousal loss and continued through the fourth and subsequent years. In contrast, depressive symptoms among widows did not change significantly during and after bereavement. Similar patterns were found for social engagement. Among men, a decrease in frequency of social interactions and participation in social activities was found from the first year of spousal loss to the fourth and subsequent years. No such patterns were found for women.

CONCLUSION

Spousal loss is a life event that spurs tremendous psychosocial changes for widowed people. This study suggests that spousal loss-associated psychosocial changes occur over a long period of time and are greater in men than in women.

The Paid and Unpaid Working Life Expectancy at 50 in Europe

OBJECTIVES

Amid growing concerns about the economic implications of population aging and the sustainability of older adults' working life, unpaid family care work receives less attention despite its direct relevance to population aging. This paper systematically compares the paid and unpaid working life expectancy at age 50 to understand the overlap and trade-off between paid and unpaid work among older European adults.

METHOD

Using data from the Survey of Health and Retirement in Europe (SHARE) with the Sullivan method, the paper presents gender differences across 17 countries in life expectancy at age 50 at various paid (employment) and unpaid (caregiving) role configurations.

RESULTS

When work is defined to include unpaid family caregiving, women and men have similar working life expectancies at age 50, in contrast to prior research. However, its paid and unpaid components are gendered. The results also show that at age 50, women are expected to spend similar number of years providing grandchild care and ADL/IADL care and that most of these years take place after retirement.

DISCUSSION

The results highlight that the gendered tension between paid and unpaid work persists into older adulthood and needs to be accounted for in working life expectancy measures. The results also underscore the gendered implications of population aging and unpaid work in older adulthood for retirement age policies and strategies for promoting gender equality in later life.

Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis

Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. Materials and Methods: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. Results: ‘Design and recruitment’ and ‘engagement and co-production’ thematic areas are presented considering the factors related to researcher–communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. Conclusions: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice.

Longitudinal Associations Between Expectations of Receiving Care in the Future and Life Satisfaction Among Older Adults in Korea

OBJECTIVES

Uncertainty about receiving care and assistance in the future has been increasing among older adults in Korea. This study examines whether expectations about receiving care from various sources (i.e., formal and/or filial caregivers) are related to life satisfaction among older adults in Korea.

METHODS

Using data from the Korean Longitudinal Study of Ageing (N = 3,607, aged 65 or older), this study estimated fixed effects regression models to investigate longitudinal within-person associations between future care expectations and life satisfaction.

RESULTS

The results of this study revealed that developing expectations of care from family caregivers is positively associated with life satisfaction. Beginning to expect care from non-family caregivers, however, is not associated with life satisfaction. When disaggregating different sources of care by family member type, expecting care from a spouse or daughter(s), but not son(s), is associated with higher life satisfaction. Gender-specific analyses showed that expecting care from daughter(s) is positively associated with life satisfaction among both men and women, whereas expectations of spousal care are associated with only men's life satisfaction. This study also found suggestive but not conclusive evidence that an association between care expectations from family caregivers and life satisfaction is stronger among older adults with lower education.

DISCUSSION

Reducing uncertainty about future care may improve older adults' subjective well-being. Policymakers may consider policies and programs that support family care of the aged, and more fundamentally, encourage family involvement in the lives of older people.

Understanding Health and Social Challenges for Aging and Long-Term Care in China

The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.

Care Life Expectancy: Gender and Unpaid Work in the Context of Population Aging

Amid growing concern regarding the potential added burden of care due to population aging, we have very little understanding of what is the burden of care in aging populations. To answer this question, we introduce a novel metric that encompasses demographic complexity and social context to summarize unpaid family care work provided to children, elderly, and other family members across the life cycle at a population level. The measure (Care Life Expectancy), an application of the Sullivan method, estimates the number of years and proportion of adult life that people spend in an unpaid caregiving role. We demonstrate the value of the metric by using it to describe gender differences in unpaid care work in 23 European aging countries. We find that at age 15, women and men are expected to be in an unpaid caregiving role for over half of their remaining life. For women in most of the countries, over half of those years will involve high-level caregiving for a family member. We also find that men lag in caregiving across most countries, even when using the lowest threshold of caregiving. As we show here, demographic techniques can be used to enhance our understanding of the gendered implications of population aging, particularly as they relate to policy research and public debate.

Resilience in Familial Caregivers of Children with Developmental Disabilities: A Meta-analysis

The aim of this meta-analysis was to investigate factors associated with resilience in familial caregivers of children with developmental disabilities. The protocol was registered in the PROSPERO database, with the registration number CRD42018105180. Several electronic databases were searched for studies. A random-effects meta-analysis was performed on 26 selected studies that associated resilience to an array of other variables (i.e., psychological distress, social support, coping, perceived health, life satisfaction). Overall, the significant pooled effect sizes were small to medium, ranging from r = 0.291 for coping to r = 0.442 for social support. Although the literature on the topic has improved, there is a lot of study heterogeneity and the need for focusing on male caregivers becomes evident.

Long Working Hours and Risk of Nonalcoholic Fatty Liver Disease: Korea National Health and Nutrition Examination Survey VII

BACKGROUND

The global incidence of NAFLD is rising sharply due to various risk factors. As previous studies reported adverse health impact of long working hours on metabolic diseases, such as diabetes mellitus and obesity, it is plausible that NAFLD is also associated with working excessive hours. However, data regarding this issue is limited.

METHODS

In this cross-sectional study based on Korea National Health and Nutrition Examination Survey VII, 5,661 working adults without previous liver disease or heavy alcohol drinking habits were included. The subjects were categorized into three groups according to working hours: 36-42, 43-52, and 53-83 hours/week. NAFLD was defined using the hepatic steatosis index (HSI), which is a validated prediction model for determining NAFLD.

RESULTS

The prevalence of NAFLD (HSI ≥36) increased with longer working hours: 23.0%, 25.6%, and 30.6% in the 36-42, 43-52, and 53-83 hours/week group, respectively (p <0.001). Subjects who worked 53-83 hours/week had higher odds for NAFLD than those who worked the standard 36-42 hours/week (OR 1.23, 95% CI 1.02-1.50, p = 0.033) after adjusting for age, sex, body mass index, smoking, alcohol, exercise, diabetes mellitus, hypertension, serum triglyceride, and total cholesterol. This association was consistent across subgroups according to working schedule (daytime vs. shift workers) or occupation type (office vs. manual workers). In particular, the relationship between long working hours and NAFLD was pronounced in workers aged <60 years and in female workers.

CONCLUSIONS

Long working hours was significantly associated with NAFLD. Further prospective studies are required to validate this finding with causal relationship.

Assessment of Burnout: A Pilot Study of International Women Physicians

INTRODUCTION

Physician burnout, wellness, and resilience have become increasingly important topics of discussion worldwide. While studies have assessed burnout globally in various individual countries, few studies directly compare or analyze gender-based physician burnout among different global regions.

METHODS

Female physicians attending the Medical Women's International Association (MWIA) Centennial Congress completed the Copenhagen Burnout Inventory (CBI) which evaluates personal-, work-, and patient-related burnout using a scale of 0 to 100. Results were analyzed using descriptive statistics and 1-way ANOVA to compare burnout scores amongst women physicians from different global regions.

RESULTS

Of 100 physicians invited to participate, 76 provided responses and 71 met the inclusion criteria. Mean burnout scores were highest amongst women from Africa in all categories. Mean work-related, patient-related, and personal-related burnout scores were significantly lower for physicians in Europe compared to Africa (p = 0.05) when evaluated using a 1-way ANOVA, with no statistically significant differences between other regions.

DISCUSSION

The data suggests that there may be regional differences in the prevalence of burnout in women physicians. Various factors could play a role in explaining the higher burnout scores in female physicians in Africa, including younger average age, establishing practice during childbearing years, and significant physician shortage. Through this study, we have begun to explore the cultural and geographical context related to women's mental and physical wellbeing in the medical field. Further research should focus on the gender-specific contributors to burnout among different global regions, so that methods can be implemented on a systemic level to alleviate burnout.

Association between Social Support and Frailty among Older People with Depressive Disorders

OBJECTIVES

This study aimed at examining the association between social support and frailty status, specifically amongst older people with depressive disorders.

METHODS

It was conducted in older people, aged 65 and over, with depressive disorders at the Psychiatry Outpatient Unit of Songklanagarind Hospital, Thailand. The main independent variable, level of social support, was assessed using the Inventory of Social Support Behaviors (ISSB) - Thai. The main dependent variable, frailty status, was assessed via the adapted Fried Frailty Phenotype. Bivariate and ordinal regression analyses were conducted to examine the relationships between variables.

RESULTS

In our study sample, 32% of the 147 participants were considered frail, 51% pre-frail, and 17% robust. From the ordinal regression analysis, four variables - social support score, current depressive symptoms, level of education, and key family caregivers - were statistically significantly associated with frailty status. The odds of having pre-frailty and frailty were statistically significantly reduced by a factor of 0.99, or around 1.0 percent, for each 1-point increment of the social support scale (Ordinal OR 0.99, 95% CI = 0.97-0.99, p-value = 0.015).

CONCLUSIONS

Social support interventions should be designed to influence multiple items of the social support scale at the same time, which might, therefore, have a substantial effect on frailty status among the older population.

CLINICAL IMPLICATIONS

We recommend a regular practice that focuses not only on biological (i.e., prescribing medications) and psychological aspects (i.e., providing psychotherapy) but also on the social dimension of older people living with frailty and depressive disorders.

Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey

Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.

Care inequality: care received according to gender, marital status, and socioeconomic status among Korean older adults with disability

Background

We sought to identify the types of care and care resources available to older Korean adults with disabilities, and document the inequality in care received according to gender, marital status, and socioeconomic status.

Method

Data were derived from the sixth wave of the Korean Longitudinal Study of Ageing. The sample consisted of 946 men and women who were disabled in ADL and IADL. Generalized linear models and analyses of covariance were used to evaluate group differences in types of care received and care resources. The outcome variables were main primary caregivers, the total number of available caregivers, hours of care received per day, number of days of care, and fees paid to caregivers.

Results

In total, 41.7% of men with ADL/IADL disabilities reported that they did not receive formal or informal care from any source, compared with 30.7% of women. Almost half (49.2%) of men without a spouse were in a state of care deficit (vs. 30.8% in women without a spouse, P < 0.001). Among care recipients, men reported receiving higher average days of care per month than women (25.6 vs. 21.2 days, P < 0.01). Both men and women received care primarily from their spouse, but adult children were more frequently care providers for older women than men. A combination of care from spouse and paid caregiver was more frequent among women. Dependent older people with high household incomes had a higher likelihood of receiving care There was the clear gradient in rate of paid formal caregivers use by household income (higher income = higher use) among women but not men.

Conclusions

Care types and resources among disabled older adults appeared to be different by gender, marital status and socioeconomic status under the cultural phenomenon and contextual circumstances in the aging Korean population.

What seems to matter in public policy and the health of informal caregivers? A cross-sectional study in 12 European countries

In Europe, informal caregiving is frequent and is expected to grow. Caregiving has an impact on caregivers’ health, but its effect may vary according to the policies of support that are available to caregivers. The aim of this study was to assess the association between the policies of support to caregivers available in 12 European countries and the health of caregivers, considering separately the policies based on financial help and those based on training and other non- financial services. We used data from 13,507 caregivers from 12 European countries from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to build a path model. Poor health among caregivers was associated with living in a family-based care country (β = 0.50; 95% CI = 0.42–0.59), and with an increased extent of caregiving (β = 0.18; 95% CI = 0.15–0.22). Non-financial support measures seem to have a larger protective impact (β = –0.33; 95% CI = –0.38 - –0.28) on the health of caregivers than do financial support measures (β = 0.03; 95% CI = 0.01–0.04), regardless of the gender of the caregiver. According to our results, the currently available policies of support associated with better health among caregivers are those that: 1) provide them with some free time, 2) help them to deal emotionally with caregiving, and 3) give them skills to both improve the care situation and to deal with it better.

Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013)

Abstract: This study’s objective was to assess the contribution of selected chronic diseases to the prevalence of disability in elderly Brazilians, based on data from the National Health Survey (PNS 2013). Disability was defined as some degree of difficulty in performing ten activities, considering three levels: (i) without disability; (ii) disabled only in some instrumental activity of daily living (IADL); and (iii) disabled in some basic activity of daily living (BADL). The multinomial additive hazards model was the attribution method used to assess the contribution of each self-reported chronic condition (hypertension, diabetes, arthritis, stroke, depression, heart disease, and lung disease) to the prevalence of disability in this population, stratified by sex and age bracket (60 to 74 years and 75 or older). Study participants included 10,537 elderly Brazilians with a mean age of 70.0 years (SD = 7.9 years) and predominance of women (57.4%). Prevalence rates for disability in at least one IADL and at least one BADL were 14% (95%CI: 12.9; 15.1) and 14.9% (95%CI: 13.8; 16.1), respectively. In general, the contribution of chronic diseases to prevalence of disability was greater in younger elderly (60 to 74 years) and in the group with greatest severity (disabled in BADL), highlighting the relevance of stroke and arthritis in men, and arthritis, hypertension, and diabetes in women. This knowledge can help orient health services to target specific groups, considering age, sex, and current illnesses, aimed at preventing disability in the elderly.

Informal and paid care for Brazilian older adults (National Health Survey, 2013)

OBJECTIVE

To describe the prevalence and sociodemographic factors associated with informal and paid care for Brazilian older adults with functional limitations.

METHODS

Of the 23,815 participants of the National Health Survey aged 60 or older, 5,978 reported needing help to perform activities of daily living and were included in this analysis. The dependent variable was the source of care, categorized as exclusively informal (unpaid), exclusively formal (paid), mixed or none. The socio-demographic variables were age (60-64, 65-74, ≥ 75 years old), gender and number of residents in the household (1, 2, ≥ 3). The multivariate analysis was based on binomial and multinomial logistic regressions.

RESULTS

Informal care predominated (81.8%), followed by paid (5.8%) or mixed (6.8%) and no care (5.7%). The receipt of care from any source increased gradually with the number of residents in a same household, regardless of age and gender (OR = 4.85 and 9.74 for 2 and ≥ 3, respectively). Age was positively associated with receiving any care while the male gender showed a negative association. The number of residents in the household showed the strongest association with informal care (OR = 10.94 for ≥ 3 residents), compared with paid (OR = 5.48) and mixed (OR = 4.16) care.

CONCLUSIONS

Informal care is the main source of help for community-dwelling older adults with functional limitations. In a context of rapid population aging and decline in family size, the results reinforce the need for policies to support long-term care for older Brazilians.

Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older Brazilians: National Health Survey, 2013

BACKGROUND

This study assesses the association between socioeconomic factors and living arrangements with activity of daily living limitations (ADL) and the receipt of informal and formal care among non-institutionalized Brazilians aged ≥ 60 years.

METHODS

Data come from a nationally representative survey (the Brazilian National Health Survey), conducted in 2013. Outcomes examined include the number of ADL tasks performed with limitations and number of tasks for which the individual received informal care (provided by unpaid relatives or friends), formal care, or no care. Key exposure variables were years of education and household assets.

RESULTS

Functioning limitations were reported by 7,233 (30.1 %) of 23,815 survey participants. Of these, 5,978 reported needing help to perform at least one ADL task. There was a strong inverse gradient between physical functioning and both education and household assets that was independent of confounders. The provision of care showed an opposite trend, with the wealthiest being more likely to receive help for performing ADL tasks. The receipt of formal care was strongly correlated with highest education (Fully adjusted prevalence ratio [PR] = 1.64; 95 % CI 1.05, 2.58) and with the highest assets level (PR = 2.24; 95 % CI 1.38, 3.64). Living with someone else was associated with provision of care (formal or informal) for those at the lowest and intermediate educational and assets levels, but not for the wealthiest.

CONCLUSION

Despite worse physical functioning, older Brazilians in worse socioeconomic conditions are much less likely to receive needed help in performing ADL tasks.

Multidimensional Caregiving Burden of Female Family Caregivers in Korea

The purpose of this study was to examine a staged theoretical model to explain cultural knowledge-based multidimensional burden of women family caregivers caring for community-dwelling older adults using a modified Poulshock and Deimling model. In the model, the antecedents included elders’ impairment in activities of daily living (ADL), elders’ cognitive impairment, caregivers’ self-efficacy, and caregivers’ familism. The perception contained the disruptive behavior burden and social functioning burden of caregivers. The consequence variable included social activity restriction and negative changes in family relationships. The total sample was 157 primary women caregivers caring for community-dwelling older adults aged 65 and older. Instruments were General Self-Efficacy Scale, Family Scale, and Burden Scale. Path analysis was done to analyze the model using multiple linear regression methods. This study showed that impairments of older adults (impairment in ADL, cognitive impairment) and caregiver beliefs (strong familism, low self-efficacy) had an indirect influence on negative changes in family relationship and social activity restriction through the perceived emotional distress.